Operation: Return to The Beach - Registration Form

If you are interested in participating in Operation: Return to The Beach, please fill out the following information and submit.
Fields with * are required.

Personal Information

Campus ID required, 9 digits only, no spaces, no dashes, no hyphens	* (9 digits only. Example: 123456789)
First Name required	*
Middle Initial optional
Last Name required	*
Address required	*
Cityrequired	*
Staterequired	*
Ziprequired	*
Phone required, 10 digits only including area code, no spaces, no dashes	* (Cell phone preferred, 10 digits only. Example: 5629851111)
Email required	*
Reenter Email required	*
Birth Date optional	(mm/dd/yyyy. Example: 01/30/1977)
Gender optional	Female Male
Ethnicityoptional

Additional Information

Have you filed for an Educational Leave of Absence? *
Yes No
Which course(s) do you need to complete to come back to CSULB? *
Math English Both
Are you taking the course(s) now? *
Yes If "Yes", where are you taking the course(s)?

No If "No", where and when do you plan to take the course(s)?
How certain are you that you will return to CSULB after completing your coursework?
Definitely certain Fairly certain Not certain/doubtful
Do you understand what you need to do/complete before you can return to CSULB?
Yes No
How would you like to receive regular communications from our office? *
Email Phone Mail

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Division of Student Services
California State University, Long Beach
1250 Bellflower Boulevard, BH-377, Long Beach, California 90840