Ohio START Registration

This information will NOT be shared outside of Ohio START.

First Name

Last Name

Cell Phone

Gender

Age

Ethnicity

What is the highest level of school you have completed?

How long have you worked at your current agency?

How long have you worked in your current position?

OhioSTART Role

Credit Type Requested

License Number

E-Track Login ID

Which START county are you associated with (choose one)?

Agency Name

Agency Phone

Agency Address

Agency City

Agency State

Agency Zip

Create Account Password

Confirm Password