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    First name on Student Record (if different)
    Last name on Student Record (if different)
    Student ID # (if you remember)
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    Address 1
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    Address 3
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    If your foreign region/state is not listed put your foreign address details in the notes/comment field below.
     
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    Graduation term





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    Notes/comments: Please share any other UC Santa Cruz affiliations you may have (e.g., academic major/minor department/s, student clubs, certifications or credentials earned, sports teams participation). Enter foreign address information here as well.
    Do you have any secondary degrees or attended other colleges/universities?

     

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