2024 PALS COMPLETE

2024 PALS COMPLETE

Pediatric Advanced Life Support - Request Form
The American Heart Association (AHA) strongly promotes knowlege 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 fee 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:
PALS Complete: Assignments are made at the beginning of your expiration month. If you expire in January, you will be assigned no later than January 5th. You will have until the end of the assigned month to complete assignment. If you submit the request any other 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 are: nursing.education@childrensal.org or call (205) 637-9127.

UAB or other non-Children's affiliates are required to pay $195.00. Check made payable to Nursing Education must be received before accesss to nline module is made available.
I have read and understand the instructions in this form
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