Account Activation Request

Account Activation Request

By checking this box and submitting this form, I accept the Terms of Use and Privacy Policy regarding use of this UCSC online service.

First Name
Middle Name
Last Name
Maiden Name
Address 1
Address 2
Address 3
If your foreign region/state is not listed put your foreign address details in the notes/comment field below.
Birth Date (mm/dd/yyyy)
Phone Area
Phone Number
Phone Type
Email Address

If we need to call you, please provide days and times that we can contact you by phone.
Enter times here:

Affiliation with UCSC, select all that apply (must select at least one):

UCSC Class Year
UCSC College
UCSC Major
Name as student if different from above.
Student Name
Notes/Comments: Please share any other UCSC affiliations you may have (e.g., academic major/minor department/s, certifications or credentials earned, sports teams participation). Enter Foreign Address information here as well.
We take the stewardship of your personal information seriously; and so we must validate the information you submitted against our records before issuing access to an account on this system. These account requests are usually processed within one to two business days. The response may be either a phone call or an email depending on the type of request and your contact information.
Phone: (800) 933-7584 Feedback

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