Ride Connect Service

** First name:

**Last name:

** Address:

** City:

** Zip Code

- (help)

** Current Status:

Student Employee Both

** Home Phone:

( ) - Department:

Message Phone:

( ) - Campus Phone #

I am:

Male Female

Student or Employee Number (without dashes):

E-mail:

(Recommended)

** Time(s) to Arrive

** Time(s) to Leave

**Please select one:

I have a car, I am insured, I will drive
I am a rider only. I will share commute cost

Comments/Preferences/Limitations/Other Information
(I prefer to ride with Smokers/Non Smokers, Staff Only/Student Only, Male/Female, etc.)

Yes, I want the Security Staff to phone or email me before sharing my personal information.

I understand that agreeing to rideshare with anyone as a result of the EvCC Ride Connect Program application process is my decision. EvCC has made no promises about the rider/driver and has no implied or expressed liability for the applicant. I also understand that this application will remain in effect for the current academic year unless cancelled by me.

** indicates a required field

Everett Community College

Ride Connect Service