Parking Permit Request

Attn: Security - Brent Perrin

200 University Parkway

Yakima WA 98901

Phone: 509-249-7727

E-Mail: security@pnwu.edu
PNWU Security Processing

Completing this form will enable building access, parking permits, and emergency notifications.
Request for: *

Employee Student Volunteer
Student Class:

Heritage BSN Program Heritage MAMS Program Heritage PA Program PNWU COM 2020 PNWU COM 2021 PNWU COM 2022 PNWU COM 2023 PNWU COM 2024 WSU Pharmacy 2020 WSU Pharmacy 2021 WSU Pharmacy 2022 WSU Pharmacy 2023 WSU Pharmacy 2024 WSU Nursing Spring 2021 WSU Nursing Fall 2021 WSU Nursing Spring 2022 WSU Nursing Fall 2022 Other
Full Name: *

First Name Middle Name Last Name
E-mail: *
Local Address: *

Street Address

Street Address Line 2

City State / Province (e.g. WA)

Postal / Zip Code Country
Primary Phone # (mobile phone for campus emergency notifications): *

Area Code Phone Number
Secondary Phone #:

Area Code Phone Number
Will you have a vehicle on campus? *

Yes No
Vehicle #1: Information
Make: *
Model: *
Color: *
License Plate Number: *
State: *
Do you have a 2nd vehicle that requres a parking permit? *

Yes No
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 Name Last Name
Signature Date: *

Month Day Year
Should be Empty:

PNWU Security Processing