CPR Instructor Sign-Up
Complete this form to share your certification details and availability—we’ll contact you about instructor opportunities.
Basic Requirements
Full Name
*
First Name
Last Name
Date of Sign-Up
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
City and State
*
Are you currently certified to teach CPR?
*
Yes
No
In Progress
Which instructor organization(s) are you certified with?
*
American Heart Association (AHA)
American Red Cross
Health & Safety Institute (HSI)
Not currently instructor-certified
Other
Instructor Certification Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload current instructor certification card(s)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Current CPR/BLS Provider Certification
*
AHA
American Red Cross
HSI
None
Other
Teaching availability
*
Weekdays
Evenings
Saturdays
Sundays
Do you have reliable transportation?
*
Yes
No
Briefly describe your CPR teaching experience or interest
*
Submit Instructor Interest Form
Should be Empty: