Complete and email to email@example.com.
|Date of Inspection:|
|Date Received by Housing Office:|
|Dormitory and Room Number:|
This form is required to be submitted within five business days after receiving your dormitory fire safety inspection report. It will first go to the Manager of Dormitories for resolution. The Manager of Dormitories will record his comments in the space provided and reply via email. If the matter is still not resolved to your satisfaction, you may resubmit the form to the Housing Office (firstname.lastname@example.org) within seven days of the date it is mailed back to you. The Appeals Committee will proceed in accordance with the Residential Living Policies and Dining Services Guides. You may be called in for personal testimony. You will be notified of the Committee's decision within one month.
Please note that the factual fines cannot be appealed. Some examples of factual fines are: an unauthorized appliance, fireworks or flammable or combustible liquids, candles, covered or blocked smoke detectors and/or sprinkler system, etc.
Appeal Statement: (use separate sheet if needed)
|Date Received by Inspection Manager:|
|Date Mailed to Student:|
|Factual Fine--No Action Taken:|
Inspection Manager's Comments:
|Inspection Manager Signature:|
|Date Received Back by Student:|