Request for Parking Fee Exemption

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Name & ID

Your Name

Your Email Address

Employee ID

Reason for Request

The parking fee pays for the cost of construction, improvements, and maintenance of the parking lot and access to the College's entrances, sidewalks, and roadways, including lighting and snow removal.

An exemption may be granted for the mandatory parking fees for the reasons indicated below. Please check the box for the reason that applies to you. Please note: Submit a new request each semester unless the reason is a full-year sabbatical.

Reason for Request

Please check the reason that applies to you.

I teach on-line classes only and do not have an office space on campus for the Fall 2017 Semester.

I am on approved sabbatical for Fall 2017 and I will not utilize parking and security services for the duration of my sabatical.

I am on an extended medical leave (please add your leave dates below).

Medical Leave From...

Medical Leave To...

Signature

I understand this information is subject to verification by the college. I am obligated to notify the college if my parking fee exemption status changes. If I violate this agreement, the exemption will be revoked and disciplinary action may be taken.

Applicant's Signature

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