TRIP REDUCTION DRAWING ENTRY
Name:
I am a:
Student
Employee
Phone:
Date of use:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2012
2013
2014
Campus Selection:
Main
Peoria
Tempe
Alternative Mode Used:
Bike
Bus
Walk
Carpool/Van pool
Other
Reason:
New (First time using alternative mode)
Regular Alternative Mode User
Clean Air Campaign
High Pollution Advisory *
* If you used an alternative mode on a high pollution advisory day, you may submit this form twice for the single day. One form should be filled out marking the advisory for the reason and the other submission should mark the other reason that is accurate.
