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 /  |  _ <    | | | |_  | |_| |
 |_|   \_/   |_| \_\  _/ |  \__|  \___/ 
                     |__/

Enter the code above *

Enter the code depicted in ASCII art style.