(THIS FORM MUST BE COMPLETELY FILLED OUT AND

UNIVERSITY OF DELAWARE
2015-2016 STUDENT CARPOOL PERMIT REGISTRATION
Please print and fill out form
NAME (print clearly)
_______________________________________________________________
UD ID NUMBER _______________________
ADDRESS _______________________________________________
I certify that any information provided by me is correct and the permit is for my use. I understand that the PERMIT AND PARKING
PRIVILEGES ARE NOT TRANSFERABLE OR ASSIGNABLE, except as provided for in the Regulations. I understand it is my responsibility to read
the University’s Parking Rules and Regulations. I understand that parking on University property is at my risk and that the University assumes
no responsibility in the event of damage and/or theft. I understand I am responsible for all violations issued to the vehicles and/or permit
listed. I will notify the Parking Office within 5 days of any changes that affect my parking eligibility. If I’m an employee, I hereby authorize
the University to deduct from my paycheck those parking fines and late fees not paid after 30 days from the date of the decision of appeal or
30 days from the date of the violation, whichever is later. In addition, I will return the permit to the Parking Office if my status changes.
Signature_______________________________
VEHICLE INFORMATION:
STATE _____ VEHICLE PLATE # ______________ MAKE _________________ MODEL ______________ COLOR ___________
STYLE (circle one): 2 Door
4 Door
Truck
Minivan
SUV
Convertible
_____ Check Enclosed
Each carpool partner must fill out one of these forms. Please return all forms together to:
Parking Services, 147 Perkins Student Center, Newark, DE 19716
Carpool partner(s) names and addresses:
_____________________________________________
_____________________________________________
PERMIT TYPE, CHECK ONE: Prices listed below are September prices per person. Since permit prices are prorated monthly, please visit our
web site to determine price if permit is purchased after Sept. 2015.
*** Undergraduate Carpoolers must live outside the UD perimeter ***
2 members
3+ members (reflects less 10%)
Per person price
Per person price
Gray North Annual (exp. 8/26/16)
_____ $ 208.00
____ $ 124.80
Gray North Academic (exp. 5/28/16)
_____ $ 177.00
____ $ 106.20
Gray East Annual (exp. 8/26/16)
_____ $ 208.00
____ $ 124.80
Gray East Academic (exp. 5/28/16)
_____ $ 177.00
____ $ 106.20
CFA Academic 24 hr (exp. 5/28/16)
_____ $ 303.50
____ $ 182.10
Central Annual – Graduate Students Only (exp. 8/26/16)
_____ $ 267.00
____ $ 160.20
Central Academic – Graduate Students Only (exp. 5/28/16)
_____ $ 227.00
____ $ 136.20
Pearson Annual – Graduate Students Only (exp. 8/26/16)
____ $ 283.50
____ $ 170.10
Garage Annual – Graduate Students Only (exp. 8/26/16)
____ $ 295.00
____ $ 177.00
____ $ 350.00
____ $ 210.00
Circle garage: Perkins Trabant
CFA
Central Gate Annual (34C, 53C) – Graduate Students Only
Circle gate:
34C
53C
(exp. 8/26/16)
When both carpool vehicles are on campus at the same time, a daily scratch off pass must be displayed on the 2nd
vehicle.
Gray permits get gray scratch off passes
CFA Academic permits get red scratch off passes
Central, Annual Garage, Central Gate permits get central scratch off passes
FOR USE BY PARKING OFFICE ONLY: Permit # __________________
Date _________
Initials ________
Rev. 6/15 dp