Maxine Goodman Levin College of Urban Affairs | Cleveland State University
Columbus Seminar Application
Student Information
Name: _______________________________________
Address: _____________________________________
City/State/Zip: ________________________________
CSU ID Number: _______________________________
Email: ________________________________________
Contact Phone: _________________________________
Graduate/Law Student, program: ___________________________________
Undergraduate Student, major: _____________________________________
Cumulative GPA: _________
Credit Hours Earned: ________
Emergency Contact Information
Name: _________________________________________
Home Phone: ____________________________________
Cell Phone: ______________________________________
Have you previously participated in the Columbus Seminar?
Expected Graduation Date: _________________
Relationship: __________________________________
Other Phone: __________________________________
 Yes
 No
Preference will be given to students who have not previously participated.
Please list any courses you have taken that focused on state government:
____________________________
____________________________
____________________________
____________________________
_____________________________
_____________________________
Do you currently work for local, state, or federal government? If yes, describe your position.
Briefly explain your interest in state government and politics, and the part state government plays in your career
plans.
By signing this application you acknowledge that, if you are selected and register, you are responsible for the $350 course
fee, transportation to and from Columbus, parking, meals, and other expenses. In addition, you acknowledge that
participation throughout the semester is a requirement for the Columbus Seminar; there are four class sessions in
Cleveland, reading, and written assignments.
Signature ___________________________________________________
Date _____________________
Return applications to: Office of Student Services, Levin College of Urban Affairs – UR 205, Cleveland State University, 1717
Euclid Ave; or email to urbanprograms@csuohio.edu. Participants will be notified of their acceptance by email. If you are
selected and register, the $350 course fee will be added to and payable with your tuition.
S:\Columbus and Washington Seminars\Columbus\Columbus Seminar Application.docx