Associate Parking Request

If this Is a Medical Emergency, please dial 911.

Associate First Name Associate Last Name Department Position Are you replacing a vehicle? Yes No If yes, Make, Model, Year and License # of old Vehicle:

Vehicle Information

Make (i.e. Ford) Model (i.e. Explorer) Year Vehicle License Plate Number State of Issuance Color Permit Number (To be assigned by security - leave blank)

2nd Vehicle Information

2nd Vehicle Make 2nd Vehicle Model (i.e. Explorer) 2nd Vehicle Year 2nd Vehicle License Plate Number 2nd Vehicle State of Issuance 2nd Vehicle Color 2nd Vehicle Permit Number (To be assigned by security - leave blank)

3rd Vehicle Information

3rd Vehicle Make (i.e. Ford) 3rd Vehicle Model (i.e. Explorer) 3rd Vehicle Year 3rd Vehicle License Plate Number 3rd Vehicle State of Issuance 3rd Vehicle Color 3rd Permit Number (To be assigned by security - leave blank)

By checking the below box I agree to operate my vehicle(s) in a safe manner at all times and in accordance with the Louisiana traffic laws and acknowledge my vehicle(s) must be located in the designated Associate Parking Area at either campus.

I Agree

Your Health

Care Access

CONDITIONS & TREATMENTS

Associate Parking Request

Vehicle Information

2nd Vehicle Information

3rd Vehicle Information