REQUEST FOR APPROVAL TO PERMIT STUDENT TO OPERATE A COLLEGE VEHICLE

 
 

NOTE: THIS FORM MUST BE SUBMITED TO THE VEHICLE ASSIGNMENT OFFICE ONE WEEK PRIOR TO THE TRIP DATE.

Name of Supervising Staff Member Making Request:_________________________________

Date(s) of Trip:______________________________

Destination: ________________________________________________________

Purpose of Trip:_____________________________________________________________

_____________________________________________________________

Reason for Use of Student Driver:___________________________________________________________

Student Driver(s) Requested:

A COPY OF THE STUDENT’S DRIVER’S LICENSE
MUST BE ATTACHED TO THIS FORM.

NAME SOCIAL SECURITY NO.
___________________________________________

___________________________________________

___________________________________________

___________________________________________

In accordance with the “Policy on Students Operating College Vehicles,” I request the student(s) listed above be authorized to operate a College Vehicle during the trip indicated.


______________________________
Signature of Supervising Staff Member


_______________________________
Date


______________________________
Signature of Department Chair


_______________________________
Date


______________________________
Signature of Appropriate Dean or VP


_______________________________
Date


______________________________
Approval by Vehicle Assignment Office


_______________________________
Date