Fillable VISTA Shuttle Card Application TRANSIT SHUTTLE CARD

Fill Online, Printable, Fillable, Blank VISTA Shuttle Card Application TRANSIT SHUTTLE CARD Form

Use Fill to complete blank online CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

VISTA Shuttle Card Application TRANSIT SHUTTLE CARD

On average this form takes 4 minutes to complete

The VISTA Shuttle Card Application TRANSIT SHUTTLE CARD form is 1 page long and contains:

  • 0 signatures
  • 13 check-boxes
  • 11 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California State University Channel Islands

BROWSE CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
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
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

VISTA Shuttle Card Application TRANSIT SHUTTLE CARD

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 March 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document