Transfer Instructor Alignment
Fill out the form carefully for us to be able to see if we are the right fit for you!
Name
*
First Name
Middle Name
Last Name
Are you 18 years or older?
*
Please Select
yes
no
Do you have a current BLS provider card?
*
Please Select
yes
no, i am willing to get one
no
Current certifying organization
*
Please Select
American Heart Association
American Red Cross
HSI
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Format: (000) 000-0000.
Instructor ID number
*
Expiration date of instructor certification
*
How many classes have you taught in the past 12 months?
*
Please Select
0-4
4-8
8-12
12+
Do you currently teach independently?
*
Please Select
Yes
No
Are you willing to follow RN CPR administrative policies and guideline updates?
*
Please Select
Yes
No
I understand alignment investment is $75 and includes 5 complimentary BLS cards issued after my first completed class.
*
Please Select
Yes
No
As a BLS instructor you will be required to purchase equipment that is required by the AHA prior to teaching a course.
*
Please Select
I understand
That is not what I want to do
I have more questions
By becoming a BLS instructor with RN CPR you will be required to teach by the AHA standards and the guidlines set by RN CPR
*
Please Select
I understand
That is not what I want to do
I have more questions
Do you understand alignment approval is not automatic?
*
Please Select
Yes
No
Have you ever had instructor status revoked or suspended?
*
Please Select
Yes
No
Were you referred by an RN CPR instructor? If yes, list their name.
*
Reason for seeking transfer
*
Current training center name
*
Anything else we need to know?
Submit
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