Vehicle Request Form


Dean's Office Vehicle Request Form

Please fill out the REQUIRED information below. Once your request has been reviewed, you will receive confirmation via email. (You are not guaranteed a vehicle reservation unless you have received notification.)
YOUR NAME: Vehicle Requestor (Person Filling out this form)

Requested Vehicle(s):
Requested Vehicle:
Will you be towing?:

Trip Information:
Vehicle Pickup Date & Time:
Vehicle Drop-off Date & Time:
Trip Destination:
Purpose of Trip:
Department:
Account Number:
Have you Received Department Chair Approval?
Have you turned in a Travel Authorization For this trip?:

Those Attending:
Faculty/Staff Student Sponsor:	If Faculty/Staff is not driving with student.
Attending: (The number of those attending).	Students	Faculty/Staff
Driver Information:
Driver Name:
Driver License #:
Alternate Driver Name:
Alternate Driver License #:

Contact Information:
Faculty/Staff Contact Information:	Office Number: Ex. 812-465-1080	Mobile Number: Ex. 812-465-1080
Faculty/Staff Email Address:
Student Driver Contact Information:	Mobile Number: Ex. 812-465-1080

For extended trips, please provide Emergency Contact Information:
Emergency Contact Name:
Emergency Contact Number:	Ex. 812-465-1080
Please list any pertinent details concerning your trip:

8600 University Boulevard - Evansville, IN 47712-3596 - 812/464-8600