Parking Decal Vehicle Registration

Commuter Resident Employee

Kineo Acadia

Is this an update to a previous record?

Vehicle Information

Plate # (1st Vehicle):

Plate Type: (chickadee, black bear, etc.)

State:

Year, Make, and Model:

Color:

Owner's Name: (If different from the driver)

Driver of Vehicle License #:

Plate # (2nd Vehicle): 

Plate type: (chickadee, black bear, etc.)

State:

Year, Make, and Model:

Color:

Owner's Name: (If different from the driver)

Driver of Vehicle License #:

Decal Holder Information:

EMCC ID# Major:

Last Name:

First Name:

Middle Name:

Address:

City, State, Zip:

Extension or Home Telephone:

E-Mail Address:

 I affirm that the vehicle registration information listed above is accurate. Parking rules and regulations can be found in the online student handbook found here

Signed:

Date:


For Office Use Only
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