Application For Parking

Note: All fields in with * asterisk are required to submit the form.

 

 

*Type of Application: New Employee (30 Day Temporary Hang Tag)
(After 30 days from start date employee will be required to purchase parking permit to park in permit required parking lot)
Temporary Employee
New Parking Application
Renewal Application
Replacement Permit (Lost, Damaged, or Stolen)
If permit was stolen provide police report #)
   
*Today's Date:
*Last Name:
*First Name:
*Position/Title:
*Department:
*E-mail:
*Phone or Ext:
   
*Status: (Check 1 applicable selection below)
Employee:
 KUSM-W (State employee) MPA KUEA School of Pharmacy
Student:
 KUSM-W MPH School of Pharmacy (no payment is due at this time)
Resident:
 List Department: *
   
Cost of Permit: $100 for faculty/staff
$85 for students/residents
   
*Type of Permit: Hang Tag (Only 1 hang tag will be issued per individual)
Repositional (static cling sticker)

Note: Replacement fee for lost permits will be $20.00. If the permit is damaged, destroyed, or mutilated it can be replaced at no extra cost when returned to the facilities office. Stolen permits can be replaced when police report # is provided.
   
*Payment Method: Cash (If permit is issued after July the parking fee will be prorated. Contact facilities
       for amount due)
Payroll Deduction (only KUSM-W state employees can select this option)
School of Pharmacy
Internal Medicine Resident (no payment is due at this time)

By clicking the submit button you are creating a digital signature signifying you have read and
agree with KUSM-W parking policies and conditions of this application.

 

 
 
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Last Modified: June 17, 2011
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