Columbia Regional Learning Center

User Registration

Complete the form below to register. Once registered, you will have access to launch courses in the system. Required items are marked with an asterisk (*).

* First Name * Last Name
* Email Address:
* Username:
* Password (case-sensitive):
  • Must be at least 6 characters and no more than 25 characters.
  • Cannot contain 'password', '123456', '654321' or contain the username.
* Re-type Password (case-sensitive):
* Work Country
Work Street Address
* Work City * Work State/Province * Work Zip Code


 State/Province, if other, please specify:
Work Phone Other Phone Fax

Phone Numbers should be in ###-###-#### format
Gender


Race - please select all that apply





Ethnicity

* Birth Date
* Education Level


 If other, please specify:
Primary Language


 If other, please specify:
* Please select your primary affiliation





* Agency or Organization


 If Academic Institution or other, please specify:
* Occupation


 If other, please specify:
* How would you characterize your job level?



Employment Status




Job Title
* How many years have you worked in your current position?
* How many years have you worked at your current agency?
* How many years have you worked in public health?
* Approximately how many online courses have you taken previously in emergency preparedness and response?

© 2016 Columbia University Regional Learning Center