4341 – Personnel – Management and Confidential Personnel – Management/Confidential Appeal Form

Policy –
Regulation –
Exhibit – x

Adopted – 4/6/2000
Revised –
Name ____________________________________ Date ____________________________
Assignment Location _______________________________________________________

Reason for Appeal: (Give names, dates, location, decision, etc.)
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Action Requested:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

I discussed this with __________________________ on __________________
(Date)

Date Received:__________________________

Appeal Review – Board of Education Date of Hearing: _______________________

Decision: ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Signature of President: _____________________________Date: ___________________

Signature of Clerk: _________________________________Date: ___________________

Reference: District Originated.

CSBA Date –

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