International Training Application

International Training Application

The American Heart Association appreciates your efforts to spread the mission of the AHA around the world. We are dedicated to the development of high-quality AHA training programs. This form provides the initial information required to evaluate requests by instructors that wish to conduct AHA courses outside of their home country. Incomplete forms will not be processed and will result in a delay of approval. Allow 4 weeks for processing.
Date the form was complete

MonthDayYear
Requesting Instructor Information
Name (required)*

First NameLast Name
Street Address (required)*
Street Address 2
City (required)*
State
Postal / Zip Code
Country
AHA Status (required)*
E-mail Address (required)*
**At least one contact number is required**
Mobile (Cell)

Area CodePhone Number
Both sides of instructors’ cards should be emailed to ECCInternational@Heart.org
or you can upload the files here.
Office Phone

Area CodePhone Number
Upload a File

Upload a File

Cancelof
Sponsor Training Center Information
TC Name (required)*
Coordinator (required)*

First NameLast Name
Street Address (required)*
Street Address 2
City (required)*
State
Postal / Zip Code
Country (required)*
E-mail Address (required)*
Mobile (Cell)

Area CodePhone Number
Office Phone*

Area CodePhone Number
Course Location Information
(Be as specific as possible)
Location (required)*
Local Contact (required)*

First NameLast Name
City (required)*
Country (required)*
E-mail (required)*
**At least one contact number is required**
Mobile (Cell)

Area CodePhone Number
Office Phone

Area CodePhone Number
Additional Course Information
(Be as detailed as possible)

List each course individually. Every column in the table below must be completed (i.e. Course Date, Type, etc..)

	Course Date	Type (Choose from the following: ACLS, BLS, HS, PALS, PEARS)	Instructor or Provider	Language	# of students	Names of additional instructors (please copy cards as noted above)
1.
2.
3.
4.
5.
6.

List all equipment that will be used. Instructor manuals should be consulted for complete equipment lists. Describe how you will obtain the equipment (i.e. shipped from U.S., on-site already, etc.)

List the number of Manuals purchased and the dates of when they will be given to students.

	Manual (Choose from the following: ACLS, BLS HCP, Heartsaver, PALS, PEARS)	Number Issued	Date Issued to Student	Manual Language
1.
2.
3.
4.

Submission Instructions

For faster processing, ask your Training Center Coordinator to send an email approving the course and accepting responsibility for course quality, monitoring and issuing course completion cards as outlined in the Program Administration Manual. Within 4 weeks of course completion, the following must be submitted via email to eccinternational@heart.org : copies of course rosters, photos of the training illustrating equipment used, students with provider manuals and venue.

Requesting Instructor Information

Sponsor Training Center Information

Course Location Information

Additional Course Information

Submission Instructions