Parking Citation Appeal Form

Clark State parking citation appeals are processed by completing the parking citation form below. This form and your citation must be received by the Office of the Vice President for Business Affairs within ten days of the date the citation was issued. The payment of the citation under appeal is suspended without penalty during the appeal process.

An appeal should be based on the fact that the violation was issued in error or contrary to established regulations. A lost permit, forgetfulness, parking only for a short period, failure to display parking permit and/or not seeing the signs are unacceptable grounds of appeal.

If the appeal is denied, failure to pay the issued citation within ten days from the date of notice will result in a hold on your account (if a student) or a payroll deduction (if an employee).

Please fill out the following form completely.

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

E-Mail

Student ID Number (if applicable)

I am a... *

Citation Number *

Citation Date *
MM/DD/YYYY

Location of Violation *

Reason for Appeal *