CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS
Police and Parking Services
CSUCI Permit
Number Issued
One University Drive Camarillo CA 93012
(805) 437-8430 (O) (805) 437-8431 (F)
PARKING REGISTRATION APPLICATION
For Semester Faculty and Students
Participants of carpools must submit their applications simultaneously and one vehicle owner must be identified as the party responsible for paying
the required fees.
PERMIT
Fall _________ Spring ___________ Summer ____________
CATEGORY
Faculty Student Volunteer
(Teaching assistants are entitled to student permits)
PARKING DESIGNATION
“A” Lots Student Housing
REGISTRANT INFORMATION
LAST NAME FIRST NAME STUDENT ID (Must be completed to process application)
MAILING ADDRESS
CITY STATE ZIP CODE
HOME TELEPHONE NUMBER WORK TELEPHONE NUMBER SCHOOL
CSUCI
VEHICLE INFORMATION
(For owners of multiple vehicles, only one permit will be issued, unless the 2
nd
vehicle is a motorcycle)
VEHICLE #1 ARE YOU THE REGISTERED OWNER OF THIS VEHICLE? Yes No If no, write name(s) below.
VEHICLE MAKE VEHICLE MODEL
REGISTERED OWNER NAME(S)
VEHICLE COLOR(S) LICENSE PLATE NUMBER STATE VEHICLE YEAR
VEHICLE #2 ARE YOU THE REGISTERED OWNER OF THIS VEHICLE? Yes No If no, write name(s) below.
VEHICLE MAKE VEHICLE MODEL
REGISTERED OWNER NAME(S)
VEHICLE COLOR(S) LICENSE PLATE NUMBER STATE VEHICLE YEAR
VEHICLE #3/MOTORCYLE ARE YOU THE REGISTERED OWNER OF THIS VEHICLE? Yes No If no, write name(s) below.
VEHICLE MAKE VEHICLE MODEL
REGISTERED OWNER NAME(S)
VEHICLE COLOR(S) LICENSE PLATE NUMBER STATE VEHICLE YEAR
PARKING FEES Semester
Vehicles (Students) Lots A1-A10
$145.00
Vehicles (Students Housing) Lots SH and A10 (SP)
$135.00
Vehicles (Faculty) Lots A1-A10
$98.45
Motorcycles (Students) Lots A4 and A7
$34.00
Motorcycles (Faculty) Lots A4 and A7
$24.19
Please make check or money order payable to: CSU Channel Islands
OFFICE USE ONLY
DATE RECEIVED AMOUNT RECEIVED FORM OF PAYMENT
Visa MasterCard ______________________________________ Expiration _____/_____
Card Holder’s Signature________________________________________________________
Batch # _____________________ Reference # _________________________
Cash Check # Money Order #
INVOICE NUMBER DATE ISSUED
APPLICATION PROCESSED BY
Return application and payment to the address above
