Do you meet the requirements above?

  • Yes
  • No

Are you a new student who will be required to take the driver training course?

  • Yes
  • No

I am the driver named above. By checking next to the numbered items below, I acknowledge that:

  • I am a licensed driver.
  • If I have received a ticket or citation for traffic violation (other than parking violations) in the past five years, I have explained fully below in the Traffic Violation History box.
  • If I receive a ticket or citation while this authorization is in effect, I will notify the Office of Campus Safety and Security immediately. All fines incurred while using University vehicles are the responsibility of the driver
  • I have never had automobile insurance coverage cancelled or denied because of my driving record.
  • I do not have a medical condition, nor am I taking any medication, which might interfere with my safe operation of a motor vehicle.
  • I agree not to consume any alcoholic beverage or illegal drugs before or during my operation of a vehicle under this application.
  • I understand that Campbellsville University is instructing me to obey all traffic laws.
  • I will report promptly to Physical Plant any safety problem I observe with any vehicle owned or leased by Campbellsville University.
  • I agree not to operate my own vehicle for the University unless it is, to my knowledge, in a good and safe condition, and a copy of my car insurance card is on file with the Office of Campus Safety and Security.
  • I understand that, if approved, I am authorized to operate a vehicle owned or leased by Campbellsville University only for University activities.
  • I will use my seat belt at all times and will instruct my passengers to do the same.

Please check by each box which may apply:

  • CU owned/leased minivan/car only
  • CU owned/leased 15-passenger van/mini-van/car
  • Personal vehicle for CU travel