Print Form
Student Parking Registration Form
Last Name
First Name
Class Standing:
First Year
First Year Student Exception
(documentation required):
Messiah ID #
Sophomore
Age 21 or Older
FY17
Junior
Medical Need
Semester:
Full Year
Fall Only
Residency:
Resident
Commuter
Job
Senior
Commuter
Graduate
Home > 250 Miles Away
Spring Only
Home Address
Address
City
State
Country
Cell Phone #
Zip Code
Messiah Address
Building
Section
Room #
Campus Mail Box #
Driver & Vehicle Info
Driver's License Number
State
Insurance Company Name
Model Year
Color
Insurance Policy #
Insurance Policy Owner Name
Make
Model
License Plate #
State
Notes
Please return your completed form to the Falcon Exchange located at Eisenhower 243.
Permit #
Office Use Only:
Lot
Date Issued
Temp Only
Vehicle Disabled
Date Expires
Permanent Permit Needed
Other
Fee
Employment Need
Issued by
Medical Need
This form is required to be updated annually. Last update by Bryan Stout as of November 8, 2016