CAL STATE FULLERTON
STUDENT-ATHLETE
AUTOMOBILE INFORMATION

		SPORT

Name		Social Security #	
	Print

1.	Use of Automobile:
Do you have use of, or possession of (regardless of ownership) any automobile or other motorized vehicle during the current academic year?
 Yes      No

If Yes, please complete all of the following:

2.	Description:
Make:  			Model:		
Year:			Color:		
3.	Car license number and state of registration			
4.	Driver’s license number and state 		
5.	Insurance carrier		
6.	Name in which title is registered		
7.	Relationship to you of title holder		
8.	If payments are made, who makes the payments?		
What relationship are they to you?			
9.	Do you have or will you be purchasing a CSF Parking Permit?   Yes    No
10.	Do you anticipate anyone else driving your vehicle on a regular basis?  Yes    No
If Yes, list individuals and their relationship to you.

		
My signature hereby certifies that the above information is truthful and complete to the best of my knowledge.

	Signature of Student-Athlete	Date