University of Arkansas at Little Rock

Driver’s full name *

Departure Date *
Please type the date in the format of mm/dd/yyyy.

Return date *
Please type the date in the format of mm/dd/yyyy.

Type of vehicle *
Please indicate if you want a 15-passenger van, accessible
van, minivan, sedan, SUV, or wagon.

Destination of vehicle *
Please type the city and state.

Department name *

UALR account (FOAPAL) *

Any special requests (removal of seats, etc.)

Email address of person responsible for receiving invoice *

Department contact for reservation request *
Please include the contact’s telephone number and/or email
address in case we have questions regarding the request.

Favorite ice cream flavor
This is not required, but it’s interesting nonetheless.