SUNSET | The Ohio State University

New Account Registration

To complete the registration process, please fill out the form below.
All fields with an * are required.

Title

*If Other, Please Provide

First Name

Last Name

Email Address

(Note: Using a mix of letters, numbers, and special characters makes for a more secure Password).

Password

Confirm Password

*Country

*Street Address

*City

*State

*Zip Code

Phone Number

(ex: 555-555-1234)

*Your Profession

*If Other, Please Provide

Yes No

If yes, please indicate the name of the organization:

Please indicate which organizations you are a member of (leave blank if you are not a member of any of these organizations):

My employer is a LeadingAge Ohio member.
I am a member of the American Association of Service Coordinators (AASC) with a current member number.
I am licensed by BELTSS (Board of Executives of Long-Term Services & Supports) in the state of Ohio with a current licensure number.
Nursing home administrator license number:

*How did you learn about the SUNSET?

*If Other, Please Provide