EmailMe Form - Student Vehicle Registration Form 2023-24

Student Vehicle Registration Form 2023-24

Please fill out form completely.

Resident students parking passes will be mailed to campus address and commuter students passes will be mailed to address you request listed in Section III.

You will be required to upload the vehicle registration listed below and driver's license.

Resident Students Must Complete Section I, II, IV, V and VI
Commuter Students Must Complete Section I, III, IV, V and VI
Master Program PA Students Must Complete Section I, III, IV, V and VI

Section I
Date Time *
MM / DD / YYYY
Name *
First Middle Last
Student ID # *
Email
Section II
Resident Students Only
Select one:
Fairview Suites
Campus Village
Smith Hall
Room #
Total credit hours earned:
Are you a Resident Assistant? (Check appropriate box)
Yes
No
Now continue to section IV
Section III
Checkbox
Commuter Students (outside parking perimeter)
Master Program PA Students (outside parking perimeter)
Home Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Address Parking Pass should be mailed to (if different from Home Address)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Section IV
Everyone must complete.
Student's Mobile Phone *
### - ### - ####
Other Phone # (Optional) *
### - ### - ####
Owner's Information *
First Middle Last
Owner’s Address (displayed on vehicle registration): *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Section V: Vehicle Information
Vehicle Make *
Make of a vehicle is the automaker, which means the company that makes the vehicle. Model is the specific type of vehicle produced by the automaker. For instance, a Camry is a model of Toyota, and a Civic is a model of Honda.
Vehicle Model *
Make of a vehicle is the automaker, which means the company that makes the vehicle. Model is the specific type of vehicle produced by the automaker. For instance, a Camry is a model of Toyota, and a Civic is a model of Honda.
Vehicle Year *
Vehicle Color *
License Plate # *
License Plate State *
Section VI
*Instructions for digital payments are found on the next page after form is submitted.
Fees:
Resident 30 or more earned credits $40.00
Resident 29 or less earned credits $80.00
Commuter living outside parking perimeter $40.00
PA Graduate Program $40.00
Resident Assistants $40.00
Campus Village Students $40.00
Students living inside the parking perimeter $80.00 (Lock Haven City limits within walking distance to main campus) $80.00
Clearfield Student $40.00
Parking Rules and Regulations: *
By checking this box you agree to adhere to the above Rules and Regulations
I agree to abide by the Lock Haven University Parking Rules and Regulations and accept all responsibility for any parking ticket violations that are issued to the above registered vehicle/vehicles and further agree to satisfy all payment of fines and said violations. I also understand that I have 5 business days to request an appeal by completing and submitting an online appeal form. Online forms are available at http://community.lhup.edu/parking. Email completed appeal form to Public_Safety@lockhaven.edu.
Please Upload Picture or Scanned Copy of your Vehicle Registration.
Please Upload Picture or Scanned Copy of your Driver’s License.

Section I

Section II

Section III

Section IV

Section V: Vehicle Information

Section VI