UCSC School of Engineering Alumni Account Registration Form

By submitting this request, you assert that you have read and agree with the terms of agreement for a UCSC School of Engineering alumni account. If you have NOT read the UCSC School of Engineering alumni account registration information in its entirety, you should do so before filling-out and submitting this form. You must still sign and return (via fax or postal mail) a copy of the terms of agreement. This form simply pre-formats the terms of agreement with your provided information.

First name: Last name:
Requested usernames (in order of preference):

Quarter graduated:
Fall Winter Spring Summer
Year graduated:
Degree obtained:
B.A. B.S. M.S. Ph.D.
Computer Science
Computer Engineering
Electrical Engineering
Applied Mathematics
Network Engineering
Bioinformatics
Information Systems Management
None of the Above

Work phone: Home phone:
Postal Address:
Email addresses: (The first is required to be current.)

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