LEV/ EV Employee Parking Permit Application
Complete the below form and return it to Parking & Transportation Services with your vehicle registration.
Your application will then be reviewed within 2 business days.
(Please print legibly)
Legal Name: ______________________________________________Phone #____________________
Home Mailing Address: ________________________________________________________________
City: _____________________________State: ___________________ZIP Code: _________________
Email address: ________________________________
Please check the appropriate box:
Employee: Department: Employee ID #:
Office Location: _________________________
Work Hours: ____________________________
Vehicle Tag:_________________ State:________ Make:________________________
Model:____________________ Year:________ Color:________________________
Vehicle Type: Please check all that apply: Engine size: Please check one:
□ Automatic □ Hybrid □ 4 cylinder
□ Manual □ EV (Electric Vehicle) □ 6 cylinder
□ 8 cylinder
□ Other ___________________
□ I agree to pay the $25 surcharge for use of campus electric charging stations. There is a 4-hour limit
at each station per day. For charging locations please visit http://www.clemson.edu/parking.
Preferred Parking Lot: Please check one:
□ Fike (E-5) □ Sikes Hall (E-6) □ Sirrine Hall (E-4)
□ East side of Cooper Library (E-15) □ Hendrix Student Center (E-1) □ Lee Hall (E-3)
□ Other ___________________________
Permit # __________________State: ________Expiration month/day/year_______/_______/_______
I agree to abide by the Clemson University Parking Regulations and be responsible for all parking
citations bearing a permit number issued to me. I will not transfer my permit to another person.
Signature: __________________________________________Date: ___________________________
Please provide the permit number and expiration date of your current state-issued disability access parking
permit if you will use it to park on campus in spaces reserved for disability access.
G-01 Edgar Brown Union
Clemson, SC 29634-4014
PATS Use Only: Approval: ________________ Date: ____________
click to sign
signature
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