Application for Motor Vehicle Permit


Note: All fields are required.

First Name Last Name
Address (home)
City State Zip
Unet ID
Brandeis Address (department, residence or local and mail box or mail-stop number)
Phone (day) E-mail
Cellphone
Status



Vehicle Information

Make Model Year Color
License Plate #    State Expiration

Attention Non Resident Students: “It is unlawful for a nonresident student to fail to file a nonresident driver statement with the police department located in the same city or town as the school or college attended, in accordance with section 3 of chapter 90 of the Massachusetts General Laws. Failure to file such a statement is punishable by a fine to exceed $200.00”

www.mass.gov/rmv/forms20098.pdf

You must come to the parking office in Stoneman to pick up your permit. Please bring your Brandeis ID, vehicle registration and operator's license.

I hereby agree to abide by the rules and regulations governing the use of motor vehicles on this campus. Regulations are available here, or can be picked up at the parking and traffic office.

I agree that Brandeis may use the necessary procedures to enforce these regulations, including booting and towing at owner's expense. Though precautions will be taken, the university will not be responsible for damage incurred to any vehicle.