Course Information

Please enter the Course Numbers, Section Numbers, and Course Titles below.

Course Number
(Example: HAZH 515430)
Section Number
(Example: 1800)
Course Title

Contact Information

First Name
Middle Initial
Last Name
Street Address
ZIP Code
Primary Phone
Cell Phone

Company Information

Business Title
Company Name
Business Address
ZIP Code
Business Phone
Business Email
Professional Contact Hours

Payment Information

  I will pay with a check payable to Cleveland State University. Please mail to address above.
  Employer will pay my tuition.  I will submit a purchase order or a completed Authorization for Third Party Billing Form.
  I will pay with a credit card via the secure ShopNet Payment System: Shop Net

Other Information

Label Code

(Numbers directly above your name on the mailing label)
Age Range
How did you hear about CSU?

Comments or Requests
Additional requests or comments?
Vegetarian Lunch


engaged learning
Mailing Address
Cleveland State University
School of Nursing
2121 Euclid Avenue, JH 238
Cleveland, OH 44115-2214
Campus Location
Julka Hall, Room 238
2485 Euclid Avenue
Voice: (216) 687-3598
Fax: (216) 687-3556
Website Content Contact
Voice: (216) 687-3598

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