1. Personal Information

 
20% of survey complete.

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* 1. FIRST Name

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* 2. LAST Name

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* 3. UC Student ID / M# (if applicable & include the "M") or last 4 digits of SSN for current non-UC students. (for internal use only)

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* 4. Please enter your official UC email address. If you are transferring into UC, please enter a valid email. 

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