First Time Sign In
Please fill this form out at your first meeting of the 2016-2017 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?
Submit
Never submit passwords through Google Forms.
This form was created inside of Bruin Democrats. Report Abuse - Terms of Service - Additional Terms