Section 1 of 4 in this document

APPLICATION FOR PERSONS WITH DISABILITIES PARKING PERMIT FOR IOWA RESIDENTS

INSTRUCTIONS:

Please enter all required information and attach the necessary files. You will be requested to attach a signed medical statement from a physician, chiropractor, occupational therapist, physical therapist, physician assistant or nurse practitioner indicating the disability status and whether it is permanent or temporary. A medical statement submitted without this application will not be processed.

By law, Iowa DOT may accept a certification of disability from the U.S. Department of Veteran's Affairs in lieu of a healthcare provider's statement for veterans.

If you are applying for a Persons with Disability removable windshield placard (Standard or Temporary), please be aware there will be a waiting period due to processing time. If you need your placard immediately, you can visit one of our Iowa Department of Transportation service centers or a county treasurer’s office to obtain your placard.

Once all information is collected, it will be pre-filled into your application for final review and sign-off.

To complete the application, you must electronically sign and click 'Finalize & Submit'.

Are you a parent/guardian applying on behalf of child with a disability? “Child” includes, but is not limited to, stepchild, foster child, or legally adopted child who is younger than 18 years of age, or a dependent person 18 years of age or older who is unable to maintain the person’s self.

Yes

Is the child with a disability one year of age or older?

Yes

Is this a temporary or standard (permanent) as indicated by your doctor?

Temporary

Standard (permanent)

Section 2 of 4 in this document

1. Applicant Information - please complete for all products

Please be sure to enter the child's information as the applicant's.

Date of birth

County

DL or SSN number

Address

City

State

ZIP Code

Phone

Please indicate the type of products being requested (check all that apply):

Windshield placard

License plate parking sticker (permanent disability only; NOT available for those applying on behalf of a child)

License plate (permanent disability only)

License plate for parent/guardian of child with a disability

Your submission on this form will not be processed.

Please proceed to the following application links for License Plates:

Standard Plates: Click Here
- Print, sign and take the form along with your medical statement or your US DVA certification (for veterans) to your local county treasurer's office.)
Personalized Plates: Click Here
- Print, sign and take the form along with your medical statement your medical statement from or your US DVA certification (for veterans) to your local county treasurer's office.)

Your submission on this form will not be processed.

Please proceed to the following application links for License Plates:

Standard Plates: Click Here
- Print, sign and take the form along with your medical statement or your US DVA certification (for veterans) to your local county treasurer's office.)
Personalized Plates: Click Here
- Print, sign and take the form along with your medical statement your medical statement from or your US DVA certification (for veterans) to your local county treasurer's office.)

Section 3 of 4 in this document

Windshield placard

Would you like a new windshield placard or do you need to replace an existing windshield placard?

New

Replacement

Number of placards requested:

One (1) placard

Two (2) placards

Type of placard requested

Temporary

Standard (five year)

Number of placards to replace:

One (1) placard

Two (2) placards

Replacement Reason

Damaged

Destroyed

Lost

Stolen

Please provide the original placard number if you still have one in your possession (If you need to replace both, please leave blank)

Windshield placard

Would you like a new windshield placard or do you need to replace an existing windshield placard?

New

Replacement

Number of placards requested:

One (1) placards

Two (2) Placards

Type of placard requested:

Temporary

Standard (five year)

Number of placards to replace:

One (1) placard

Two (2) Placards

Replacement Reason

Damaged

Destroyed

Lost

Stolen

Please provide the original placard number if you still have one in your possession (If you need to replace both, please leave blank)

License plate parking sticker (permanent disability only)

The sticker must be displayed on the rear license plate.

Would you like a new license plate parking sticker or do you need to replace an existing license plate parking sticker?

New

Replacement

Please provide the original sticker number. If you have more than one sticker, please list them all.

Current Plate Number

Enter current plate number:

Are you a veteran with a certification of disability from the U.S. Department of Veterans Affairs?

Yes

Veteran self-certification

By law, Iowa DOT may accept a certification of disability from the U.S. Department of Veterans Affairs in lieu of a health care provider's statement for veterans.

Acknowledge

I attest under penalty of perjury that the permanent disability underlying my U.S. Department of Veterans Affairs disability rating impairs my mobility to the extent defined in Iowa Code 321 L.1 (8).

Uploaded files must be scanned in black and white and attached as a .pdf file.

Upload File(s): Certification of disability from the U.S. Department of Veterans Affairs

Click Here to Upload

Upload File(s): Signed Medical Statement

Click Here to Upload