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University of California, Santa Cruz
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Enter student information:

Student ID #:
   Either Social Security number or Student ID must be entered.
Social Sec #: 
   In accordance with the Ferderal Privacy Act of 1974, as amended, you are hereby notified that disclosure of your Social Security Number is voluntary.
First Name: 
Middle Name: 
Last Name: 
Suffix:    Jr - II - III - IV   (Only enter here - NOT in Last Name field)
Other Name(s): 
  
Birth Date:    Required - Enter as mmddyyyy
Current Address: 
 
City:     State: 
Zip Code:      
Country:       
Student Tel #:    


       


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