CAVPOOL: 2-4 Riders Application

Thank you for your interest in the CavPool program. The member of the carpool with the most desirable permit that all members of the carpool would like to share will be considered the Primary Rider of the group and should fill out the following online application for the group. TDM:  Transportation Demand Management

How Many Total U.Va Riders in Your Cavpool?

Primary CavPool Contact:

First Name:
Last Name:
U.Va Affliation:
Department:
Work Location:
Shift (Check all that apply): Days   Nights   Weekends   Rotating Schedule
U.Va E-Mail Address:
Home Mailing Address (Your Information Packet Will Be Mailed to This Address)
Street Address: (Include Apartment/Suite)
City:
State:
Zip Code:
Current Permit:
NOTE: The Primary Rider's permit will be used as the preferred parking assignment permit that the CavPool group will share if an alternate premium permit is not selected (see below).
Desired Occasional Parking Permit Location:
   

Second Rider:

First Name:
Last Name:
U.Va Affliation:
Department:
Work Location:
Shift (Check all that apply): Days   Nights   Weekends   Rotating Schedule
U.Va E-Mail Address:
Home Mailing Address (Your Information Packet Will Be Mailed to This Address)
Street Address: (Include Apartment/Suite)
City:
State:
Zip Code:
Current Permit:
Desired Occasional Parking Permit Location:
   

Third Rider:

First Name:
Last Name:
U.Va Affliation:
Department:
Work Location:
Shift (Check all that apply): Days   Nights   Weekends   Rotating Schedule
U.Va E-Mail Address:
Home Mailing Address (Your Information Packet Will Be Mailed to This Address)
Street Address: (Include Apartment/Suite)
City:
State:
Zip Code:
Current Permit:
Desired Occasional Parking Permit Location:
   

Fourth Rider:

First Name:
Last Name:
U.Va Affliation:
Department:
Work Location:
Shift (Check all that apply): Days   Nights   Weekends   Rotating Schedule
U.Va E-Mail Address:
Home Mailing Address (Your Information Packet Will Be Mailed to This Address)
Street Address: (Include Apartment/Suite)
City:
State:
Zip Code:
Current Permit:
Desired Occasional Parking Permit Location:
   

What Permit Would Your Group Like to Share: