AHA Instructor Information Request
Tell us a little about yourself so we can see if we're a good fit for you. This form is for current AHA Instructors looking to transfer or additionally align with our AHA Training Center.
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Instructor Certifications do you hold?
Heartsaver
ACLS
BLS
PALS
Your AHA Instructor ID number and recommended renewal date
*
Why would you like to join our Training Center?
How many people do you train annually?
Your business name and website (if you have one)
Your business social media accounts (if you have them)
Your current Primary Training Center, their TCID, and contact information
Name and Contact Information for your current Training Center Coordinator or Training Site Coordinator.
Do you have additional alignments besides your Primary Alignment? If you do, what other alignments do you hold? Please include their TCID or TSID.
Please upload a copy of your current instructor eCard(s)
*
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What other Instructor Certifications do you hold?
Please sign to confirm that the information you have entered is accurate and true
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