Instructor Interest Application

Instructor Interest Application

Thank you for your interest in working with Baseline CPR to help make critical training a standard in our communities. Baseline CPR, as an American Heart Training Site, is able to train BLS and Heartsaver instructors. This can allow YOU to play an active role in our mission. Please make sure to review our website to learn more about what we are striving for.
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Do you have any current CPR certifications? *

Yes, BLS Yes, other non BLS certifcation No, my certification is expired No, I have never had CPR certification
Please select any previous experience that you have:

First Aid or CPR Instructor Teaching, healthcare related Teaching, non-healthcare related Healthcare Provider
Please list any current medical licensure or certifications:
ie BLS, ACLS, CPR, EMT
Latest CPR Certification:

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Please upload your most recent CPR certification card
Cancel of
What institutions are you affiliated with?
Please list any schools, shuls, or other community organizations that you are familiar with.
Comments:
Thank you!

While this is not an instructor application, we appreciate your interest and we will get back to you as soon as we can. Please visit https://cpr.heart.org/en/resources/aha-instructors/become-an-instructor to learn more about becoming an instructor. Feel free to reach out to us at office@baselinecpr.org with any questions.
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Instructor Interest Application

Thank you!