University of California Santa Cruz
Transportation and Parking Services
1156 High St., Santa Cruz, CA 95064

2017 - 2018 Retiree Parking Permit Application
Applicant Information
Last Name
First Name
Middle Initial

Residential Address
City
ZIP

Employment Status
Email
Phone
Permit and Bus Pass Selection
Choose one of the following complementary options:

Free SCMTD Bus Pass

I would like to receive a Metro (SCMTD) Bus Pass.

 

Free Motorcycle Permit

Free Motorcycle permit. Not valid in metered spaces.

 

Free A Parking Permit

Good for close in parking in A spaces, not including metered spaces.

Disability-Related Parking Needs
 
Select one of the following if applicable:
I have a DMV Placard or plates that I will display with my UCSC Retiree Parking Permit to park in ADA spaces (or other non-reserved spaces) on campus.

I do not have a DMV Placard or plates but need closer parking for medical reasons. 
I am submitting the required authorization from a medical practitioner, the Disability Resource Center, or the Health Center, confirming my need for disability-related parking in Medical spaces. I understand that I will not be allowed to park in ADA spaces.

Delivery Options
Vehicle Information
Enter your license plate number.
If applying for programs only (such as a Metro Bus Pass) enter 123456 in the Vehicle 1 field.
  
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Authorization
My signature, whether in writing or transmitted electronically, authorizes the issuance of the above permit(s) and program(s). I have provided accurate information on the application and will abide by all parking and program policies.
Signature
Signature Date
Comments and Submission
Comments