Clemson University Employee Pre-tax Parking Benefit Election/Change Form
Employee Name:
Last First Middle Initial
Employee ID Number:
Department Number: Department Name:
Check permit choice(s) below:
(1) The pre-tax payroll deduction amount is subject to increase or decrease with changes in the annual gross salary amount
and/or the parking permit rate schedule.
Indicate your selection(s) below with check marks:
I accept the parking benefit on a pre-tax basis offered via payroll deduction.
The amount of the pre-tax deduction is subject to increase or decrease with changes in the annual gross salary amount
and/or the parking fee schedule. I agree to return my parking permit should I terminate employment or change status so
that payroll deduction is no longer possible and understand that failure to return the parking permit will result in the
revocation of all campus parking privileges associated with the parking permit.
Note: Student employees and intermittent employees are not eligible for this benefit. The final determination for benefit
eligibility will be made by Clemson University Human Resources Payroll Department.
I am a: 9 month employee
12 month employee
Return this completed form to Parking Services. , G-01 Edgar Brown Union, Clemson, SC 29634-4014
I wish to change my parking permit type.
I wish to terminate my pre-tax parking benefit.
Return this completed form, with your current parking permit attached, to Parking Services. This form must be
processed and approved by Parking Services before Human Resources will process any changes to this benefit.
I have indicated my choice to accept, modify or terminate the pre-tax parking benefit. This choice will remain in effect until I
authorize a change by properly completing another Election Form.
Employee’s Signature: Date:
Form CUPS22
(REV 05/11/2018)
Payroll Use Only
Pay Group _______ ____ Hire Date ___________ Approval Date _______
Approved By________________________________________________________
Employee Annual Gross Salary Range
Semi-Monthly Permit Rates
1
9 Month
Payroll Deduction
12 Month
Payroll Deduction
click to sign
signature
click to edit
![]()
