Non-Employee Parking Fee Program And On-Campus Parking Privileges Enrollment Form
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Parking Fee Program and
On-Campus Parking Privileges
NON-EmPlOyEE
Last Name: ______________________________________First Name: _________________________________________
Home Address: ______________________________________________________________________________________
City: ___________________________________________State: _____________________ Zip: _____________________
Home / Cell Phone Number: (_____) _________________Email: ______________________________________________
Supervisor: __________________________________Office Location and Program: ______________________________
Begin date: __________________________ End date: ______________________________
Full-Time
Part-Time
DEClINE: I do not wish to participate in the Parking Fee Program. I understand that I will no longer have
access to the GRCC staff parking on campus and will be required to find alternative parking or
use the off-campus parking provided by GRCC.
ElECT:
I wish to park in GRCC staff parking on-campus and participate in the Parking Fee Program.
Please select employee group. The monthly rate (September-April) will be as follows:
Full-time
$15.00
Part-time
$ 5.00
Volunteer
No Cost
I understand and agree to prepay the indicated amount for each month of parking September-April.
I understand that this amount will change if there is a change in the GRCC published parking fee rate; however,
I will be notified prior to such a change taking place.
Signature: _________________________________________________________________ Date: ____________________
You must print and mail OR return this form to:
GRCC Human Resources
143 Bostwick Avenue, NE
Grand Rapids, MI 49503-3295
OR FAX this form to:
(616) 234-3907
OR scan/email this form to:
bcary@grcc.edu
Replacement cost for lost/stolen cards: $5.00 for first time and $10.00 for second time.
ThIS SeCTIOn TO be COmPleTed bY GRCC CAmPuS POlICe
Ramp Assignment: ______________________________________________________ Hanging Tag Number: _________
Campus Police Authorization Signature: ___________________________________ Date: ________________________
143 Bostwick Avenue, NE
Grand Rapids, Michigan 49503-3295
ph: (616) 234-GRCC
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Grand Rapids Community College is an equal opportunity institution. GRCC is a tobacco free campus. GRCC146-05/14
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Parent category: Business