Professional Development

Levin College of Public Affairs and Education

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

Campus Location
Urban Building
1717 Euclid Avenue
Cleveland, OH 44115

OCPM Academic Credit Registration Intake Form

Please complete the form below. If you have any questions contact Katie Mazanetz, Levin College Recruitment & Engagement Director at k.mazanetz@csuohio.edu.

Preferred Email Address for Communications:

First Name:

Preferred First Name (if different than above):

Middle Name:

Last Name:

Former/Maiden Name:

Suffix

Date of Birth:

Preferred Pronouns

He/Him/His

She/Her/Hers

They/Them/Theirs

Other...

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Cell Phone:

Position or Title:

Employer:

Work Telephone:

Work Address

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Home Address

Street Address 1:

Street Address 2:

City:

State:

Zip Code:

Are you a U.S. Citizen or permanent resident?

What is your country of citizenship?

What is your visa type?

Are you a Cleveland State University alumnus/a or current student?

Please provide your CSU ID number.

Are you a permanent resident of Ohio?

Date Ohio Residency Established:

Ethnicity and Race (This information will be used for reporting purposes only.)

Ethnicity: Are you Hispanic/Latino?

Race: Select one or more races that describe you best:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Are you employed by a state agency?

What is your state ID number?

What state agency do you work for?

What is your Business Unit?

Enter other…

Please select from the list below for the professional development programs that you are seeking credit for:

LeanOhio Boot Camp (2 credits)

Public Management Academy (6 credits)

Leadership Academy (6 credits)

Do you plan to use the Union Education Trust tuition benefit?

Select the academic degree that you are interested in applying the credit to.

Leave this field blank