UNIVERSITY
TRANSPORTATION & PARKING SERVICES
SPECIAL
CONSIDERATION
Parking Permit
Registration
Dept. Use ONLY
PERMIT #
Classification:
Pkg. Code:
Date:___/___/___
Initials:
Complete this form and return it to Emorys Parking Office in the Starvine Parking deck on the Clairmont campus.
Email : parking@emory.edu or Fax : 404.727.2673
I. APPLICANT INFORMATION
Full Name:
Last
First
Middle
Emory E-mail address :
Emory ID #
Current deck assignment_____________________
Desired deck assignment_____________________
II. REQUEST
I am requesting priority on the wait list for my first preference for parking for any one or more of the following
reasons. Check one or more boxes and explain fully below.
[ ] WAITLIST ME Please make sure I am on the waitlist to receive __________ deck. I understand that I
am placed on the wait list for the decks I requested. I understand that Parking Services will email me if a
swap out is possible. NOTE: Lowergate South deck is only available for second year or higher graduate,
commuting students. Student must be a senior in the college or in a graduate school to be eligible for Peavine
deck.
[ ] DISTANCE OF COMMUTE I need a parking reassignment due to the length of my commute to Emory, as I
have fully described below.
[ ] ACCESSIBLE ACCOMMODATION I am attaching a copy of my state-issued accessible parking permit and
will direct Emorys Office of Disability Services to contact Parking Services on my behalf.
[ ] INTERNSHIP / JOB My off-campus internship / job hours are immediately after my scheduled class. I am
attaching documentation from my employer.
[ ] DUAL ACCESS My class schedule has timing conflicts and I am requesting dual access for_______________
deck and_________________deck for the reasons detailed below. I am attaching my class schedule, as well.
[ ] FIRST YEAR UNDERGRADUATE EXCEPTION I am a first-year undergraduate seeking one of the Allowed
Exceptions (1.) I commute to campus and public transit is unavailable; (2.) I work 3 or more days/week off campus
and public transit is unavailable; (3.) I have accessibility needs.
[ ] OTHER _________________________________________________________________________________
III. DETAILS OF REQUEST Explain fully the reason(s) for your request. Use reverse side if needed.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
NOTE: Provide any ancillary documentation to substantiate your request for dual parking access and attach to
this form. DO NOT contact the Parking Office in regard to this request or to its status - you will receive an email
response from Parking Services. Make certain before submitting this request that your contact information is correct.
You are automatically placed on the waitlist for the deck(s) you have requested.
IV. AGREEMENT / SIGNATURE
I confirm by my signature below that the above information is true and correct. I also understand that the same
Rules & Regulations apply to me and to my vehicle regardless of the assigned parking location(s) on Emory
University property.
Applicant
Signature
_______________________________________________________________________________
Name (print)
_________________________________________________________________/____/____/____
Signature
Date (mm/dd/yyyy)
rev 01/2014