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Internet Registration Technical Problem Report Form

Please enter all information to help 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.

What is your full name? (required)

If you are a Foothill or DeAnza student, please enter your 8 digit SID.

What is your e-mail address? (required)

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

In case we need to talk to you, what is your phone number? (required)

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

Your Location:
Off Campus   On Campus

Your Internet Connection Type:
Dial-up   Broadband (Cable / DSL)

Select Internet service provider:

Computer Type:
PC   Macintosh   Linux/Unix

Select your operating system:

Enter your operating system version:
(Example: 2000, XP, 9.2, 10.4)

Select Brower name*:

Enter Browser version:
(Example: Internet Explorer 6.0, Netscape 7.0)
* Note: The registration system supports Internet Explorer 5 and above, and Netscape 7 and above.

You are using the system to:
Apply   Register

Select the quarter and year you are applying or registering for:
    

List other applications running at the time problem occurred:

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

Enter error messages received:

Enter a detailed description of the problem:


Please click button once ---

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