SOP 209.09-att-8: Tier III Program 60 Day Review_Classification Appeal Form

SOP 209.09
Attachment 8

04/23/25
Page 1 of 2

Special Management Unit: Tier III Program

60-Day Review/Classification Appeal Form

I. Offender: _________________________ GDC #: __________________

Phase: __________ Bed Assignment__________ Date _____________

II. Appeal of Special Management Unit: Tier III Program Classification Committee Action

I wish to appeal the decision of the Special Management Unit: Tier III Program Classification Committee
regarding my 60-Day Review:

REASON FOR APPEAL (within 5 Business Days from date Notice of 60-Day Review Hearing Form
(Attachment 5) submit to the assigned counselor who shall forward to the SMU Warden (or designee)).

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

______________________________ _________________
Offender’s Signature Date

Date appeal received: ______________ By: _____________________________(COUNSELOR)

Offender Acknowledgment Appeal Received by Counselor: _____________________________
_Signature/Date_
Date Appeal Sent to SMU Warden: ____________________ _(Send within 3 calendar days of receipt of Appeal)_

_**If appeal is for denial of transfer to Tier III STEP, send directly to Director, Field Operations (or designee)**_

Date Appeal Sent to Director, Field Operations (or designee): __________________ _(send within 3 calendar_
_days of receipt of Appeal)_

III. SMU Warden (or designee) Review

Date Appeal Received: ____________

I concur / disagree with the Special Management Unit: Tier III Program Classification Committee's
Action and the following recommendation(s) has/have been made in this case:

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

_______________________________ _________________
SMU Warden (or designee) Date

Date Appeal Sent to Director, Field Operations (or designee): ____________________
_(Send within 10 business days of receipt of Appeal)_

Retention Schedule: Upon completion, this form shall be placed in the offender’s institutional file.

SOP 209.09
Attachment 8

04/23/25
Page 2 of 2

IV. Director, Field Operations (or designee) review

Date Appeal Received: ________________

I concur / disagree with the Special Management Unit: Tier III Program Classification Committee's
Action and the following recommendation(s) has/have been made in this case:

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

__________________________________ __________________
Director, Field Operations (or designee) Date

Date Appeal Sent to Assistant Commissioner for Facilities: ____________________
_(Send within 10 business days of receipt of Appeal)_

V. Assistant Commissioner for Facilities

Date Appeal Received: ________________

I concur / disagree with the Special Management Unit: Tier III Program Classification Committee's
Action and the following decision(s) has/have been made in this case:

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

_________________________________________ __________________
Assistant Commissioner for Facilities DATE

VI. Offender’s Acknowledgment of Final 60-Day Review Appeal Decision

_______________________________________________
_Signature/Date_

Retention Schedule: Upon completion, this form shall be placed in the offender’s institutional file.