Facilities Forms

Medical Center Remote and Offsite Permit Application

1. Remote Permits are for employees that are working from home and at a Medical Center location where a parking permit is required.
2. Offsite Permits are for employees working at a Medical Center location where a parking permit is required and at locations where a parking permit is not required.

This application is to be filled out by Managers or Supervisors to request Remote or Offsite permits for employees working at a location that requires a parking permit and at one or more locations that do not require a paid parking permit. This permit is not applicable for business meetings and training sessions. A copy of your request will be super_emailed to you.

Manager/Supervisor

Department:

First Name:

Last Name:

Email:

Phone Number:

Requesting Remote/Offsite Permit for

Type of Request

Remote

Offsite

Employee First Name:

Employee Last Name:

Employee Email Address:

Phone Number:

Employee or University ID:

Parking Schedule

Building Location 1:

Hours/Week Parked at Location 1:

Building Location 2:

Hours/Week Parked at Location 2:

Building Location 3:

Hours/Week Parked at Location 3:

Building Location 4:

Hours/Week Parked at Location 4:

*If you have multiple staff with the same schedule, please list their names and employee ID's below.

Comments:

SUBMIT