The Ohio State University and American Association of Service Coordinators -- Professional Service Coordinator Certificate Program

THE OHIO STATE UNIVERSITY HEALTH SCIENCES CENTER & THE AMERICAN ASSOCIATION OF SERVICE COORDINATORS

The Ohio State University Sciences Center and
The American Association of Service Coordinators
Professional Service Coordinators Certificate Program

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Required Fields

User Informtion

*First Name	*Last Name
*E-mail Address
When choosing a Username and password use only letters and numbers with no spaces. For a password, choosing a mix of letters and numbers makes for a more secure password.
*Preferred Username	*Password	*Re-type Password

*Organization Address

The name and address of the organization you work for is a required set of fields.
*Organization Name
*Street Address
*City	*State	*Zip Code
*Phone Number (ex. 111-222-3333)

Property Address

Please enter the name and address of the property you work at if applicable.
Property Name
Street Address
City	State	Zip Code
Phone Number (ex. 111-222-3333)

Home Address

You may also optionally enter your home address.
Street Address
City	State	Zip Code
Phone Number (ex. 111-222-3333)

AASC Membership

*Are you a current AASC Member? Yes No	*AASC Membership Number [required if an AASC member]
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Education

*Please Indicate your highest level of education achieved: Other
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*Do you possess a professional license? Please indicate: Other