WEAPONS STORAGE APPLICAITON
Please fill in the information requested below. Prior to being allowed to store a weapon or ammunition on the campus of
Liberty University this form must be completed and approved. Any false information or attempt to falsify information on this
application will result in immediate disqualification for storing a weapon on the campus. Any incomplete application will not be
considered.
Full Name:
Date of
Birth:
Current Address:
City:
State:
Zip:
Resident
Student
Hall &
Room #:
LU Mailbox #:
Cell Phone:
LUID#:
Student
Staff / Faculty
Email Address:
Please answer the following by a Yesor a Noin the box to the right of the question and provide any additional information on
the back of this form. Applicants, if approved, are required to inform LUPD immediately if the answer to any of these questions
changes for any reason.
Are you on probation for violation of any
academic or honor code, or of the Liberty
Way?
Are you subject to any no-contact directive
from Liberty University, any court or
government agency? If yes, list each person,
date of directive (Liberty, court, agency).
Are you under indictment or information, or
have charges pending court disposition in
any court for any crime? If yes, list each
offense and arresting agency.
Are you subject of a court order restraining
you from harassing, stalking, or threatening
an intimate partner or child of such partner?
Have you ever not contested, plead guilty to or
been convicted of a criminal offense? If yes,
list each offense, date, and location.
Description of weapon(s) and ammunition to store.
MAKE
MODEL
CALIBER
SERIAL NUMBER
LOCATION STORED
AMOUNT
CALIBER
LOCATION STORED
THE INFORMATION I PROVIDED IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I hereby authorize the Liberty University Police Department to check
my student/employee records and criminal background, as necessary, to determine whether I should be permitted to store any weapons or ammunition on campus. I
understand that such permission can be granted, conditioned, revoked and denied at any time at the discretion of the LUPD. By signing below I agree to abide by the Liberty
University Weapons Policy and to indemnify and hold Liberty University harmless for any and all liability arising from my possession, storage, use, and misuse of any firearm
on University property.
Signature of Applicant:
Date:
POLICE DEPARTMENT USE ONLY
Date Received:
Received By:
Signature:
VCIN
Proof of Status Verified
Date of Approval:
Approved By:
Signature:
If denied, reason for denial:
If conditionally approved, restrictions:
LUPD 27 AUG 2018
Additional Information: