CSAF Vehicle Driver Application

Please Type or Print

Organization Name:__________________________________________________

Organization Number:________________________________________________

Driver's Name:_________________________________ Date:_______________

Local Address:______________________________________________________

Home Address:_______________________________________________________

Driver's License Number:____________________________ Class:_________

Restrictions: ______________ Age: ________ SS Number: ______________

This form must be completed in its entirety before the vehicle request can be considered. This application must be signed by the organizational fiscal agent and president. It remains in effect for the current academic year. The following statements should be read and understood by the idividual requesting to drive the University vehicle. The same individual should sign on the line provided following the statement.

I agree to abide by all State of Illinois rules of the road and motor vehicle laws enacted by the Illinois General Assembly. I further agree to abide by all regulations of local autorities and procedures and regulations enacted by the Council on Student Activity Funds (CSAF) and Western Illinois University.

CSAF Vehicle Procedures and Regulations can be found in the CSAF Manual.

Driver's Signature:_________________________________________________

Fiscal Agent's Signature:___________________________________________

Fiscal Agent's Phone Number:________________________________________

President's Signature:______________________________________________

President's Phone Number:___________________________________________