Request for Application Health Sciences Parking

Please fill out the form below and click Next to continue the request process.

Applicant Name Legal First Name Last Name Middle Initial Phone Number Place of Employment UW Hospital and Clinics UW Medical Foundation UW School of Medicine and Public Health UW School of Nursing UW School of Pharmacy University Health Services State Lab of Hygiene Shift you will be working after your training period? 1st Shift 2nd Shift 3rd Shift Start Date - Month, Day, Year MM DD YYYY Do you have any previous WI State employment? No Yes (years from - ) Do you have any previous UWHC employment? No Yes (years from - ) Are you an undergrad student employee? No Yes If you are in a dual pay status (i.e., paid by School of Medicine and Public Health & UW Medical Foundation), please check the appropriate box below: I am not in a dual pay status School of Medicine and Public Health & UWMF Once we have processed your request, you will receive a notification from the Health Sciences Parking Unit Office. Email Address: