UC RIVERSIDE TRANSPORTATION & PARKING SERVICES

TRANSPORT & MOBILITY SERVICES 683 Linden Street – Riverside, CA 92521

Phone: 951-827-3872 - Fax: 951-827-4218

TEMPORARY TRANSPORT & MOBILITY SERVICES REQUEST FORM
Duration of service is limited to one week. If additional time will be required to accommodate your need for transport and mobility services contact Student Disability Services administrative office at 951-827-4538.
NAME (Last) SID # / (First) / UCR ID #: / Today’s Date: MM/DD/YYYY
PHONE NUMBER: / (###) XXX-XXX / UCR Web Mail address: / @ucr.edu
Check appropriate box:
Commuter / Student / UCR Housing Student / Faculty / Staff
MO/DAY/YEAR / DAY OF WEEK / PICK-UP TIME / PICK UP FROM / DROP-OFF AT / SPECIAL EQUIPMENT
10/10/2011 / MON / 8:45 AM / Pentland Way / CHASS North -372a / Wheelchair

Pick-up time going to class is 25 minutes before class start time. Note: No same day changes.

COMMENTS / Other Information:

Pick-up time is the time students must be at the pickup location. Students must submit a new schedule if there are additions and/or changes to this schedule. Call 951-827-3872 when rescheduling, canceling and or dropping your rides.

Temporary Transport Request Form Revision Date: 05/18/2011