Apply for a parking permit

Personal Details

*Surname:

*Forename:

*Student Registration No:

Course title:

*UCLan email address:

*Contact phone number:

Term Time Address

*Line 1:

*Line 2:

Line 3:

Line 4:

*Postcode:

Permit Eligibility

*How are you eligible for a permit?

*Are you car sharing?

Permit to be issued under 'Special Conditions' (as stated in the University Student Eligibility Criteria)

Car Sharing - Additional Person Details

Important: If choosing a car share permit, all car sharing applications will be registered on the UCLan car share database - www.sharewheels.co.uk

Please check this box if you do not want your name included on this database

Surname:
How are they eligible for a permit?

Forename:

Student Number:

Permit Requirements

*Campus

*Please select one of the following requirements
(please note that if you cannot select a day, parking permits are no longer available for this day)

Permit required for set days

Mon Tue Wed Thu Fri

I don't need a permit for the times I'm on placement

Nursing permit
(total number of days)

Please note: you will need to provide your placement timetable as proof.

I only need a short term permit - Valid on indicated dates only

From:

To:

I don't have set days - You will need written authorisation/details from your tutor

Vehicle Details

Make:

Model:

*Registration no:

Vehicle 2 Details

Make:

Model:

Registration no:

Vehicle 3 Details

Make:

Model:

Registration no:

Declaration *

I confirm the following statements:
I have read, understand and accept the current Car Parking Regulations before applying.
The information I have given on this form is correct.
I understand that giving false information can amount to deception in obtaining services and may give rise to legal liability.
I accept the terms and conditions of the university's car parking policy and procedures.

Apply for a parking permit

Student Support

Apply for a parking permit

Application - Semester 3, 2018-19 Academic Year Only

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