Van Request Form – Pitzer Forms

Pitzer College has 4 mini-vans which seat 7 people each, including the driver. The vans may be used in support of the College’s academic program, 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.
The vans may only be driven by persons approved by the Office of Risk Management to drive college vehicles.
Persons who have not been approved may not drive the vans.
Please submit your request at least 72 hours in advance. You will be sent an email once the status of the reservation has been confirmed.
There is a mileage charge of 70¢ per mile for all van use.
Keys can be picked up at the mail center in Atherton Hall, and returned at in the outside drop box.

Questions? Email Transportation or call 909.607.3827

Contact Name / Requestee*
First Last
Contact Email*
Contact Phone*
Group*
Pitzer Account Owner*
Please list the office responsible for managing your account.
Office Responsible for Account*
Workday Cost Center Number*

Please enter your Workday Cost Center number.
Pitzer Staff Supervisor*
Destination Address
Street Address City ZIP Code
Event Type*

Provide a short description
Number of Passengers - Including Driver(s)*
Number of Vans Requsted*
Please enter a number from 1 to 4.
No more than 4 vans are available.
Date*
MM slash DD slash YYYY
Begin Time*

:
End Time*

:
Is this a reoccurring request?
- Yes
- No
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)