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Applicant Information
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Vehicle Information
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Declaration

Application for Staff Car Parking Permit Tier 2b – Temporary Health Condition & Mobility Difficulty

Step 1 of 3

Required fields are marked with an asterisk (*).

This form is for staff including associate staff members and contract services staff who have a temporary health condition and mobility difficulty. Please complete the details below.

Applicant Information

Full Name *

Email Address *

Faculty/Department *

Staff Number *

Contact Telephone Number *

Home Campus *

Belfast
Coleraine
Jordanstown
Derry~Londonderry

Please indicate one of the following *

Option 1 - A recommendation for a temporary car parking permit has been provided by the Occupational Health Department as part of the University’s ‘Return to Work’/ referral process.
Option 2 - I require a referral to a health professional for an independent assessment.(A member of the Car Parking Team will be in touch to arrange an appointment for you)

Line Manager/Head of School/Department Name This is required if you have selected Option 1 above.

Line Manager/Head of School/Department Email This is required if you have selected Option 1 above.

Application for Staff Car Parking Permit Tier 2b – Temporary Health Condition & Mobility Difficulty

Application for Staff Car Parking Permit Tier 2b – Temporary Health Condition & Mobility Difficulty

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