Vehicle Use Request Form

VEHICLE USE REQUEST FORM
College of Social Sciences and Interdisciplinary Studies

TODAY'S DATE:

NAME:

DEPARTMENT:

DATE OF TRIP:

TIME OF DEPARTURE: TIME OF RETURN:

DESTINATION:

PURPOSE OF TRIP :

INSTRUCTOR(S):

NAME OF DRIVER(S):

MARK ONE: FACULTY STUDENT STAFF

I certify that I have a current, valid California Driver's License; that I am familiar with the contents of the Defensive Driver's Manual, and the CSU Vehicle Manual. I further certify that I have not been issued more than three moving violations or have been responsible for more than three accidents (or any combination of more than three thereof) during the past twelve-month period. As a student driver, I have signed the Volunteer Employee Form required by the University.

DRIVER'S SIGNATURE: DATE:

DEPARTMENT CHAIR'S APPROVAL: DATE:

DEAN'S OFFICE APPROVAL: DATE:

DEAN'S OFFICE USE ONLY:

Date Received: __________ Initials: _____ Approved: _____ Denied: _____

Facility Reserved: ___________ OnTime: _______ Requestor Notified: ________

Notes: _____________________________________________________

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