SUBMIT COMPLETED FORM TO THE PARKING & TRANSPORTATION SERVICES OFFICE. 601 SOUTH COLLEGE ROAD • WILMINGTON, NC 28403-5914 • 910-962-3178 • WWW.UNCW.EDU/PARKING University of North Carolina Wilmington ϮϬϭϱͲϮϬϭϲFaculty/Staff Carpool Vehicle Registration Form Print Form Information and Rules: Reset Form The Carpool Program requires a minimum of two participants. All participants and all of their vehicles must be registered on the Faculty/Staff Carpool Registration form to be associated with the carpool program. A primary driver must be designated and is responsible for the use of the permit. The primary driver is issued the permit. The permit is then to be displayed in whichever vehicle is parked on campus. Participants may carpool with permanent employees in a different pay range; each individual is charged based on their respective pay range. All participants within a carpool must purchase a parking deck permit to use the parking deck. The parking deck is an optional location and carpoolers may also use faculty/staff lots. The cost of the permit per participant is half of what their permit would be according to their salary tier. In addition to the primary permit, the primary driver will receive 10 scratch off day passes to be distributed between the other participants for use when carpooling is not feasible. Additional scratch off day passes can be purchased for $5 each. Misuse of the carpool program will result in revocation of carpool permit. Example Name Jane C. Doe University ID (850#) 850999999 Department Name Auxiliary Services Department Mailing Code 5914 Campus Phone Number 962-9999 License Plate State NC License Plate Number ABC123 Vehicle Make Ford Vehicle Model Explorer Vehicle Color Space Type & Monthly Cost Black (Select from the chart below) Primary Driver Carpooler #2 Carpooler #3 Carpooler #4 3 Carpoolers Monthly Cost (Annual Cost) $4.05 ($48.60) $8.05 ($96.60) $11.38 ($1ϯϲ͘ϱϲ) $14.44 ($1ϳϯ͘Ϯϴ) $6.13 ($73.56) $10.13 ($121.56) $13.47 ($1ϲϭ͘ϲϰ) $16.52 ($19ϴ.Ϯϰ) 4 Carpoolers Monthly Cost (Annual Cost) $3.04 ($36.48) $6.04 ($72.48) $8.54 ($ϭϬϮ͘ϰϴ) $10.83 ($12ϵ.ϵϲ) $4.60 ($55.20) $7.60 ($91.20) $10.10 ($ϭϮϭ͘ϮϬ) $12.39 ($14ϴ.ϲϴ) Standard Space $12.08 Office Use Only Permit Number Space Type Standard Space Standard Space Standard Space Standard Space Deck Space Deck Space Deck Space Deck Space 1ϲC9999 Salary Tier $25,000.01 - $40,000.00 $40,000.01 - $65,000.00 $65,000.01 - $90,000.00 $90,000.01 - $999,999.00 $25,000.01 - $40,000.00 $40,000.01 - $65,000.00 $65,000.01 - $90,000.00 $90,000.01 - $999,999.00 2 Carpoolers Monthly Cost (Annual Cost) $6.08 ($72.96) $12.08 ($144.96) $17.08 ($ϮϬϰ͘ϵϲ) $21.66 ($25ϵ͘ϵϮͿ $9.20 ($110.40) $15.20 ($182.40) $20.20 ($2ϰϮ͘ϰϬ) $24.79 ($29ϳ.ϰϴ) I, the undersigned, agree to abide by all regulations, ordinances and laws governing the safe and lawful operation and parking of a motor vehicle on the campus of UNCW including payment of citations and fees. Note: Registration is not complete until the parking permit is displayed in accordance with prescribed regulations. Signatures: Primary Driver: ___________________________Date: __________ Carpooler #3: ___________________________Date: __________ Carpooler #2: ___________________________Date: __________ Carpooler #4: ___________________________Date: __________ Rev. 08/2015