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Transportation Demand Management (TDM)
Carpool Gas Incentive Card Application

To qualify for the carpool gas card incentive program you must:
1. Be a benefit eligible full-time employee
2. Participate in the carpool for a minimum of 3 months before you are eligible to receive the incentive.
3. Carpool 18 or more working days of the month.

4. Once you have submitted your application, you and your carpool partner will be contacted to schedule a brief orientation to the program.

Driver #1:
University ID#:
Department:
Email Address:
Type of Employee:
Payroll Schedule:
   
Driver #2:
Department:
University ID#:
Email Address:
Type of Employee:
Payroll Schedule:
   
   
1. Town & State of Carpool Departure:
   
2. What main road do you take to campus?
   
3. Would you be open to other employees joining your carpool?
   
4. Date your carpool began:
   

Note: Gas cards are considered taxable income and are subject to federal and state income taxes. The value of the card will appear as imputed income on a subsequent paycheck following the receipt of each card.


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