First Time Sign In
Please fill this form out at your first meeting of the 2017-2018 Year
Are a Current UCLA Student or Faculty Member? *
Last Name *
Your answer
First Name *
Your answer
Mailing Address *
Please put the mailing address of your UCLA Dorm/Apartment. Example: 330 De Neve Plaza SMT-870C
Your answer
City *
UCLA and surrounding apartments are in the city of Los Angeles
Your answer
State (Acronym) *
Put CA unless you are routinely commuting each day from a different state.
Your answer
Zip Code *
The Zip code for Dorms on the Hill and surrounding apartments is 90024
Your answer
Assembly District *
The State Assembly District for UCLA and surrounding apartments is 54
Your answer
Senate District *
The State Senate District for UCLA and surrounding apartments is 26
Your answer
Congressional District *
The Congressional District for UCLA and surrounding apartments is 33
Your answer
Home Number
Optional. If you don't have a number you want to use please put N/A or leave blank
Your answer
Work Number
Optional. If you don't have a number you want to use please put N/A or leave blank
Your answer
Cell Number *
Example: (916) 817-9801
Your answer
Email *
Your answer
Are you on the BD GroupMe? *
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