Fillable Student Permit Application113010 TRANSIT SHUTTLE CARD

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Student Permit Application113010 TRANSIT SHUTTLE CARD

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CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS
Police and Parking Services
One University Drive •Camarillo, CA 93012
(805) 437-8430 (O) • (805) 437-8431 (F)
CI Permit
Number Issued
PARKING REGISTRATION APPLICATION
For 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 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 E- MAIL ADDRESS
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
PARKING FEES Semester
Vehicles (Students)- Fall or Spring Semester Lots A1-A10 $145.00
Vehicles (Students Housing)- Fall or Spring Semester Lots SH1 and SH2 $135.00
Vehicles - Summer Session Lots A1-A10 or SH1/SH2 $126.87
Motorcycles (Students)- Fall or Spring Semester Lots A4 and A7 $34.00
Motorcycles (Student Housing)- Fall or Spring Semester Lots SH1 and SH2 $34.00
Motorcycle- Summer Session Lots A4 and A7 $29.75
Please make check or money order payable to: CSU Channel Islands
OFFICE USE ONLY
FORM OF PAYMENT
American Express Discover MasterCard
Card #:_____________________________________ Expiration _____/_____
Card Holder’s Name:_______________________________________
Card Holder’s Signature:________________________________________________________
Cash Check # Money Order #
DATE RECEIVED AMOUNT
RECEIVED
DATE ISSUED
APPLICATION PROCESSED BY
Return application and payment to the address above
Print Form
California State University Channel Islands
Police and Parking Services
Guidelines for Student Parking
A student is defined as someone who is currently enrolled at CSU Channel Islands during
the spring or fall semester, summer period, or one who has completed the immediately
preceding term and is eligible for re-enrollment. This also includes non-matriculated (i.e.
Open University, Extended University, Osher, and prospective/intent to enroll students).
Parking of motor vehicles on the California State University Channel Islands campus is
regulated in accordance with Section 21113 (a) of the California Vehicle Code and
Sections 42200 and 42201 of Title 5 of the California Code of Regulations.
All parking registration applications for students must be completed in their entirety
(including name, student ID number, contact information and vehicle information of
the student) and must be submitted to Police and Parking Services when the student
purchasing a permit is either making changes to their address or vehicle information
from a previous semester or when the student purchasing the permit has not filled out
an application in the past.
Parking permit applications are subject to being denied for the following reasons:
• The requestor is not currently enrolled in any classes at CSU Channel Islands
• The student purchasing a permit currently has a financial hold on their MyCI
account
If the application is approved, Police and Parking Services will assign a semester Student
or Student Housing permit to the applicant. Vehicles displaying an S (student) permit,
may only park in any unmarked stalls in the A1-A11parking lots on campus. Vehicles
displaying an SH (student housing) permit, may only park in any unmarked stalls in the
SH1 and SH2 parking lots on campus. Failure to park in the specified areas that these
permits pertain to or failure to abide by the campus parking rules and regulations may
result in a parking citation.
Any student applicant found lending, transferring or selling their permit to another
person will be in violation of Section 11.14 of the CSU Channel Islands Parking
Regulations. This action may result in a parking citation being issued and/or other
corrective measures including criminal prosecution and referral to judicial affairs.
If you have any additional questions in regards to the application or the parking
guidelines for student permits, please call (805) 437-8430 or visit our main office located
in Placer hall. Our office hours are Monday through Friday, 8:00am to 3:00pm.
Revised 10/10
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Student Permit Application113010 TRANSIT SHUTTLE CARD

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Completed 11 March 2020

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