Last Updated: July 1, 2019
S:\SDS Staff Schedules & Groups\Metro Center\shared\Fall 2019\Faculty\Faculty Parking and Key Form (fillable).pdf
UTC Faculty Parking Permit Form
PERSONAL INFORMATION:
Name: ___________________________________________________________
Department: ______________________________________________________
Home Address & Zip Code: __________________________________________
__________________________________________
Phone: (home) ____________________ (work) __________________________
(cell) ____________________________
Email: ___________________________________________________________
VEHICLE INFORMATION:
Make, Model, & Color of Vehicle: _____________________________________
License Plate Number with State: ______________________________________
Alternate Vehicle Make, Model, & Color: _______________________________
Alternate Vehicle License Plate Number with State: _______________________
GARGAGE ACCESS CARD INFORMATION (to be completed by staff):
Number on Access Card: ____________________________________________
Date issued/re-issued_______________________ Staff Initials __________________
Date Returned/Transferred__________________ Staff Initials __________________
I understand that I am responsible for the cost (currently $20) of replacing any lost or
stolen access cards (keycards). I understand that I must return the parking access card on
the day that the grades are due each semester or my department chair will be notified.
Keycards not returned on time may be deactivated. In which case, the cardholder will be
charged a $20 fee.
Signature: _________________________________ Date: ___________________
FACULTY KEYS
Initials:
1
st
Fl. Mast. (A7/AA7) ________
Bio. Mast. (B/A4) ________
2
nd
Fl. Mast. (208-220) ________
Other: __________ ________
Fob #: __________ ________
Spring 2020 – GARAGE B
