Van Request Form

Pitzer College has 4 minivans which seat 7 people each, including the driver. The vans may be used in support of Pitzer’s academic programs, for administrative purposes, and for approved student activities.
Programs must provide/arrange for their own driver(s). A list of approved drivers can be made available upon request by emailing transportation@pitzer.edu.
The vans may only be driven by people approved by the Office of Risk Management to drive college vehicles.
People who have not been approved may not drive the vans.
Requests must be submitted no later than 72 hours in advance.
Once the status of the reservation has been confirmed, you will be sent an additional email.
Please note, there is a mileage charge of 75¢ per mile for all van use.
Keys may be checked in at the front desk of the Student Affairs Office in Scott hall between the hours of 8:00 a.m. – 5 p.m. (except during the lunch hour 12:00 – 1:00 p.m.).
Keys must be returned to the drop box located outside of Scott Hall 120 in the key dropbox.

Questions? Email Transportation or call (909) 607-2344

Contact Name / Requestee(Required)

First Last

Contact Email(Required)

Contact Phone(Required)

Group or Organization(Required)

Student Club/Organization(Required)

Academic Department/Class(Required)

Pitzer Office/Department(Required)

Please list the office responsible for managing your account.

Other(Required)

Please enter Club/Organization information

Other(Required)

Please enter Class information

Other(Required)

Please enter Class information

Other(Required)

Please enter Office/Department information

Office Responsible for Account(Required)

Pitzer Staff Supervisor(Required)

Destination Address

Street Address City ZIP Code

Event Type(Required)

Provide a short description

Number of Passengers - Including Driver(s)(Required)

Number of Vans Requsted(Required)

Please enter a number from 1 to 4.

No more than 4 vans are available.

Date(Required)

MM slash DD slash YYYY

Begin Time(Required)

Hours

Minutes

AM/PM

End Time(Required)

Hours

Minutes

AM/PM

Is this a reoccurring request?

Yes

Dates and Times

Please list each date followed by start and end times as a new line.
Example: MM/DD/YY Start HH:MM End HH:MM

Additional Notes

Please include additional instructions or information here. (optional)

Terms and Conditions:

Please read these Terms and Conditions carefully before using the Pitzer Vans. Your access to the Pitzer Vans is conditioned on your acceptance of and compliance with these Terms. These Terms apply to all drivers driving the Pitzer Vans. By accessing or using the Pitzer Vans you agree to be bound by these Terms.

NOTE: All following Terms must be accepted.

Pitzer Vans Program Terms and Conditions

Please note, entering beginning and ending mileage is no longer required as each van is monitored via GPS tracking.(Required)

Please note, entering beginning and ending mileage is no longer required as each van is monitored via GPS tracking.

Only use the Van during your scheduled time frame..(Required)

Only use the Van during your scheduled time frame.

There are multiple sets of keys per van, others will be using the Van before and after your reservation.(Required)

There are multiple sets of keys per van, others will be using the Van before and after your reservation.

Return the Van promptly, others may be waiting to use it.(Required)

Return the Van promptly, others may be waiting to use it.

Return the Van key to the drop box outside of Scott Hall 120(Required)

Return the Van key to the drop box outside of Scott Hall 120

Inside the Van glove box is the Insurance Card, Registration, and Best Roadside Service plan.(Required)

Inside the Van glove box is the Insurance Card, Registration, and Best Roadside Service plan.

If at any time the Van breaks down, please use the Best Roadside Service card for assistance and follow Emergency Procedures located in the van glove box.(Required)

If at any time the Van breaks down, please use the Best Roadside Service card for assistance and follow Emergency Procedures located in the van glove box.

The vans may only be driven by persons approved by the Office of Risk Management to drive college vehicles.(Required)

The vans may only be driven by persons approved by the Office of Risk Management to drive college vehicles.

People who have not been approved may not drive the vans.(Required)

People who have not been approved may not drive the vans.

Please take all items and trash out of the Van when your reservation is over.(Required)

Please take all items and trash out of the Van when your reservation is over.

Report any damage during your trip to the Transportation Coordinator in the Student Affairs Office in Scott Hall.(Required)

Report any damage during your trip to the Transportation Coordinator in the Student Affairs Office in Scott Hall.

You are responsible for all passengers during your reservation time frame.(Required)

You are responsible for all passengers during your reservation time frame.

The driver will be responsible for any Vehicle/Parking violations during trip.(Required)

The driver will be responsible for any Vehicle/Parking violations during trip.

Always drive safe.(Required)

Always drive safe.

By checking "I Agree," you are accepting our Terms and Conditions. Please note that non-compliance with these Terms and Conditions will result in a loss of privilege for the requesting group (not just the driver).

Agreement(Required)

I Agree

Van Request Form

Terms and Conditions:

Pitzer Vans Program Terms and Conditions

Support Pitzer