* = Required field
Please supply the following information: Humboldt ID (or Social Security Number) and Date of Birth
This information is submitted via SECURE SERVER, and is requested pursuant to Section 41201, Title 5, Calif. Code of Regulation and Section 6109 of the Internal Revenue Code.
Your voluntary response is requested to comply with Federal and State legislation. If the California State University system is asked to report only ONE summary race/ethnicity description for you, choose the ONE category below that you want us to report: