ETA 6-131C Right to Appeal

U.S. Department of Labor Employment and Training Administration Office of Job Corps

ETA FORM 6-131C OMB Control No. 1205-0219 Expiration Date: 05/31/2025

Right to Appeal

I have been informed of my right to have a reasonable amount of time in which to submit an appeal. If I decide to appeal, I may be given the assistance of any individuals on center to prepare the written and signed statement.
Legal Name	Enter Information
Student ID	Enter Information
Date	Click or tap to enter a date.
Check One
I elect:	☐ Not to appeal
	☐ To appeal for the following reasons (list reasons below):
	List reasons here
Reason for Appeal	☐ Decision to Discharge (Center Director)
	☐ Recommendation for disciplinary discharge (Center Review Board)

Student: I the undersigned, certify that all information on this form is accurate.
SIGNATURE:	DATE: Click or tap to enter a date.
Date Appeal Received by Center Director	Click or tap to enter a date.

Paperwork Reduction Act Public Burden Statement: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents' obligation to complete this form is required to obtain or retain benefits (P.L. 113-128). Public reporting burden is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate to the U.S. Department of Labor, Division of Adult Services, Room S-4209, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0035). Please do not submit completed forms to this address.

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