5454-E, Student Parking Permit Application – Vehicle Registration and Permission Form

SHAKER HIGH SCHOOL
Latham, New York

Student Operator (Last Name, First Name): ________________________________________________

Homeroom Number: _______ 

School Year (Circle One):  11  12

Home Address: _______________________________________________________________________

Home Telephone Number: _______________________

Year and Make of Vehicle: ________________________________________________

Color: _______________________

Vehicle License Plate Number: _______________________

List all moving violations: _______________________________________________________________________

If currently employed, please complete the following:

Name of Employer: ________________________________________________

Telephone number: _______________________

Address of Employer: _______________________________________________________________________

Name of Manager or Supervisor: ________________________________________________

Reporting Time to Work: _______ P.M.

——————————- DO NOT WRITE BELOW THIS LINE ——————————-

Student Information Verified by: ________________________________________________

Date of Verification: _______ 

Student Parking Permit Number: _______