Dashboard Pass Application/Authorization Form
This form is used to request authorization to purchase one or more departmental Dashboard Passes (“Pass”). The Pass is available for use by
employees who, based on job responsibilities/function, must park in locations which are distant from their assigned lot for extended periods of time
beyond what a Blue or Red permit allows. Eligibility for a Pass is based on justified departmental business need, rather than individual convenience
e.g., the Pass is not intended to make attendance at meetings across the campus more convenient. Individuals who are eligible to purchase an “X
Permit” may not use a Pass.
The Pass, valid only when displayed with the employee’s Red or Blue permit, authorizes the employee to park in a Red or Blue lot other than the
permit’s assigned lot for an indefinite period of time. Individuals with Blue permits may not park in Red permit lots, even with the Pass. The Pass is
NOT valid in Service Vehicle spaces. All other privileges and restrictions associated with Red or Blue permits are applicable when using the Pass.
The Pass is not specifically assigned to an individual employee; consequently, departments may purchase one Pass to be used by multiple eligible
employees, or departments may purchase multiple Passes. The department is charged an annual fee of $288 for each Pass issued.
Date
Prepared:
Department:
Prepared by
(Print Name):
Extension:
List Name(s) of Employees Eligible for Pass (If space for more than three names is required, attach Addendum to Dashboard Pass Application/Authorization form.)
1
Last Name:
3
Title Code:
Title:
First Name:
Title Code:
Title:
First Name:
Title Code:
Title:
Brief statement why
duties require Pass use:
Last Name:
2
First Name:
Brief statement why
duties require Pass use:
Last Name:
Brief statement why
duties require Pass use:
Total Number of Dashboard Passes Requested:
FAU to Recharge:
Signature of Department Head or Chair:

Signature of Vice Chancellor FBO:
Approved

Denied
To be completed by TAPS
Date Pass(es) Issued:
Retention: Two-years after printed permit expiration date
Total Amount Recharged:
Completed by (Initial):
Last Revision: Oct 24, 2011
Dashboard Pass Application/Authorization Form
Addendum to Dashboard Pass Application
Department:
Date
Prepared:
Prepared by
(Print Name):
Extension:
List Name(s) of Employees Eligible for Pass (If space for more than three names is required, attach Addendum to Dashboard Pass Application/Authorization form.)
4
Last Name:
6
7
8
Title Code:
Title:
First Name:
Title Code:
Title:
First Name:
Title Code:
Title:
First Name:
Title Code:
Title:
First Name:
Title Code:
Title:
Brief statement why
duties require Pass use:
Last Name:
5
First Name:
Brief statement why
duties require Pass use:
Last Name:
Brief statement why
duties require Pass use:
Last Name:
Brief statement why
duties require Pass use:
Last Name:
Brief statement why
duties require Pass use:
Retention: Two-years after printed permit expiration date
Last Revision: Oct 24, 2011