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USI UCR Current Member Form
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Student ID
*
Your answer
Email
*
Your answer
Phone number
Your answer
Select the following that applies:
*
Formerly Incarcerated
System Impacted
Both
Ally
Faculty or Staff
None
Gender:
*
Male
Female
Transgender
Non-binary
Gender non-conforming
Two-Spirit
Other
Prefer Not to Answer
Race/Ethnicity
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latinx/a/o
Native Hawaiian or Other Pacific Islander
White
Other
Required
Select the following that applies:
*
Freshman
Sophmore
Junior
Senior
Graduate Student
Faculty or Staff
Other:
What's your Major? Do you have a Minor? If so, what is it?
*
Your answer
Expected Graduation (Term, Year)
*
Your answer
Are you a transfer student?
*
Yes
No
Planning to apply to graduate school?
*
Yes
No
Not sure yet but willing to learn more
Current Grad Student
Other:
Please select the following that applies:
*
First Generation
Parent Scholar
Veteran
Undocumented
None
Other:
Required
Are you registered on HighanderLink?
*
Yes
No
Unsure
Any comments, questions, or concerns? How can USI support you?
Your answer
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