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Western Parking Services: Graduate Students Permit Application Form
University Parking Permit Application Form for
Graduate Students

Statement of Agreement

Do you accept the Statement of Agreement as the terms and conditions of this parking permit?
*I accept I DO NOT accept

Account Information

Please enter the following data to update/setup your parking account.
Your Status is:
* Graduate Student
Western email address (for example, jdoe@uwo.ca)*:
Surname*:
Firstname*:
Initial:
Employee/Student Number*:
Local Address Information
Local Address:
City:
Province/State:
Postal Code:
Phone Number:
Home Address Information
Home Address*:
City*:
Province/State*:
Postal Code*:
Country*:
Home Phone Number*:

Vehicle Information

Vehicle 1* Vehicle 2 Vehicle 3
License Plate*: License Plate: License Plate:
Province/State*: Province/State: Province/State:
Vehicle Make*: Vehicle Make: Vehicle Make:
Vehicle Model*: Vehicle Model: Vehicle Model:
Vehicle Colour*: Vehicle Colour: Vehicle Colour:
Vehicle Type*: Vehicle Type: Vehicle Type:

Type of Permit Requested*

Please choose the type of permit according to your needs.
Please refer to Campus Parking Map for more information on names and locations of green lots.


I have the flexibility to park in any Non-Reserved parking space in any green lots. Please issue me an economy Non-Reserved permit so that I may park wherever there is space in one of the green lots. I understand that I am not guaranteed a space in my preferred lot every day and will park in other green lots as space is available (changes daily).

Rate for Green Lot non-reserved is $31.6 per month from September, 2013 to August, 2014.


Transponder Information

All permit holders require a transponder. A $30.00 refundable deposit will be added to the cost of your permit.

Start and End Date of Permit Requested
Please indicate start and end dates.*
Start Date of Permit:
End Date of Permit:

Special Parking Arrangements

Disabled Permit Information
Ministry of Transportation Disability Permit Number:

Expiry Date:
Motorcycle Permit
Motorcycle Permit Required Motorcycle Permit Not Required



NOTE: All outstanding violations (if any) must be paid before a new permit is issued.
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Western Parking and Visitor Services is proud to be a member of the:
Ontario Campus Parking Assoc., Canadian Parking Assoc., International Parking Institute

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