Brevard Drop-In Center, Inc.

Appeal Form

Name: ______________________         Date ____________________

Appeal decision should be sent to: (provide your address)

What decision are you appealing?

What is the basis for your appeal and the facts supporting your appeal?

What steps have you taken to make certain that you will follow the Code of Conduct in the future?

Do you request to appear before the Board of Directors to make this appeal? 

Yes _______                No _____________

If yes, do you prefer to have an open (public) or closed (private) meeting?

Open  _____________     Closed  _____________

You may write on the back or use additional paper stapled to this sheet.