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 –