Middlebury

 

Medical & ADA Permits

This page is to be used by Health Services, ADA Office, & Human Resources Staff members to notify Public Safety that specialty parking permits needs to be issued.  The form can also be used to notify DPS that a student's card needs ADA Access privileges.

Please view the right sidebar to see descriptions and limitations of individual permit types to ensure that the correct permit is assigned.  Please note which permits can be issued by your respective department.

In order to complete the form, you will need the recipient's ID number, full name, and email address.  You will also need to specify the length of time the person needs to permit.  

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The request is sent to the Department of Public Safety.  A copy of this request will be sent to:

  • The department selected below (submitting the request)
  • The staff member submitting the request
  • The individual needing parking accommodation (Note:  the individual's e-mail address must be entered)
Submitted By:

Will receive a copy of this request by e-mail to keep on file.

Permit Information

If included, the recipient will receive a copy of this notification.

Select the best option from the list. Please use the Sidebar for Reference information.

Selecting "Auto Opening Doors Needed" will authorize the user to obtain ADA access in specified locations (see ADA sidebar). After ADA access is added by public safety, ADA doors will automatically open when using an ID Card if access is authorized.

Notes/Comments only necessary if an area has limited or no handicapped parking available.