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Rideshare Registration

Complete all sections of this application that apply to your commute and click "submit" to the Rideshare Office.

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) 985-7832

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.

Required: *

Personal Information

* First Name:

* Last Name:

* Campus ID #:

* Extension / Phone:

* Home Address: (Kept Confidential)

Mail Stop:

* City:

*Zip Code:

Department:

* Email:

Typical Work Hours
Start Time:

End Time:

If your work hours vary from day to day, please check here.

* Status - Please select only one. CSULB Faculty Student Worker(Any Type) CSULB Staff

Foundation/CCPE Employee ASI Employee 49er Shops Employee KJAZZ

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.

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

Bike Registrants Thanks for riding your bike to work! Please contact the Kinesiology Dept. locker room at 985-4051 if you would like to arrange for use of a locker & shower facilities.

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)

I am requesting a monthly transit subsidy for (select all that apply) U-PASS = LBT subsidy provided automatically with your CSULB ID

OCTA Employee Annual Pass

$50 MTA Commuter Cash Subsidy

Carpool (C) Registrants Only

Carpool Permit #:

Please check all that apply.

I am carpooling with: CSULB Faculty/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:

Dept / Job Site / School:

Carpool Partner 2

Name:

Ext. / Phone:

Dept / Job Site / School:

Carpool Partner 3

Name:

Ext. / Phone:

Dept / Job Site / School:

Zero Emission Vehicle Registrants Only

Year:

Make:

Model:

Color:

Licence Plate #:

Fuel:

Van Pool Registrants Only

Vanpool Permit #:

Vanpool Company:

Contact Phone:

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