8

University of Wisconsin - Stout

Parking Permit Registration

Continuing Resident Student

Continuing residence hall students may apply for their parking permit by completing and submitting this form.

Please provide the following information:

(Tab between fields. Do not use the enter key.)

First Name
Middle Initial
Last Name
Student ID Number
E-mail Address (Stout only)

2008-2009 Residence Hall Address

Residence Hall
Room Number
Hall Phone (xxx) yyy-zzzz
Cell Phone (xxx) yyy-zzzz

Your Home Address

Street Address
City
State
Zip
Home Phone (xxx) yyy-zzzz

Vehicle Registration Information

Make (e.g. Ford, Honda, etc)
Model (e.g. Taurus, Accord)
License Plate
State of Registration

Additional Vehicles

Make (e.g. Ford, Honda, etc)
Model (e.g. Taurus, Accord)
License Plate
State of Registration
   
Make (e.g. Ford, Honda, etc)
Model (e.g. Taurus, Accord)
License Plate
State of Registration
   

Comments, Questions, Additional Information:

It is important that you review the information on this form and verify for accuracy before you submit the form.