Request for University Transportation Date:

PRIMARY DRIVER INFORMATION

Driver’s Last Name: Driver’s First Name:

UID:

License #: State Issued: Expiration Date: _____

Department: School of Art Campus Box: 5620 Phone: 438-5621

Driver Status: x Faculty  Graduate Student  Staff  Student  Student Employee  Volunteer

***NOTE: EVERY DRIVER must present actual driver’s license the day of departure.

Contact Completing Form: Contact’s Phone: 438-5619

Account Number: Number of Vehicles Requested: __ __

Departmental Fiscal Agent’s Name: Tony Crowley

Fiscal Agent’s Phone: 438-5621

Select Type of Vehicle: (include number of each type requested)

Economy-Sized Car
Mid-Sized Car
Full-Sized Car / _____
_____
_____ / Minivan Passenger Van / _____
_____ / Pick-Up Truck
Mini-Bus / _____
_____

Vehicle Destination: (City) ______(State) IL (Miles) ______

Pick-Up Date: ______Time: ______.

Return Date: ______Time: ______. 

Number of Passengers: Students Faculty/Staff Other

Reason for Travel:

* The Vehicle Authorization for Special Users Form must be completed and signed for all student and volunteer drivers. In addition, the occupant list must be completed and submitted at the time of receiving vehicle keys. www2.fac.ilstu.edu/fleetreservations/

Driver’s Certification

x I hereby certify that I have a current and valid driver’s license to drive a motor-operated vehicle; and I will comply with all applicable traffic laws and all Illinois State University rules, regulations, and policies and procedures, including the “No Personal Use” provision.

x I have read and comply with Illinois State University Policy 8.1.2 Use of University-Owned Vehicles, including a guarantee of insurance coverage for the authorized trip. www.policy.ilstu.edu/policydocs/owned.htm

Driver’s Signature: Date: ______

Departmental Approval: Date:

(Signature of Fiscal Agent Authorizing Travel)

* Vehicles may also be requested through the computerized reservation system (Mainframe)

* Contact Fleet Reservations at 438-2038 for assistance or questions.

* Please return to 9000 Facilities Management *

This document is available in alternative formats upon request by contacting Barbie Dooley, Facilities Management at 438-2038.