ltcGAIN Program | The Ohio State University

New Account Registration

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

*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

*Organization Name

*Organization Type

*Country

*Street Address

*City

*State

*Zip Code

Phone Number

(ex: 555-555-1234)

*Please Indicate your highest level of education achieved:

How long have you worked in long-term care?

*How did you learn about the ltcGAIN Program?

*If Other, Please Provide