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Registration Form

Please complete the registration information below. All fields must be completed (unless otherwise indicated). You will have an opportunity to pay your tuition by check or credit card once your registration is complete. Please begin by choosing your username and password, which you will use to login to the website and course each time you visit the site.

Account Information
Choose a Username:
Password:
Please Confirm Password:
Personal Information
First Name
Last Name
Home Address
City
State
Zipcode
Home Phone
Email
Employment Information
Employer
Address
City
State
Zipcode
Phone
Email
Preferred Mailing Address?
Education Background
Are you currently an Ohio State student?
Have you ever attended Ohio State?
If yes then please indicate the last college of enrollment, year and quarter:
Have you attended other universities?
If yes then please indicate the college/university, degree(s) received and date:
Are you currently under suspension or dismissal from any post-high school education program including Ohio State?
If yes then please explain:
Additional Information



Yes No

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