USTA Alabama Youth Progression Pathway Appeals Form
Name of the Parent /Guardian:
*
First Name
Last Name
Address of the Parent/Guardian:
*
City
*
State
*
Please Select
Alabama
Arkansas
Georgia
Kentucky
Louisiana
Mississippi
North Carolina
South Carolina
Tennessee
Zip
*
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Player Name
*
First Name
Last Name
Player USTA #
*
Player Date of Birth
*
-
Month
-
Day
Year
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Current Progression Level
*
Please Select
Orange Level 2
Orange Level 1
Green Level 1
Yellow
Appeal Rationale:
*
Appealing to Level
*
Please Select
Orange Level 2
Orange Level 1
Green Level 1
Yellow
Medical appeal description:
(please attach signed “Attending Physician Statement”)
Parent/ Guardian Certification
*
By submitting this Appeal Form, I certify that all information is accurate to the best of my knowledge.
Date
*
-
Month
-
Day
Year
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Attach any supporting documents
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