Register for a New Account

Fill out the form below in order to create a new account on this system. Once you've successfully registered, you'll be able to log in to the system immediately. Questions marked with a * are required.

Email Address *

Telephone Number

Age *
-- please select --Under 1818-25Over 25

Gender (check all that apply) *

Man

Woman

Transgender

Genderqueer

Another gender identity not listed here

Prefer not to respond

If another gender identity, please specify

Preferred Pronouns
-- please select --He/himShe/herThey/themOther

If other, please specify

First or Home Language *
-- please select --EnglishArabicChineseFrenchGermanHmongJapaneseKoreanPortugueseRussianSpanishOther

If other, please specify

Standing *
-- please select --FreshmanSophomoreJuniorSeniorGraduate StudentSpecialStaff

School/College *
-- please select --ArchitectureBusinessEducationEngineeringFreshwater SciencesHealth SciencesInformation StudiesLetters & ScienceNursingPeck School of the ArtsPublic HealthSocial WelfareAcademic Opportunity Center

Racial/Ethnic Background *
-- please select --Black/African-Amer.Asian/Asian-Amer.WhiteHispanic/LatinoAmer. Indian/Alaskan NativeNo ResponseOther

If other, please specify

Student ID *

Password

Email Preferences

Send me an email when my appointments are made, modified or canceled: YES or NO

Send me an email with center announcements or other mass mailings: YES or NO

Send me an email to remind me of my upcoming appointments: YES or NO

Include iCal links with appointment confirmation messages? YES or NO

Text Messaging Preferences

You have the option of receiving appointment reminders and waiting list "appointment available" notices via text message instead of via email. If you would prefer to receive text message notices, enter your ten-digit mobile phone number and select your carrier below. Depending on your mobile carrier and plan, you may incur charges for receiving text messages. By entering your number below, you agreee to be responsible for those charges.