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.