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Acknowledgment & Verification
for University & Private Vehicles |
| I hereby acknowledge that I have read and understand the policies and procedures outlined in the University and Private Vehicle Usage Policy. |
| I, the undersigned, further agree to comply with the policies and procedures as set forth in the University and Private Vehicle Usage Policy. Failure to comply with these policies and procedures could result in the loss of my privilege to operate a university or private vehicle while on official state business. This verification is freely and voluntarily disclosed. |
| Signature: ____________________________________ |
| Print Name: ___________________________________ |
| Date: __________________________ |
| Please keep a copy of this form in your files. |