Materials Review Appeal Request Form
Submit your appeal within 15 business days and include the original review case details.
Appellant Name
*
First Name
Last Name
Appellant Contact Information
*
Title of Material Under Appeal
*
Author
*
School
*
Please Select
Antimony Elementary
Boulder Elementary
Bryce Valley Elementary
Bryce Valley High
Escalante Elementary
Escalante High
Panguitch Elementary
Panguitch Middle
Panguitch High
Garfield Online
Case Number from Original Review
Date of the Review Committee's Determination
*
-
Month
-
Day
Year
Date
Determination Being Appealed
*
Retained
Restricted
Removed
Grounds for Appeal
*
Requested Outcome
*
Retain
Restrict
Remove
Other
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Appeal
Submit Appeal
Should be Empty: