COSMOS Registration

Please provide your basic demographic information to create an account.  This will be the first step to your COSMOS application, and an email will be sent to verify your account. Please note that this registration is just for your initial profile and login. 

Personal Information

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

Address

I am a California resident * Help
I am a California resident

Hint: This field is required

Error: This field is required

Are you currently attending a California High School? *
Are you currently attending a California High School?

Hint: This field is required

Error: This field is required

imgPCountry

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

imgPState

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

Phone Number

International Number

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: This field is required

imgPhoneType

Hint: This field is required

Error: This field is required

Demographic Information

imgDOBMonth
imgDOBDay
imgDOBYear

Hint: This field is required

Error: This field is required

Please note that the following questions are optional and your responses will not affect the review of your application.

imgGender

Hint: This field is required

Error: This field is required


Hint: This field is not required

Error: This field is required

Are you Hispanic or Latino?
Are you Hispanic or Latino?

Hint: This field is required

Error: This field is required

Ethnicity *

Racial/ethnic data is collected and disaggregated solely for reporting purposes. This information is not used for admissions consideration.

Ethnicity

Hint: This field is required

Error: This field is required

How did you learn about COSMOS?
How did you learn about COSMOS?

Hint: This field is required

Error: This field is required

Hint: This field is required

Error: Please enter valid e-mail address

Error: This field is required

Hint: This field is required

Error: Please enter valid e-mail address

Error: This field is required

Hint: This field is required

Error: Password must at least 8 characters long, contain at least one number, one capital letter, and one special character.

Error: This field is required

Hint: This field is required

Error: The passwords do not match.

Error: This field is required


Submit
Cancel