2024 BLS COMPLETE

2025 BLS COMPLETE

Basic Life Support - Request Form
The American Heart Association (AHA) strongly promotes knowledge and proficiency in BLS, ACLS, and PALS Courses and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent sponsorship by AHA. Any fees charged for such a course, except for a portion of fees needed for AHA course materials, does not represent income to the Association.
Today's Date:

MonthDayYear
Date
Employee ID:*
Example: CHS12345
Name

First NameLast Name
Work Number:*
(Do not use personal number)
Work/COA Email:*
Example: Jane.doe@childrensal.org
Department/Unit or Area
(Your Work location)
Job Title:
Educator or Director:
BLS Complete: Assignments are made at the beginning of your expiration month. If you expire in January, you will be assigned no later then January 5th. You will have until the end of the assigned month to complete. If you submit the request any time during your expiration month you will have until the end of that month to complete.

NOTE: Children's allows renewal every two years. if you open assignment that is a license used.
Month of Expiration:*
If New Hire enter 00
Month Requested*
If you have questions contact us at: nursing.education@childrensal.org or call (205)638-9127.

UAB or other non-Children's affiliates are required to pay $75.00. Check made payable to Nursing Education must be received before access to online module is made available.
I have read and understand the instructions in this form.
Should be Empty:

2025 BLS COMPLETE