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 Name
Middle Name
Last Name
Request for:
*
PNWU COM Student
PNWU MAMS Student
PNWU SOPT Student
PNWU SOT Student
PNWU Staff
PNWU Faculty
PNWU Board Member
PNWU Volunteer
WSU Nursing Student
WSU Pharmacy Student
WSU CON Staff
WSU CON Faculty
WSU CPPS Staff
WSU CPPS Faculty
Vendor
Other
Student Class:
PNWU MAMS 2024
PNWU COM 2024
PNWU COM 2025
PNWU COM 2026
PNWU COM 2027
PNWU SOPT 2025
PNWU SOPT 2026
PNWU SOT 2025
WSU Pharmacy 2024
WSU Pharmacy 2025
WSU Pharmacy 2026
WSU Pharmacy 2027
WSU Nursing Fall 2023
WSU Nursing Spring 2024
WSU Nursing Fall 2024
WSU Nursing Spring 2025
N/A
E-mail:
*
Primary Phone (mobile phone for campus emergency notifications):
*
-
Area Code
Phone Number
Local Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Will you have a vehicle on campus?
*
Yes
No
Vehicle #1: Information
Make:
*
Model:
*
Color:
*
License Plate Number:
*
State
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Do you have another vehicle that requires a parking permit?
*
Yes
No
Vehicle #2: Information
Make:
Model:
Color:
License Plate Number:
State
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
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:
*
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Month
-
Day
Year
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