Parking Exception Request

NOTICE:
In order for this form to be completed, YOU MUST submit your supporting documentation.
This form will NOT be considered complete unless you submit your documentation.

Background Information
Your Full Name: Your Full Name: First Middle Last
Your Permanent Address Your Permanent Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Urgency of this report:
Semester/Year
Location of Accomodation:
Detailed Student Information

Please be sure your contact information is accurate, including your active phone number.
ID Number
DOB (YYYY-MM-DD)
Phone Number
Email Address
Hall/Off Campus Address
Questions
Pronouns
Major
Semester and Year you are requesting your vehicle(s) on campus:
Request Type

Request Type Requesting to have a vehicle on campus Requesting to park near my resident hall
Residence Hall
Length of time needed:

Length of time needed: Temporary Request Academic Year Request
Reason for the Request:

Reason for the Request: Mobility Health Psychiatric/Emotional If other, please explain: If other, please explain:
Appliances You Use (i.e. Crutches):
Please Describe How Your Disabling Condition Affects Your Need for a Car on Campus:
Sources of Documentation of Disability: I give my permission for the Accessibility Resources Center and/or Health Services staff to contact the professional provider listed below for additional information if needed: 1. Physician/Specialist and Phone Number 2. Agency/Clinic and Phone Number:
Supporting Documentation

ARC agrees to coordinate accommodations/services for students found eligible who have provided appropriate documentation of a temporary medical condition and requests accommodations in accordance with established policies and procedures. By submitting below, I am requesting reasonable accommodation for my temporary medical condition. I am submitting documentation and agree to adhere to the established policies and procedures for acquiring accommodations. 5GB maximum total size.
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Parking Exception Request

Parking Exception Request

Background Information

Detailed Student Information

Questions

Supporting Documentation