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Internet Application & Registration
Technical Problem Report Form

Please enter all information to help us locate, track, and resolve the problem you are experiencing. Please be aware that during peak registration times (beginning of the quarter), there may be a delay in the response to your technical problem.

While your technical problem is being investigated, you can also try the phone registration system. See Phone Registration Instructions for more information.

• Note: If you are connecting to the registration system behind a proxy (many times this is the case with large corporations), your network's security settings may not allow you to connect to the system. The system will display an error similar to "Cookies need to be enabled" -- even though your browser's cookies are enabled. Unfortunately, we have not found a solution to this problem. The phone registration system is another option to consider.


(required)

:
(example: 10000001)

(required)

(example: name@email.com Double check your entry for correctness. )

(required)

(Please include area code, example: (408) 555-4567)



(Example: 9/22/2003 9:15 AM)

Your location:
 

Your Internet connection type:
 



(Example: AOL, Comcast, Earthlink)

Computer Type:
   



(Example: Windows 2000/XP, Mac OS 9.2, Mac OS 10.2)



(Example: IE 6.0, Firefox 1.5)
* Note: The registration system has been tested on IE6, FireFox 1.5 and Safari 1.2

You are using the system to:
   



(Example: Fall 2003)



(Example: Norton Anti-Virus, firewall, anti pop-up)




Please click button once ---


Page updated: August 2, 2007 De Anza College. Just What You Need.