Petition for New Student Parking on Campus General Information: For the purpose of this form, “New Student” is defined as a first-time California Maritime Academy student. Effective Fall 2008, all incoming students are restricted from purchasing a campus vehicle parking permit. This form may be used by new students with a compelling need for a campus parking permit to request special consideration. Please include all pertinent information that you think will be helpful in supporting your petition, and attach supporting documents to this form when submitted. The petition will be reviewed by the Chief of Police, Director of Public Safety, or appropriate designee(s). Petitions are reviewed on a case-by-case basis. Questions regarding the petition process may be directed to the Police & Public Safety Office at (707) 6541179. If the petition is sent separately, please send directly to Police & Public Safety Office, 200 Maritime Academy Drive, Vallejo, CA 94590. First Priority will be given to requests received before June 1, 2012.
Name Last
First
Driver’s License #
M.I.
State
Home Address Street City
Home Phone # (
State
)
-
Zip
Cell Phone # (
Your Reason for Petition:
)
-
US Veteran returning to School
Approved for Off-Campus Living Date ________________
Student with Disability DMV Placard # ______________
Pending Approval for Off-Campus Housing Submission Date _________________
Victim of Violent Crime City ____________________ Case # __________________
Medical
Other
(Specify below)
Please explain. Use additional sheets if necessary.
I, the undersigned, certify that to the best of my knowledge and belief, the information stated above is true and accurate.
Petitioner’s Signature
Date For Official Use Only
Approved
Not Approved
Roseann Richard, Ed. D. Chief of Police, Director of Public Safety 45
Date