Visitor Parking Waiver Form

If you are a visitor to our campus and you received a parking citation, please fill out and submit this form.

Last Name: *

First Name: *

Visiting: *

Date of visit: *

Month

Day

Year

Citation Number: *

Driver's License Number: *

State: *

Address: *

City: *

State: *

Zip Code: *

Phone: *

Vehicle Year: *

Vehicle Make: *

Vehicle Model: *

Vehicle Color: *

License Plate: *

State: *

I hereby certify that I was a visitor on the ULM Campus and request a waiver of this citation. I further certify that I am not a student enrolled in classes, or an employee of ULM. *

Yes

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

  _      __     __  _     _   _   _            
 | |__   \ \   / / | |_  | | | | (_) __      __
 | '_ \   \ \ / /  | __| | | | | | | \ \ /\ / /
 | |_) |   \ V /   | |_  | |_| | | |  \ V  V / 
 |_.__/     \_/     \__|  \___/  |_|   \_/\_/

Enter the code above *

Enter the code depicted in ASCII art style.