College of Extended & International Education - OSHA Training Institute

OSHA Course Registration Form

Please review our cancellation policy prior to submitting your registration. This registration form is for first time students in our live-classroom courses. Once you have submitted this form, you may call with payment at 877-464-4557 or 310-243-3741. Your registration is not complete until payment is submitted and verified. To register for our online courses go to www.csudh.edu/oshaonline.

Course #1
  Course Number
(e.g. OSHA 2015)		 Location
(e.g. Carson)		 Start Date
(e.g. 6/8/08)
Complete
Course
Title (e.g. Hazardous Materials)

Course #2
  Course Number
(e.g. OSHA 2015)		 Location
(e.g. Carson)		 Start Date
(e.g. 6/8/08)

Complete
Course
Title (e.g. Hazardous Materials)

Course #3
  Course Number
(e.g. OSHA 2015)		 Location
(e.g. Carson)		 Start Date
(e.g. 6/8/08)

Complete
Course
Title (e.g. Hazardous Materials)

Personal Information
Name (First & Last): * *
Address Line 1: *
Address Line 2 (if needed):
City / State, ZIP: / * , *
Phone:
E-Mail: *
Employer *
Job Title *
Work Zip Code: *
If current or former CSUDH Student, Enter Student ID Number *
If new CSUDH Student, Enter Birthdate *

* Required Fields

If you have already filled out your educational needs submit form here. Otherwise, please continue below.

Educational Needs Survey
Age
Marital Status
Married Single
Gender
Male Female
What level of schooling have you completed?
HS Graduate Some College AA/AS Degree
BA/BS Degree Masters Degree Doctorate
Why are you interested in OSHA courses?
Career Change Enter the Workforce General Interest
Prof. Growth Job Promotion Required for Job
What is your employment status?
Full Time Part time Unemployed
Full time student Part time student Retired
In what business or industry do you work?
What is your occupation?
What type of job do you have?
Professional Sales Managerial
Self-employed Technical Clerical
Administrative Other
How did you learn about this program?

Search Engine
Name

E-mail

Another Web Site
Name

EE Catalog Employer Word of Mouth
Education Fair or
Job Fair 		Current CSUDH Student Brochure/Flyer
Television Radio Newspaper/Magazine
  Other

 
It would be most convenient for me to take classes:
On CSUDH Campus Via the Internet At my job
It would be most convenient for me to attend courses at the following time:
Weekday Mornings Weekday Afternoons Weekday Evenings (after 6pm)
Weekends Via the Internet  
What time of year would you most like to take classes?
Fall (Sept-Nov) Winter (Jan-Feb) Spring (March-May)
  Summer
(June-Aug) 		 
What time of year would you least like to take classes?
Fall (Sept-Nov) Winter (Jan-Feb) Spring (March-May)
  Summer
(June-Aug)