Parking Application - Eastern Connecticut State University

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Application Type: (apply for one only)
Eastern Connecticut State
University Department of Public
Full Time Faculty or Staff (expires August 31, 2025)
Safety
Adjunt Faculty/Part Time/UA (expires August 31st each year)
UNIVERSITY PARKING
Resident Student (expires august 31st each year)
PERMIT APPLICATION
Commuter Student (expires August 31st each year)
2016-2017
Special Less Than 24 Credit Exemption (expiration varies)
Instructions:
Fill out application. Type or print legibly. Print application. Application will not be accepted electronically at this time.
1.
nclude a clear photocopy of your current vehicle registration. Applications CANNOT BE PROCESSED without the vehicle
2.
I
registration. The MAIL-IN Deadline for Fall 2016 is 8/21/2016. After the deadline, applications must be brought in person to the
University Police Department.
Mail application and registration copy to: Eastern Connecticut State University, Department of Public Safety, 83 Windham St.,
3.
Willimantic, CT 06226. ATTN: PARKING SERVICES.
PERMITS WILL NOT BE MAILED. Residents will be issued permits at move-in upon presentation of a valid Eastern ID or class
4.
scheudle. Commuters must pick up their permits in person at the University Police Department
5.
Special Parking Permits for employment, medical or other reasons require verification. Please attach a legible, signed letter from
your employer or medical provider that must be dated no more than 30 days prior to your applicaion for the exemption. Letters
should be on company or office letterhead and clearly state the dates requested for the parking exemption. A contact phone
number for verifying all requests must be included in the letter. Please notify the University Police of any changes in the
exemption requests.
APPLICANT INFORMATION:
First Name:
Last Name:
Campus Address:
EASTERN ID #:
Home Address/Street:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
VEHICLE INFORMATION:
Year:
Make:
Model:
Color:
Vehicle Owner:
Home Phone:
Owner Street Address:
City:
State:
Zip Code:
I certify that all of the above information is true and correct. I have received and will abide by the campus parking
regulations.
Signature: ________________________________________
Date: __________________________
DO NOT WRITE BELOW THIS LINE – OFFICIAL USE ONLY
 Valid ID  Schedule
Registration #
State:
Permit #:
Rev. 05/13/2016

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