University of California Santa Cruz
Transportation and Parking Services
1156 High St., Santa Cruz, CA 95064

2019 - 2020 Retiree Parking Permit Application
Applicant Information
Last Name
First Name
Middle Initial

Residential Address

Employment Status
Permit and Bus Pass Selection
Choose one of the following complementary options:

Free SCMTD Bus Pass

I would like to receive a Metro (SCMTD) Bus Pass.


Free Motorcycle Permit

Free Motorcycle permit. Not valid in metered spaces.


Free A Parking Permit

Good for close in parking in A spaces, not including metered spaces.

Disability-Related Parking Needs
Select one of the following if applicable:
I have a DMV Placard or plates that I will display with my UCSC Retiree Parking Permit to park in ADA spaces (or other non-reserved spaces) on campus.

I do not have a DMV Placard or plates but need closer parking for medical reasons. 
I am submitting the required authorization from a medical practitioner, the Disability Resource Center, or the Health Center, confirming my need for disability-related parking in Medical spaces. I understand that I will not be allowed to park in ADA spaces.

Delivery Options
Vehicle Information
Enter your license plate number.
If applying for programs only (such as a Metro Bus Pass) enter 123456 in the Vehicle 1 field.
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
My signature, whether in writing or transmitted electronically, authorizes the issuance of the above permit(s) and program(s). I have provided accurate information on the application and will abide by all parking and program policies.
Signature Date
Comments and Submission