Loss of Privilege Appeal Request

Please complete the Appeal Request form below if you would like to appeal the revocation of a privilege.
Appeals are reviewed on a weekly basis. Upon review, you will received a communication via myStudent as to the outcome.

Student Name Student Name First Last
Student Number
Grade Level

Grade Level 9th Grade 10th Grade 11th Grade 12th Grade
Number of Absences/Tardies that Resulted in Revocation
State why you are appealing your revocation of privilege.
Upload Documentation for Support
Parent/Guardian signature signifies an understanding that appeals are reviewed on a weekly basis and the decision of the Principal or Designee is final.

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.