Parking Permit, Building Access & Emergency Contact

Attn: Security

200 University Parkway

Yakima WA 98901

Phone: 509-249-7727

E-Mail: security@pnwu.edu
Parking Permit, Building Access & Emergency Contact

Completing this form will enable building access, emergency notifications, and register your vehicle with Campus Security.
Full Name:*

First NameMiddle NameLast Name
Request for:*

PNWU COM StudentPNWU MAMS StudentPNWU SOPT StudentPNWU SOT StudentPNWU StaffPNWU FacultyPNWU Board MemberPNWU VolunteerWSU Nursing StudentWSU Pharmacy StudentWSU CON StaffWSU CON FacultyWSU CPPS StaffWSU CPPS FacultyVendor
Student Class:

PNWU MAMS 2024PNWU COM 2024PNWU COM 2025PNWU COM 2026PNWU COM 2027PNWU SOPT 2025PNWU SOPT 2026PNWU SOT 2025WSU Pharmacy 2024WSU Pharmacy 2025WSU Pharmacy 2026WSU Pharmacy 2027WSU Nursing Fall 2023WSU Nursing Spring 2024WSU Nursing Fall 2024WSU Nursing Spring 2025N/A
E-mail:*
Primary Phone (mobile phone for campus emergency notifications):*

Area CodePhone Number
Local Address:*

Street Address

Street Address Line 2

CityState / Province (e.g. WA)

Postal / Zip CodeCountry
Will you have a vehicle on campus?*

YesNo
Vehicle #1: Information
Make:*
Model:*
Color:*
License Plate Number:*
State:*
Do you have another vehicle that requires a parking permit?*

YesNo
Vehicle #2: Information
Make:
Model:
Color:
License Plate Number:
State:
Signature

My typed signature is my symbol and intent of authentication where I willingly signed, understand, and adopt this document.
Name:*

First NameLast Name
Signature Date:*

MonthDayYear
Should be Empty:

Parking Permit, Building Access & Emergency Contact

Vehicle #1: Information

Vehicle #2: Information

Signature