OFF-CAMPUS RESIDENT STUDENT INFORMATION FORM
The City of Philadelphia requires all college /university students who do not live on campus, but do live in the fourth council district while attending school to supply the college or university with his or her local address and applicable vehicle registration information. You can read the City of Philadelphia law Bill #020482 at www.PhilaU.edu/34M02doc.pdf

NOTE: Your information will be kept private and has been gathered on a secure webpage.  For those students who wish to purchase a parking sticker in order to park on campus, click here.
PERSONAL INFORMATION    
     
First Name:
Last Name:  
University Mailbox #:  
Email Address:  
     
HOME ADDRESS:    
     
Home Address Line 1:  
Home Address Line 2:  
Home City:  
Home State:  
Home Zip Code:  
     
LOCAL ADDRESS:    
     
Local Address Line 1:
Local Address Line 2:
City:
State:
Zip Code:
     
VEHICLE INFORMATION:    
   
I do not own, operate or control a vehicle
in the fourth council district.
     
Operator's License #:  
State of License Issue:  
Vehicle Year:  
Vehicle Make:  
Vehicle Model:  
Vehicle Color:  
License Plate:  
License Plate State of Issuance:  
     
Completion of this form is required by the City of Philadelphia Bill #020482.