| Basic Contact Information |
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| Local Address (Dorm, Apartment, Off-campus) |
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| Vehicle Information |
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Commuter Employee
On-campus Resident |
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Submitting this form signifies that I agree to abide by Clarkson University Motor Vehicle Regulations, all state laws and ordinances of the village of Potsdam pursuant to the operation of this/these vehicle(s). Misuse of the privilege to operate a motor vehicle on campus may result in revocation of this authorization and any other sanction warranted. I also agree to notify Campus Safety & Security immediately of any change(s) in vehicle or license plate information.
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