University of Wisconsin - Stout

Damage Prevention Program Appeal Form

Name:Name:
Address:Address:
Email:Email:
Phone:Phone:

Date of Damage / Date Notice Posted:

Type of Charge:

Description of Damage:

Actions taken to rectify damage (Find student(s) responsible, clean, etc.):

Reason for appealing:

Additional information:

If you are not responsible, who should be charged? and why?