Traffic and Parking Citation Appeal Form
The University of Texas at Tyler

Any person who has received a University traffic or parking citation may file a request to have the citation reviewed by submitting this appeal form to The University of Texas at Tyler University Police Department (USC 125) no later than ten (10) working days after the citation was issued. If an appeal is not filed within this time period, the citation is deemed final.

Citation No.: ____________________ Vehicle license No.: __________________

Name: _____________________________ Student ID:______________________

Address:_____________________________ City:_______________ State: _____ Zip: _______

Phone:  (_____) __________________________

Statement of Appellant: (attach additional sheet if necessary)
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Signature: _______________________________ Date: __________________________

Received by the Police Department: _________________________________________

Signature: _______________________________ Date: __________________________

Comments: ____________________________________________________________________

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Submitted to the Traffic and Parking Citation Appeals Panel on: ____________________ (date)

The Traffic and Parking Citation Appeals Panel may order the payment of the fines in whole or in part, or the cancellation of such charges. If the appeal is denied, the appellant is required to pay the charges within ten (10) working days after the notification of the Panel’s final decision.  The Panel's decision is final and there are no further appeals.      

Panel Comments: _______________________________________________________________

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Appeal is granted (    ) or denied (    )

Senior Member’s Signature:_______________________________ Date: ___________________