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.

          _       ____     ____       _         
  _ __   | |__   |___ \   / ___|     | |   __ _ 
 | '_ \  | '_ \    __) | | |      _  | |  / _` |
 | |_) | | |_) |  / __/  | |___  | |_| | | (_| |
 | .__/  |_.__/  |_____|  \____|  \___/   \__,_|
 |_|

Enter the code above *

Enter the code depicted in ASCII art style.