California State University Channel Islands
Request for Waiver of Campus Parking Fee
The campus parking fee may be waived for students with disabilities who meet the eligibility standards based on the financial information provided on this form.
Incomplete responses will delay processing and may be cause for denial of this request. Please take form to campus Financial Aid Office for authorization and bring it to
Transportation and Parking Services for completion of the process.
In order for a student to be eligible for the campus parking fee waiver, a student must:
1. Show proof of student registration for period listed on this parking waiver request;
2. Possess a valid state DMV Handicap Parking Placard or Plates in their name; and
3. Demonstrate financial need for parking fee financial assistance according to the need analysis procedure for campus based financial aid authorized by
Title IV of the Federal Higher Education Act of 1965, as ameded (20 U.S.C. 1087kk et seq.). and obtain authorization from Campus Financial Aid office.
Student Name Student ID
Address Telephone Number
City
Zip Code
State
Campus
Term/Year for which waiver is requested
License/Placard Number
State
Expiration Date:
No
Yes
No
Yes
No
Yes
1. Are you a Department of Rehabilitation or other agency client?
2. If 1 is "yes", do you receive parking fee assistance?
(If 2 is "yes" , you do not qualify for this waiver. Do not submit this form.)
3. Have you applied for financial aid at this campus?
(If 3 is "yes", date Financial Aid Application submitted _______________)
(if 3 is "no", the Financial Aid Office is unable to determine whether you have financial need. You must qualify for financial aid.)
Student Signature Date
Name of Financial Aid Official (Please Print) Signature Date
STEP ONE - FINANCIAL AID OFFICE for evaluation of "demonstrated financial need."
Applied for financi al aid: Evaluated as having no financial need. Ineligible for a waiver.
Applied for financi al aid: Evaluated as having a financial need. Eligible for a waiver.
STEP TWO- PARKING SERVICES for verification of valid state DMV Disabled Persons Parking Placard or plates in your name
Disabled Person Placard or License Plate Information:
Valid DMV verified by CSUCI Transportation and Parking Services, eligible for parking fee waiver
No valid DMV placard. Ineligible for parking fee waiver.
Permit # Issued: ________________________ Permit previously received; refund requested.
Name of Authorized Parking Services Agent (Please Print) Signature Date
Student Acknowledgement: I acknowledge receipt of :
Copy of this completed form Parking Permit
Signature of Student Date
STEP THREE - PARKING SERVICES forwards copy of form to Cashier's Office.
ACTION REQUEST: Please credit student for permit previously charged. See attached permit refund request. No action needed. Information only.
Student Certification: I certify that all information provided is true, complete and accurate to the best of my knowledge.
