Learner's Permit Pass Application

This form must be completed to request a Learner's Permit pass. The pass must be displayed in the dash area to gain access to Student Parking.

Parents should drive to the far end of the student parking lot and park in a space to allow the switching of drivers.

Student ID Number
Student Name Student Name First Last
Upload a picture of Learner's Permit

Attach Files
Expiration Date of Learner's Permit Expiration Date of Learner's Permit / MM / DD YYYY
The Learner's Permit pass must be returned when the learner's permit expires.

The Learner's Permit pass must be returned when the learner's permit expires. I understand and agree to return the Learner's Permit pass once my learner's permit has expired.
Parent Name Parent Name First Last
Make (i.e. Ford, Toyota, etc.)
Model (i.e. Explorer, Camry, etc.)
Vehicle Color
Licence Plate
Upload a picture of Vehicle Insurance

Attach Files