Fillable Low Emissions and Hybrid Vehicle Parking Permit Application (State University of New York at Farmingdale)

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Low Emissions and Hybrid Vehicle Parking Permit Application (State University of New York at Farmingdale)

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BROWSE STATE UNIVERSITY OF NEW YORK AT FARMINGDALE FORMS

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University Police Department
Tel. 631.420.2111
Fax: 631.753 2128
police@farmingdale.edu
A Campus of The State University of New York
Farmingdale State College ·2350 Broadhollow Road · Farmingdale, New York 11735 · 631-420-2000 · www.farmingdale.edu
HYBRID VEHICLE PARKING APPLICATION 0913
Low Emissions and Hybrid Vehicle Parking Permit Application
In keeping with Farmingdale State College’s commitment to sustainability, parking spaces for Low Emissions and Hybrid Vehicles
have been installed in front of the new LEED Certified Campus Center. Charging stations for electric vehicles have been installed in
Parking Lot 5. In order to assure that these spaces are being used properly we have initiated a permit/decal process. The information
requested on this form is essential in determining if your vehicle qualifies for a permit. To qualify, your vehicle must either be a
hybrid or meet the LEED definition of a Low Emissions Vehicle, below.
“… vehicles that are either classified as Zero Emissions Vehicles (ZEV) by the California Air Resources Board or have achieved a
minimum green score of 40 on the American Council for an Energy Efficient Economy (ACEEE). “ http://www.greencars.org
Please complete the application and return it to University Police. If the vehicle qualifies, you will be issued a permit indicating that
your vehicle qualifies for LEV/Hybrid parking. You may also be asked to produce the vehicle for inspection.
Contact Information
Name: ___________________________ Department: ____________________________
Phone #: __________________________ E-Mail: ________________________________
Vehicle Information
Make: ____________ Model: _____________Year: ______VIN:_______________________
Engine: ___________ Hybrid: _____ Electric: ______ Flex Fuel: _______
Transmission: Automatic _______ Manual _______
Vehicle Color: _________ Vehicle License Plate #: ________________ State: _________
1. Permit must be prominently displayed on dashboard of vehicle.
2. PERMIT IS VALID ONLY ON THE VEHICLE APPROVED IN THIS APPLICATION AND
DOES NOT GURANTEE A LEV/HYBRID PARKING SPACE.
Applicant Signature: ______________________________________ Date: _____________
Application Reviewed by: _____________________________ Approved: _______ Denied: _____
Reason denied:
_________________________________________________________________________________________
_________________________________________________________________________________________
Permit # ________________ Date Issued: __________________ Issued By: __________________________
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Low Emissions and Hybrid Vehicle Parking Permit Application (State University of New York at Farmingdale)

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Completed 1 October 2020

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