NWACC - Parking Form

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NorthWest Arkansas Community College Parking Preferences

All fields are required!

Use the tab key or your mouse to move between fields.
Using 'enter' will submit the form.

Note: All students, faculty, and staff who park in Burns Hall or the Garage are required to have hangtags. Vehicles without hangtags will be ticketed. See Parking Policy for additional information.

This form is for employees ONLY!

First Name:
Middle Initial:
Last Name:
Department:
Employee ID:	(Do not enter your SSN. Employee ID is located on pay check.)
Telephone:	(Format example: 479-619-0000)
Email Address:

Parking Selection (see maps):	12 Months

Faculty/Staff Parking-General Burns Hall Surface Lots	$5.00
Reserved/Numbered Parking
Burns Hall East Lot	$245.00
Burns Hall West Lot	$245.00
Student Center West Lot	$245.00
Garage	$275.00

Yes No	This is a renewal of my current parking selection for this upcoming year.
Yes No	I am a new employee OR this is a change of my parking preferences.

	I authorize payment by payroll deduction. I understand that a one-time deduction of $5.00 will be made for general faculty/staff parking. For reserved/numbered spaces, payroll deductions will be made in 24 installments.
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For questions/comments on this form, please contact Sean Lucero.

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NorthWest Arkansas Community College, Bentonville, AR (479) 636-9222. We also have locations in Washington County and Bella Vista.
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