Housing Maintenance Damage Appeal Form

Appeals must be received within 90 days of the charge posting to your account . Any items not appealed within 90 days will be considered valid and owed by the resident.

Name Name First Last
Building and Room #
Date Date / MM / DD YYYY
Email
Cell Phone Cell Phone - ### - ### ####
Charge(s) being appealed

If you are appealing more than (3) charges, please submit an additional form
Damage being appealed
Please provide a thorough narrative of why you feel you should not be financially responsible for the above listed damage:
Do you have a second charge to appeal?

Do you have a second charge to appeal? Yes No
Damage being appealed
Please provide a thorough narrative of why you feel you should not be financially responsible for the above listed damage:
Do you have a third charge to appeal?

Do you have a third charge to appeal? Yes No
Damage being appealed
Please provide a thorough narrative of why you feel you should not be financially responsible for the above listed damage:
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Housing Maintenance Damage Appeal Form

Housing Maintenance Damage Appeal Form

Charge(s) being appealed