Rideshare Application

If you have any questions or would like more information please contact the Rideshare Etc. Program.

(* indicates required fields)

Commuter Name
First Name: *
Middle Initial:
Last Name: *
Home Address (Home information will be kept confidential and will be used only for ride matching purposes.)
Address: *
Apt. #:
City: *
State:
Zip: *
Nearest Intersection:	and
Contact Information Two of three phone numbers required with area code *
Home Phone:
Cell Phone:
Work Phone:
Email Address:
I would like other commuters to contact me by (check all that apply): Cell Phone Work Phone Email
Employer/Work/School Destination Address
Company Name: *
Address: *
Suite/Department:
City: *
State:
Zip: *
Nearest Intersection:	and
Mailing Address (Please provide your mailing address if different from above. This includes post office boxes.)
Address:
Apt. #:
City:
State:
Zip:
Commuter Preference
Work/School Hours: *	to
Are your work/school times flexible?	Yes No
Minutes of flexibility:	minutes variance in start time minutes variance in end time
Match Preferences
Carpool Interest: Driver Rider Either Vanpool Interest: Driver Rider Either Bike Buddy Interest: Novice Experienced Either I prefer to be matched with non-smokers Yes No
I am interested in:
Carpool	Yes No
Vanpool	Yes No
Park and Ride Lot info	Yes No
Transit	Yes No
Bicycle	Yes No
I have a vehicle	Yes No