Retirees Parking Permit Application

Due to COVID-19 precautions this year, permits may not picked up; permits must be ordered online and will be mailed to your home address.

This form is for MSU Retirees only. If you are a student or employee, please visit www.moreheadstate.edu/parking for permit information.

By submitting this form, you agree that this permit is for personal use only. This permit may not be sold or transferred. Any unauthorized or fraudulent use (including family members, current students and faculty/staff) is prohibited. Anyone found in violation of this agreement can/will have their parking privileges permanently revoked.

Name:*
MSU ID #:*
Home Address:*
Phone:*	( ) - Second three digits Last four digits
Email:
Are you currently employed by MSU in any capacity, including part-time or temporarily? If you are currently employed, you may receive a free Employee permit for 20+ years of service.:*	Yes No
Campus Address:
Campus Phone:
Vehicle Make:*
Vehicle Model:*
Vehicle Color:*
Vehicle Year:*
License Plate #:*
State:*
By checking this box, you agree to the terms listed above.:*	I agree.