CITIZENS APPEAL FORM
*LEVEL III

(To County Board of Education)

_____________________ COUNTY SCHOOLS


*For a Level III apppeal to be considered by the county board of education, it must be presented to the county superintendent withn fifteen days after receiving the decision from Level II. While the original claim may not be altered greatly in content or working, additional supportive information may be provided.
CITIZEN(S) MAKING APPEAL

______________________________
Name		 ______________________________
Address		 ______________________________
Phone
______________________________
Name		 ______________________________
Address		 ______________________________
Phone
______________________________
Date		 ______________________________
Signature(s)

REQUEST FOR HEARING

Citizen(s) are entitled to a hearing before the county board of education if requested at the time the Level III appeal is filed.

I/we do _______ , do not __________ request a hearing before the county board of education.

______________________________
Date		 ______________________________
Signature(s)

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