Seattle University Student Carpool Application and Agreement
Please circle the relevant term: Fall Winter Spring Summer / Quarter Semester / Year______
Instructions: To apply for student carpool parking, complete this form and return it to the Parking and Transportation Staff at the Public Safety Office, with dated signatures and attached class schedules of all carpool members. Carpool Members must have reasonably compatible schedules, in the relevant term, to be considered for carpool. Carpool must travel all trips to and from campus together. Each member of the carpool group may only travel to/from campus as a Single Occupant Vehicle one day each week.
Conditions: If this application is approved, one Carpool Permit will be issued. It may be used, exclusively, on any of the registered vehicles listed below. Each vehicle must also be registered with Seattle University Public Safety through seattleu.thepermitstore.com. No vehicle may use a Carpool Permit without carrying at least 2 carpool members to campus. All carpool members must live more than one mile’s distance from campus. Additionally all members must commute from generally the same area or be along a reasonably direct route commuting to campus. Carpools involving members unreasonably far from one another, on opposite sides of campus, or less than one mile from campus do not serve the purposes of this permit and will not be approved. Additionally, any unpaid parking citations, or carpool members having other SU parking or transportation products, will result in disqualification of the carpool application. All Carpool Members must sign below, certifying that they have read and will abide the terms of this document. All members of this Carpool Group must be currently enrolled students.
Carpool Leader, Name: SU Email: SU ID:
Phone Number: ( ) - Street Address: ______
City: State: Zip Code: ______
Vehicle Plate #/State: / Make: Model: Color:
Carpool Leader’s Duties: The Carpool Leader is responsible for coordinating and purchasing this permit under the Carpool Leader’s student information. The Carpool Leader will be the primary point of contact for Public Safety.
2nd Carpool Member, Name: SU Email: SU ID:
Phone Number: ( ) - Street Address: ______
City: State: Zip Code: ______
Vehicle Plate #/State: / Make: Model: Color:
3rd Carpool Member, Name: SU Email: SU ID:
Phone Number: ( ) - Street Address: ______
City: State: Zip Code: ______
Vehicle Plate #/State: / Make: Model: Color:
4th Carpool Member, Name: SU Email: SU ID:
Phone Number: ( ) - Street Address: ______
City: State: Zip Code: ______
Vehicle Plate #/State: / Make: Model: Color:
Certifying Statement: I do not currently have any other Seattle University-sponsored parking or transportation products. I have read, understand, and will follow the Parking and Transportation Regulations at seattleu.edu/transportation/parking/carpool. I understand how to use this pass. I acknowledge that improper use of this pass may subject me to the loss of parking privileges or other consequences. I have provided true and accurate information to the Department of Public Safety.
Carpool Leader’s Signature: Date:
2nd Carpool Member’s Signature: Date:
3rd Carpool Member’s Signature: Date:
4th Carpool Member’s Signature: Date:
For Office Use: Enrollment Verified Leader, 2nd, 3rd, 4th; Copy of Signed Form Given to Carpool Leader ; Desk Initials____.
Follow-up: Approved (affected date)__/__/____ Initials:____ Denied (reason)______.
Entered into Database (Initials)_____; iParq Updted (Initials)_____; Carpool Leader notified(date) __/__/____ Initials____.