AT15
Florida High School Athletic Association
Revised 07/12
Petition for Reconsideration of Unsportsmanlike Conduct Penalty
Instructions for petitioning a student-athlete/coach suspension and/or fine (reference FHSAA Policy 30.5):
1. Petitions must be submitted within fourteen (14) working days of penalty notice
2. Incomplete petitions will not be accepted (i.e., no blank lines, all signatures obtained)
3. Only the principal, athletic director or FHSAA representative may file a petition
4. A separate form is required for each appeal
5. Petitions are reviewed in the order they are received. Please allow five (5) business days for a response
6. Video evidence submitted must be either cued to the incident or the cue location must be identified in your written petition
7. Petition determination will be sent via e-mail to those parties whose signatures appear below
Print and submit via fax to: (352) 244-5043; or e-mail to: [email protected]; or mail to: 1801 NW 80th Blvd., Gainesville, FL 32606
Please remember that all periods of ineligiblity (suspensions) remain in effect during the petition process
School: _________________________________________________ City: ______________________________ Today Date: __________________
Sport: ________________________________________________
Gender: __________
Level (Varsity, JV, etc.): ________________________
Officials Association: ______________________________________________________________________________________________________
Name of Penalized Student or Coach: ___________________________________________________
Uniform No.: _____
Uniform Color: _______________
Date of Incident: _______________
Basis for Appeal:
_____
Incident did not occur
_____
Incident not as severe as written
_____
Disciplinary action(s) imposed by school
If Student, Grade Level: ____________
Opponent: ______________________________
Required information submitted:
• Letter from individual (student-athlete or coach)
• Letter from school (principal or athletic director) stating disciplinary action(s)
Additional information submitted:
_____ Video
Cue location: ____________
Link to submit video file: http://www.fhsaa.org/upload
Required signatures: Three (3) different signatures (as designated) must be provided before action will be taken by the FHSAA.
______________________________________
_________________________
____________________________ [ ___ Agree] [ ___ Disagree]
______________________________________
_________________________
____________________________ [ ___ Agree] [ ___ Disagree]
______________________________________
_________________________
____________________________ [ ___ Agree] [ ___ Disagree]
School’s FHSAA Representative or Athletic Director
School’s Principal/Headmaster/Director
Title
Title
Public School: Supintendent or County AD
Title
Private/Charter/Lab School: Governing Body Rep (i.e. Board member, owner)
E-mail Address
E-mail Address
E-mail Address
FHSAA Office Use Only
_____ Approved (as stated)
_____ Denied
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____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________
Signed: _____________________________________________
Date: _________________________