Download a PDF file here or use our online form provided below. All fields are required!

Student Car Authorization Request

Note: All student permits must be placed on the rear bumper of the vehicle.

Name:   Class year:   

Residence hall for current year:   

Extension for current year:

Vehicle make:   Model:   Color:

License plate number:   Please re-enter:

State:   Owner's name (from registration card):

Reason for requesting a permit (select one):

Name of company:

Address:   Phone number:

 

 

 

Any student who receives a permit is required to make two medical transports for the Worth Health Center. The student driver will receive $5 per trip. Faliure to meet this requirement will result in the REVOCATION of the parking permit.

 

 

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