PLEASE PRINT AND FILL OUT ALL APPLICABLE FIELDS
Once the form has been completed, take the form to the Office of Finance and Business Services, Room 106 Williams Building to receive your parking pass. All fields are required.
Name (Last, First, MI):_____________________________________________________
Cell Phone Number:__________________ Penn State ID Number:___________________
Local Address:____________________________________________________________
City:____________________________ State:__________ Zip Code:_________________
Check the appropriate box:
_____ Student _____ Faculty
_____ Staff _____ Part-Time Faculty or Staff
_____ Information Change
Vehicle Identification
Make of Vehicle:_______________ Model:______________ Color:___________
Year:________ License Plate Number:_________________ State:___________
Make of Vehicle:_______________ Model:______________ Color:___________
Year:________ License Plate Number:_________________ State:___________
I certify that I have read the regulations and agree to fully abide by them.
Signature:__________________________________________ Date:____________