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.