California College of ASU Student Parking Reimbursement

Please complete the form below to enroll in the Parking Reimbursement Program. At this time, reimbursements are only available by direct deposit. Reimbursements will be processed every four weeks, with the funds crediting the given account in the fifth week. You must be in good academic and financial standing with the college to be eligible for the reimbursements.

You only need to opt in for this program once. Reimbursements will be processed for each student that posts attendance for their on-ground course at the Herald Examiner Building. Online, remote, and individual class modality changes will not be eligible for reimbursements. The maximum allowed reimbursement is $10.00 per day.

By opting into the California College of ASU Parking Reimbursement Program, I am not eligible to participate in the U-Pass Program.

First Name: *

Last Name: *

Last Four SSN: *International students use 0000* *

Home Address: *

City: *

State: *

Zip Code: *

Email Address: *

Estimated Daily Milege To/From School: *

Please provide proof of California residency (lease, utility bill, etc.): *

Direct Deposit Information

Name on Account: *

Bank Name: *

Checking or Savings: *

Checking Account

Savings Account

Account Number: *

Routing Number: *

Confirm Account Number: *

Confirm Routing Number: *

Do the account numbers and routing numbers above match? *

Yes

I authorize California College of ASU (the college) to initiate credit entries to my checking or savings account shown above for parking expenses. I also authorize the college to initiate debit entries to this account solely to adjust or correct an error resulting from a deposit or credit entry made under this authorization. This authorization is to remain in full force and effect until the college has received written notification of its termination in such a manner as to afford the college a reasonable opportunity to act on it. I also agree to notify the Business Office of any bank or account change relevant to this authorization. The college is not responsible for banking errors or bank fees resulting from incorrect information.

By signing below, I understand that I am opting into the California College of ASU parking reimbursement program. I also understand that all reimbursements will be processed via direct deposit into the above-mentioned account. By opting into the California College of ASU Parking Reimbursement Program, I am not eligible to participate in the U-Pass Program.: *

clear