Campus ID#
First Name
Last Name
Department
Building
Room
Work Phone Number
Email
Permit Type Faculty (A - Permit for Faculty): $100.00 per month Faculty/ Staff (A1 - Permit for approved Fac/Staff): $100.00 per month Carpool (L-Permit): $50.00 per month Staff (D- Permit for Staff ): $100.00 per month One Day Intermittent Pass (D- Permit for Staff ): $26.00 per month Two Day Intermittent Pass (D- Permit for Staff ): $52.00 per month Three Day Intermittent Pass (D- permit for staff members): $76.00 per month
Permit Length
Number of Vehicles
License Plate (Vehicle # 1)
State (Select) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Make (Chevy, Honda, ...)
Body (number of doors)
Color
(Vehicle # 2)
State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
I accept responsibility for any enforcement action that may be taken due to my providing either inaccurate or incomplete registration information. I also agree to read and abide by all signage and written regulations.
I accept the Parking Registration/Regulations Acknowledgement (click here to view Parking Regulations)
I authorize Seattle University to deduct the current monthly parking fee from my paychecks. I understand that payroll deductions will continue until such time as the assigned parking permit is returned to Campus Public Safety or when the permit expires (whichever occurs first). Note the NEW FEATURE below: "continuous payroll deduction" - for 12 month staff ONLY.
I accept the Payroll Deduction Authorization
I accept the Continuous Payroll Deduction Authorization (Currently for 12 month Staff ONLY)
I elect to waive the opportunity to participate in the Seattle University Pre-Tax Transportation Plan. I understand that by waiving participation the monthly parking fee will be deducted from my paycheck after all federal taxes have been withheld.
I accept the Pre-Tax Transportation Plan Waiver (read carefully before selecting this option)
By clicking "Submit" below, you verify that everything stated on this form is true and you authorize Seattle University Payroll to deduct the current monthly parking fee from your paychecks.
Other Notes