2018-2019 Columbiana County Resident Educator Registration
Please complete all of the information requested below.

Once you have answered all of the questions, be sure to click on the submit button to finalize your response.

What Year Are You? *
Please choose whether you are a 1st, 2nd, 3rd or 4th year resident educator in the 2018-2019 school year.
Required
First Name *
(Please CAPITALIZE THE FIRST LETTER of your name)
Your answer
Middle Initial *
(Please CAPITALIZE THE FIRST LETTER of your name)
Your answer
Last Name *
(Please CAPITALIZE THE FIRST LETTER of your name)
Your answer
Name when License Issued *
(Please CAPITALIZE THE FIRST LETTER of each name)
Your answer
Date of Birth *
(mm/dd/yyyy)
Your answer
Please Check One *
Please choose the one most appropriate
Ohio License Number *
(ex: OH122333)
Your answer
Work Information
School District *
Please select your School District from the list provided:
Required
Work Email Address *
Please provide the email address that you use to receive email while at work.
Your answer
Contact Phone Number *
EX: 000-000-0000 (please use this format)
Your answer
Teaching Assignment
Type of school where currently assigned *
Required
Level of primary teaching assignment *
Required
Submit
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