Fine/Fee Appeal Form

Use the following form to contact us with any questions, comments, or concerns.
Fields marked with an * are required.

Name: *

Email: *

Phone *

Status: *

If you have selected "Other" please specify your affiliation with PCOM:

Department:

Campus: *

If you have previously discussed your fine, please provide the staff member's name:

Date discussed:

Fine/fee amount(s) you are disputing: *
Please list barcode and amount for each dispute; this information can be found in your fine/fee notice, or you can obtain a copy of your fine statement from the library circulation desk.

Reason for appeal: *
Clearly state why you feel that your fines should be adjusted or cancelled.

Please leave this field empty.

If you are claiming extenuating circumstances, appropriate documentation should be provided in Word or PDF format as an additional attachment to this form.