Parking Permit & Emergency Contact

Attn: Security

200 University Parkway

Yakima WA 98901

Phone: 509-249-7727

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

Completing this form will enable emergency notification and register your vehicle with Campus Security.
Full Name:*

First NameMiddle NameLast Name
Request for:*

COM, StudentMAMS, StudentSOPT, StudentSOT, StudentPNWU StaffPNWU FacultyPNWU Board MemberPNWU VolunteerWSU CON, StudentWSU CON, StaffWSU CON, FacultyWSU CPPS, StudentWSU CPPS, StaffWSU CPPS, FacultyOther
Student Class:

PNWU MAMS 2025PNWU COM 2025PNWU COM 2026PNWU COM 2027PNWU COM 2028PNWU SOPT 2025PNWU SOPT 2026PNWU SOPT 2027PNWU SOT 2025PNWU SOT 2026WSU Pharmacy 2026WSU Pharmacy 2027WSU Pharmacy 2028WSU Pharmacy 2029WSU Nursing Spring 2026WSU Nursing Fall 2026WSU Nursing Spring 2027WSU Nursing Fall 2027N/A
E-mail:*
example@example.com
Primary Phone (mobile phone for campus emergency notifications):*
Format: (000) 000-0000.
Local Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Will you have a vehicle on campus?*

YesNo
Vehicle #1: Information
Make:*
Model:*
Color:*
License Plate Number:*
State*

Street Address

Street Address Line 2

City

Zip Code
Do you have another vehicle that requires a parking permit?*

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

Street Address

Street Address Line 2

City

Zip Code
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 & Emergency Contact

Vehicle #1: Information

Vehicle #2: Information

Signature