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DAF Home > PP&FM > Parking > Program > Rideshare >

Rideshare Application

Complete all sections of this application, sign, and return to the Rideshare Office.
Please allow 10 days for processing your application.

All Rideshare benefits & incentives, including carpool permit upgrade, transit or vanpool subsidy, bike locker, guaranteed ride home, Beach Bucks, and other cash-value items will be issued on the basis of this application and your Monthly Rideshare Record.

Phone:work (562) 985-4091

Fax:fax (562) 985-7488

rideshare@csulb.edu

Once you are accepted and registered into the system, you must complete and submit a monthly Rideshare Record by the 5th of each month.

Personal Information

First Name:

Last Name:

Campus ID #:

Extension / Phone:

Home Address:

Email:

City:

Zip Code:

Department:

Start Time:

End Time:

Status

Please check all that apply.

Full Time Part Time CSULB Faculty CSULB Student CSULB Staff
ASI Employee 49er Shops Employee UCES Employee

How did you hear about the Rideshare Program?

New Staff / Student Orientation Rideshare Promotional Materials
Prior Participant Co-worker / Student

If you answered "Co-worker / Student" what is his / her:

Name:

Ext. / Phone:

Other:

Commute Information

Please indicate the one-way distance of your commute to CSULB. miles from CSULB

For assistance in estimating your commute, use the Google Maps service.

Please indicate the primary mode of sustainable transportation you use to commute to CSULB. Bike Walk Compressed Work Week Telecommute Carpool
Vanpool Hybrid / Electric Vehicle Public Transit Campus Connection Shuttle

Faculty & Staff Bicycle / Hand Bike Registrants Only (B)

I would like to use staff shower facilities & a locker, if there is one available. Yes No

Compressed Work Week (CWW) / Telecommute (TC) Registrants Only

I am on compressed work week: 3/36 4/40 9/80

Telecommuting Number of days I telecommute per month:

Public Transit (PT) / Campus Connection Shuttle (S) Registrants Only

List your transit route from home to CSULB:
(ex - MTA Blue Line to LBT 91, or OCTA 60, or Shuttle from Brooks College) OCTA Pass #:

Carpool (C) Registrants Only

Carpool Permit #:

Please check all that apply.

I am carpooling with: CSULB Faculty/Staff ASI Staff USU Staff CSULB Student V.A. Employee(s)
Other local non-CSULB employee/student I get dropped off

To park in a CSULB carpool space, you must display a valid carpool permit AND park with carpool partner/s in the car. If you are dropping others off before you park, you should park in a general staff/student space to avoid getting a ticket.

Carpool Partner 1

Name:

Ext. / Phone:

Home Address:

Start Time:

End Time:

Dept / Job Site / School:

Carpool Partner 2

Name:

Ext. / Phone:

Home Address:

Start Time:

End Time:

Dept / Job Site / School:

Carpool Partner 3

Name:

Ext. / Phone:

Home Address:

Start Time:

End Time:

Dept / Job Site / School:

Hybrid Electric / CNG / LNG / BioDiesel (H) / Ethanol (E85) Vehicle Registrants Only

Year:

Make:

Model:

Color:

Licence Plate #:

Fuel:

Van Pool Registrants Only

Vanpool Permit #:

List your vanpool partner names:

Name 1:

Name 2:

Name 3:

Name 4:

Name 5:

Name 6:

Name 7:

Name 8:

Name 9:

Name 10:

Name 11:

Name 12:

Name 13:

Name 14:

By clicking the "Submit Application" button I agree to immediately inform CSULB Rideshare of any changes in my contact information, employment, enrollment or commute status. I understand that Rideshare incentives may be subject to federal & state taxes. I understand that falsification or willful misrepresentation of Rideshare claims to obtain any available incentive may result in disciplinary action, including repayment of any monetary incentives and/or termination.

Rideshare @ the Beach