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Fill out ALL the fields in the form, and receive a complimentary UCLA Advocacy lapel pin. You’ll be set for your first in person meeting with elected officials or at a community town hall advocating for UCLA and public higher education.

First Name*

Last Name*

Email Address*

Telephone Number*

Address*

Address 2

City*

State*

Zip Code*


Additional Information

Answer the following questions to receive a complimentary UCLA lapel pin.


Social Media Handle(s)

What is your Campus affiliation?
StudentAlumniParent/FamilyRetireeFriendStaffFaculty/LecturerDonorOther

About which issues do you care most passionately?
Student financial aid (scholarships and loans)Science research fundingHealth/medicine research fundingTechnology and innovationResearch and other support for veteransState funding for public higher educationLocal issues that affect public higher edEconomic developmentTransportation issuesEnvironmental issuesCampus climateAthleticsLabor relationsOther:

Do you advocate on behalf of any organizations? If so, which one(s)?

Do you have interaction with or do you support any of your elected officials? If so, please specify the nature of the relationship(s).

Are you interested in participating in advocacy days, where UCLA advocates visit elected officials locally, in Sacramento, and in Washington, DC? If so, which levels of government interest you?
LocalStateFederal

Did you receive grants or financial aid in order to attend UCLA or other institution of higher education? If so, please specify

What profession or industry do you work in?

Are you interested in other volunteer opportunities in addition to our advocacy efforts (i.e. beautification projects and other community service in Los Angeles)
Yes, please add me to the UCLA Volunteer Center email list.No, I am only interested in UCLA advocacy efforts.

Graduation Year

Area of Study

How did you hear about UCLA Advocacy