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
Employment Information
Preferred Mailing Address?

LeadingAge Member LeadingAge Ohio

Is your organization a LeadingAge Ohio member (The Advocate for Not-For-Profit Services for Older Ohioans)?

AASC Member AASC

Are you a member of the American Association of Service Coordinators?

BELTSS Member BELTSS

Are you a BELTSS member (Board of Executives of Long-Term Services & Supports)?

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






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