SJV Prime+ Information Form

Personal Information

Student First Name

Student Last Name

E-mail Address

Confirm E-mail Address

Student Date of Birth

Select your County - The Prime+ Program will be giving preference towards students who are residents of and have ties to the eight San Joaquin Valley Counties (high school students residing in the foothills, Salinas, and Greater Central Valley will also be considered). Please select your county of residence below:

Would you like to receive information about UC Merced by mail?

Student Enrollment Information

Student Type

Start Term

Year

Anticipated Major

Current School Name

If you don’t see your school, type Unknown.

Contact Information

Phone Number

Mobile Opt-In

Yes

Address Line 1

Address Line 2

Address Line 3

City

Country

State

State/Province/Region

Zip/Postal Code

Please review the information you have provided. Once you click the SUBMIT button you will not be able to return or change your entries.

Contact Information