Application for a Green Bike
Please fill out this form if you are interested in receiving a Dickinson Green Bike. This application does not guarantee that you will receive a Dickinson Green Bike, but ensures that you are placed on the waiting list if a bike becomes available. The Green Bikes are then assigned in the order that the requests were received, taking into account your bike preference and size.

Once you receive a green bike, you will be sent an e-mail with a link for an online training that must be completed as well as directions and times for pick up. Thanks for your interest in this program.

Email address *
First Name *
Your answer
Last Name *
Your answer
Banner ID Number *
Your answer
Campus Classification *
Class Year (Students Only)
Preferred bike style *
Your Height ( ft' in'' ) *
Your answer
Anything else we should know about you?
Is there a specific reason you need a bike (job, financial, religious or cultural needs etc.)
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.