Verizon Community Forward Learning Center at CSU

Contact Information

Mailing Address
Cleveland State University
2121 Euclid Avenue, JH 130
Cleveland, OH 44115

Campus Location
2485 Euclid Avenue
Julka Hall, Room 130
Cleveland, OH 44115

Contact Us
Phone: 216.687.4768
communitylearningctr@csuohio.edu

General Outreach Family Intake Form

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  • Complete

Select up to four choices

Course Selection

Student information (please enroll only one student at a time. Complete additional form for each additional child enrolled):

Student Name/Grade/School Name

2. Student Gender:

3. Grade

5. Medium of Regular School Instruction

6. Disability Status

7. Preferred Method of Contact/Permission

Parent/Guardian Contact Info (Primary)

Please enter your phone number in the designated format with numbers and dashes (e.g. 555-555-5555)

11. Cell Phone Provider (Primary)

Parent/Guardian Contact Info (Secondary)

15. Cell Phone Provider (Secondary)

Student contact info (usable by student)

19. Devices Available for Use (Select all that Apply)

20. Programs/Applications Used/Approved for Student use during Tutoring

Contact Information

Mailing Address
Cleveland State University
2121 Euclid Avenue, JH 130
Cleveland, OH 44115

Campus Location
2485 Euclid Avenue
Julka Hall, Room 130
Cleveland, OH 44115

Contact Us
Phone: 216.687.4768
communitylearningctr@csuohio.edu