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Citizens Review Board appeal form

The City of Charlotte does not discriminate based on disability. We will provide auxiliary aids and services, written materials in alternative formats, and reasonable modifications in policies and procedures to persons with disabilities upon request. To make a request, please email cityclerk@charlottenc.gov or call our office at 704.336.2248.

1. YOUR PERSONAL INFORMATION

Name of Attorney (if applicable)

Phone Number (Include area code)

Gender

2. APPEAL DATA

Date of Internal Affairs disposition (printed on the letter you received)

Date you received your disposition letter

Complaint number

Date your original complaint was filed

Why do you want to appeal?

Why do you feel the decision was wrong?

Do you feel your rights were violated? If yes, please explain.

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Citizens Review Board appeal form

1. YOUR PERSONAL INFORMATION

Name of Complainant or Next of Kin

Address

2. APPEAL DATA

Date of Internal Affairs disposition (printed on the letter you received)

Date you received your disposition letter

Date your original complaint was filed