UC Merced Student Inquiry Form

Personal Information

Student First Name

Student Last Name

Student Date of Birth

Contact Information

Phone Number

Mobile Opt-In

Yes

E-mail Address

Confirm E-mail Address

Address Line 1

Address Line 2

Address Line 3

City

Country

State

State/Province/Region

Zip/Postal Code

Student Enrollment Information

Student Type

Start Term

Year

Anticipated Major

Current/Last School Attended

Current School Name

If you don’t see your school, type Unknown.

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