Disabled Parking Permit Form Disabled Parking Permit Form Form to request Disabled Parking Name* First Last Email* Enter Email Confirm Email Phone*Faculty, Staff or Student*FACULTYSTAFFSTUDENTDisabled Hangtag # or DA License Plate #*The hangtag or license plate MUST be registered to the applicant's name.Expiration Date of DMV received Disabled permit* Date Format: MM slash DD slash YYYY Permit Options* Summer Term (Students only) Fall Semester (Students only) Spring Semester (Students only) Annually (F/S only) Check the permit option which best suits your needs. Permit is valid until the expiration date of the hang-tag or the time period chosen, whichever comes first. The annual permit is valid annually until 5/31, or the expiration date of the DMV received hang-tag or plate. Whichever comes first.Method of PaymentPAYROLL DEDUCTION (Faculty and Staff Only)CREDIT CARDPAYROLL DEDUCTIONPAID BI-WEEKLYPAID MONTHLY - 12 MONTHSPAID MONTHLY - 9 MONTHSNotice for Students When selecting Credit Card, you will receive confirmation from a Transportation Services representative who will assist with the payment portion for the permit. Confirmation for all requests for a Disabled Permit will be provided within 48 business hours.Please check the box* I AGREE TO THE FOLLOWING CONDITIONS Those electing “Payroll Deductions” PLEASE READ AND COMPLETE THE FOLLOWING: I hereby authorize payroll deduction as my method for payment of my parking fee. I understand that if my payroll deduction is taken pre-payroll taxes a) I can still cancel my permit any time to end my payroll deductions; b) there is no refund for previous payroll deductions taken and c) there may be a final payroll deduction amount owed for parking received. I further understand that deductions will be taken regularly until payment in full or cancellation and in accordance with a deduction schedule established by the Parking Department. The schedule will be based on: a) the type of Parking Permit I choose; and b) how often I receive a payroll check. Depending on the date this permit is purchased, the first payroll deduction will be processed in the following pay period. Parking rules and regulations can be found here.Vehicle Information*License PlateState of PlateCar MakeCar Model CommentsOnce the information is verified the applicant will be contacted.