Charge Appeal Request
Which Area Is this Request For

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Appeal Period

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Name (*)

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T# (*)

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Email Address (*)

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Phone (*)

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I am currently Living....

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If On Campus, Box#

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If On Campus, Building

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If On Campus, Room#

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If Off Campus, Street Address

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If Off Campus, City, State & Zip

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Reason for Appeal

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Please Enter the Following Numbers
Please Enter the Following Numbers

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I understand this is an appeal form and I am not guaranteed this appeal will be granted. Appeals are commonly reviewed within 24-48 hours and notification will be made via e-mail or to above listed address.
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