Faculty/Staff Vehicle Registration
Contact Information
Last Name
First Name
MI
What are your shift start and stop times?
Building
Email
Phone Number
Department
New Employee Orientation Date
(MM/DD/YYYY)
Work Location:
If you have a state-issued handicap parking placard or registration, please contact
parkingservices@pennstatehealth.psu.edu
for parking accommodations.
Vehicle Information
Vehicle Plate Number
Vehicle Make
Vehicle Model
Vehicle Color
State
Please select...
Pennsylvania
Other
If "Other" is selected, list state here
Authorization Acknowledgement
Download Parking Rules and Regulations
Authorization:
I hereby authorize Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine to deduct any parking fines/fees I incur from my salary at the applicable rate. I have received an electronic copy of the Parking Rules and Regulations and will receive my parking sticker(s) during orientation. I understand that the parking sticker is the property of Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine and must be surrendered upon request.
By typing my name in the field below, I acknowledge that this will serve as my signature. I confirm that I agree to the terms listed above and that the information I have provided is accurate to the best of my knowledge.
Signature
(First name, MI, Last name)
Date
(MM/DD/YYYY)
Questions? Contact
parkingservices@pennstatehealth.psu.edu
Contact Information