24-Hour & Commuter Parking Application

24-Hour & Commuter Parking Application

Personal Information

First Name: *

MI:

Last Name: *

SSN (last 4 digits): *

Contact Number:

E-Mail: *

Street Address: *

Apt:

City: *

State: *

Zip: *

Columbia Information

Faculty Member:

Yes

If not Faculty, Officer Grade:

Start Date as full time employee:

Title: *

University Department: *

CU ID Card#:

(9-digit # on back of Columbia University ID card)

Office Phone:

Office Address:

Parking Requirements

Date Parking Needed: *

Parking Preference

Indicate preference with a 1,2,etc.

Commuter Garages:

IAB:

Engineering Terrace:

Interchurch:

for officers at Interchruch only

24-Hour Garages:

560 Riverside Drive:

635 West 131st Street:

Riverside Church:

Arbor:

Henry Hudson Parkway

Vehicle Information

Vehicle registration(s) must be faxed to 212-854-2891. Applications without registrations will not be considered.

Number of Vehicles: *

I have vehicle(s) I need to register for parking

I have no vehicle

Vehicle 1

Make:

Model:

Year:

Color:

Plate #:

State:

Vehicle 2

Make:

Model:

Year:

Color:

Plate #:

State:

If no vehicle, please select the reason for requesting parking:

This office should be notified of any change in information supplied on this application. The University does not provide insurance for individual car owners and accepts no responsibility for vandalism, theft, or malicious mischief. The car owner agrees to make no claim against the University for any such incident.

Comments:

Initials: *

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24-Hour & Commuter Parking Application

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