Achieve UC Registration Question Title * 1. Student's First Name: Question Title * 2. Student's Last Name: Question Title * 3. Student's High School: Arlington High Canyon Springs High Carter (Wilmer Amina) High Citrus Hill High Colton High Eisenhower High Fontana High Kaiser High La Sierra High Norte Vista High North (John W.) High Perris High Rancho Verde High Riatlo High San Jacinto High Sherman Indian High Valley View High Vista Del Lago High Other (please specify): Question Title * 4. What is your graduation year? 2017 2018 2019 2020 Question Title * 5. Do you belong to any of the following Community Based Organizations? BLU Council of African American Parents (CAAP) San Bernardino Independent Living Program (ILP) Seventh Day Adventist Church Heritage N/A Question Title * 6. Student's E-mail Address: Question Title * 7. Confirm Student's E-mail Address: Question Title * 8. Student's Primary Contact Number: Question Title * 9. Parent/Guardian 1 First Name Last Name Relationship Email Address Contact Number Question Title * 10. Parent/Guardian 2 (if applicable) First Name Last Name Relationship Email Address Contact Number Question Title * 11. Please specify if the student or parent/guardian needs special accommodations due to a disability. Yes No If yes please specify Question Title * 12. Please select the number of additional guests (ie. siblings) 0 1 2 3+ Question Title * 13. Would you like to participate in a UC Riverside campus tour following the Achieve UC event? Sure! No thanks! Submit
