Certified Fundamental Swim Instructor Attestation Form
Instructor Name:
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First Name
Last Name
Instructor Email
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*copy of form will be emailed here
Swim School or Org Name:
Instructor Desired Behaviors:
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Rows
Yes
Instructor is welcoming, positive, and encouraging to students.
Instructor is Professional.
Instructor demonstrates and executes a thought out lesson plan in alignment with the curriculum.
Instructor individualizes activities and language to meet the needs of swimmers.
Instructor Teaching Competency:
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Rows
Yes
Safety is always at the forefront of this instructor’s mind and evident while teaching.
Positive behavior management techniques are used to manage classes.
Individualization of skills to meet the needs of different learners is present.
Instructor manages time well: gives equal time to students and plans well, ensuring enough time to meet goals is evident.
Instructor makes corrections using a variety of means: verbal, physical, and modeling.
Overall, this instructor’s swim lessons flows, class is managed appropriately, learning is happening and the environment is positive.
Instructor In-Water Experience:
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Rows
Yes
This instructor has completed at least 30 of in-water swim instructor training.
Is the applicant applying for the CFSI with Curriculum Endorsement? (required in some states)
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Yes
No
CFSI with Curriculum Endorsement Additional Requirements:
You are required to answer these additional questions if the applicant is seeking a CFSI with Curriculum Endorsement. Please attest you have witnessed the instructor do the following:
Infant & Toddler Level 1:
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Rows
Yes
Arm’s Reach Supervision
Clear Submersion Cueing
Respect for Child Comfort
Warm Welcome & Rules Review
Water Familiarization Activities
Supported Backfloat Instruction
Safety Skills Taught/Reinforced
Positive Reinforcement
Predictable Closure Routine
Professional Parent Coaching
Preschool Learn-to-Swim Level 2:
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Rows
Yes
Arm’s Reach Supervision
Maintains constant visual contact
Uses safe entry and exit techniques
Monitors for fear, fatigue, distress
Guides gentle face dips (2–3 seconds)
Never forces submersion
Provides consistent cues and routines
Adjusts for individual comfort levels
Keeps children engaged and participating
Ends lesson with positive closure and recap
Foundations & Fundamentals Level 3:
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Rows
Yes
Maintains visual contact with all swimmers
Gives clear safety instructions
Monitors fatigue and allows rest breaks
Teaches streamline push-offs and flutter kicks
Demonstrates and corrects underwater pulls
Teaches swim-float-swim and rollovers
Introduces elementary backstroke with clear cues
Practices dolphin kick fundamentals appropriately
Uses positive reinforcement and encourages effort
Adjusts instruction based on individual needs
Beginning Stroke Development Level 4:
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Rows
Yes
Maintains visual supervision at all times
Keeps swimmers spaced and safe
Provides clear safety reminders
Demonstrates accurate stroke technique
Freestyle with side breathing included
Backstroke drills included
Dolphin dives practiced safely
Breaststroke/butterfly kicks introduced
Offers encouragement frequently
Ends lesson with positive closure and recap
Stroke Development and Endurance Level 5:
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Rows
Yes
Actively supervises all swimmers
Reviews safety rules (circle swimming, entries)
Teaches proper technique for all four strokes
Uses drills appropriate for Level 5
Gives pacing tips (“start slow to finish strong”)
Monitors swimmers’ stamina
Encourages effort and progress
Uses games and challenges to reinforce skills
Manages group transitions smoothly
Has a clear lesson plan
Side Stroke Mini-Curriculum Level 6:
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Rows
Yes
Instructor stays within reach of swimmers in deep/shallow water
Reinforces side stroke as a survival/safety stroke
Teaches proper side floating body position
Demonstrates and corrects scissor kick form
Uses "pull ➔ glide ➔ kick ➔ glide" rhythm cues
Follows lesson sequence (intro ➔ drills ➔ practice ➔ cool down)
Gives clear, simple instructions and visual models
Adjusts pacing to swimmer needs
All swimmers are active and engaged
Encourages calmness and rhythm over speed
Instructor Demonstrates The Ability to Perform The Following Swimming Skills:
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Rows
Yes
Front Crawl – 25 yards
Back Crawl – 25 yards
Breaststroke – 25 yards
Elementary Backstroke – 25 yards
Sidestroke – 25 yards
Butterfly – 15 yards
Back float for 60 seconds (floating or sculling)
Tread water for 60 seconds
Survival float for 60 seconds
Based on my knowledge of this instructor’s competency, I believe this instructor meets the USSSA standards regarding what is expected to be a certified instructor. I do attest that this information is true, accurate and complete to the best of my knowledge
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Print Name
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First Name
Last Name
Title
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Email
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*copy of form will also be emailed here
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