Medical Permit Form

Please fill out this form if you are unable to obtain a state-issued DMV accessible placard. This information will only be reviewed by the Office of Equal Opportunity. No personal information will be disseminated elsewhere.

Full Name

Phone Number

Enter phone number with area code

Confirm email

Affiliation

Please indicate your primary affiliation with Iowa State University

** Due to the Family Educational Rights and Privacy Act of 1974 (FERPA), the university will only engage in a conversation regarding this subject with the student. Please have your student complete this form themselves.

Explanation

Please explain your extenuating circumstance that renders you ineligible for a state-issued DMV accessible placard

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