THERE ARE SEVERAL WAYS FOR YOU TO CONTACT US:

Email us at blkcare@ucla.edu, call us at (310) 825-9858 or, you can simply fill out the form below and we will contact you. Please provide us with as much or as little information as you are comfortable with, as long as it will allow us to contact you. Real names are NOT needed, but please give us a nickname so we know who to ask for. Please be specific about when we should contact you as it helps us to ensure your privacy.

         

 

 
Name/Nickname:
Phone #:
Email address:
 
 Please check the days of the week and the times of day that are best to reach you.
 
     SUNDAY:
     MONDAY:
     TUESDAY:
     WEDNESDAY:
     THURSDAY:
     FRIDAY:
     SATURDAY:
 

 

** Be sure to include an e-mail address if you want us to respond to your questions &
comments. This form does not automatically provide us with a way to contact you.

 

 Copyright 2001-2004 Vickie M. Mays, PhD