Admissions System (Slate) Access Request

First Name

Last Name

Preferred First Name

UCLA Anderson Email Address

Cellphone

Anticipated End Date of Admissions Role

UCLA Logon [used to login to MyUCLA at https://my.ucla.edu/ and used by Duo for multi-factor authorization]

UCLA ID Number [must be accurate 9-digits]

I hereby certify that I will maintain full confidentiality as outlined in the mandatory Admissions Confidentiality Agreement which I am submitting along with this access request.

Full Name as Signature