VISTA SHUTTLE CARD APPLICATION
For Students, Staff and Faculty
CARD STATUS
New Renewal Replacement Defective
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
Which satellite “Park and Ride”site will you use? (Select one)
Oxnard- “C” Street Transfer Point (“C” Street & Channel Islands Blvd.- Behind Centerpoint Mall)
Oxnard- Near Oxnard College (SW Bard Road & Simpson Drive)
Camarillo- Metrolink Station (Lewis Road & Ventura Blvd Intersection)
This transit shuttle card is non- transferrable and is intended for the sole use by the applicant to facilitate transportation only to and from CSU Channel Islands. For
compliance, audit, and planning purposes, the Ventura County Transportation Commission, will upon request, submit information regarding the usage of the transit
shuttle card to the Police and Parking Services department. The following information is required to protect you in case your card is lost or stolen. Data provided
will be treated as confidential and used only for compliance, audit, and planning purposes. There is a $15.00 fee in order to replace a transit shuttle card that is lost
or stolen.
By signing below, you acknowledge that you have read and understand the statement above and agree to the terms and conditions of having a CSU Channel
Islands transit shuttle card.
Signature: _____________________________________________________ Date:_______________________________________________
SHUTTLE FEES
Semester
Fall or Spring Semester
$25.00
Summer Session
$21.87
Replacement Card $15.00
Please make check or money order payable to: CSU Channel Islands
OFFICE USE ONLY
FORM OF PAYMENT
Cash Check/Money Order Credit Card
Shuttle Card Number: Date Issued:
APPLICATION PROCESSED BY
CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS
Police and Parking Services
One University Drive Camarillo, CA 93012
(805) 437-8430 (O)
(805) 437-8431 (F)
Print Form