Commuter Student Parking Permit Application

First Name

Last Name

Mobile Phone Number

Vehicle Information

I agree that the parking decal provided by the College will be used for this vehicle only. Violation of this may result in termination from the parking program without prior notice being provided to the Office of Campus Safety and/or Parking Program manager.

Plate Number

State of Registration

Make/Model

Year

Color

Car Owner

Self

Other

Car Owner's Info (if other than yourself)

Owner's Name

Country

Street

City

Region

Postal Code

Have you participated in the parking program in prior years?

Yes

No

PLEASE READ: By typing my name below I realize I am responsible for understanding and complying with all Dean College Parking Regulations. Dean College is not responsible for any damages incurred while my vehicle is parked on any property owned or leased by Dean College. I am parking at my own risk. I understand I can be fined for not parking in my designated area. I understand my vehicle is subject to being towed if I receive three (3) or more parking citations or if I park in a tow zone, handicapped space, fire lane, or an emergency situation requires the vehicle to be towed. I understand I can lose my driving privileges for any of these infractions during the school year and that prior infractions or conduct history may forfeit future participation in the Dean College parking program.

Name

Date