Clinical Training Center - Instructor Renewal Page

Clinical Training Center - Instructor Renewal Page

Please submit this form at least 60 days before your current expiration date.
This form is used to submit your request for American Heart Association instructor status renewal to the CTC. In order to eliminate delays in proccessing please complete all fields and submit the required documentation with your renewal request at least 60 days before your status expiration date. We proccess Instructor renewals the last week of each month- so please plan ahead.

You must submit a seperate application package for each dicipline that you wish to renew.
Name *

First Name Last Name post-nominal
Email *
example@example.com
Phone Number

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Type of instructor Certification *
Current Expiration Date *
Step 1: The Heart Association requires instructors to teach (Or assist teaching) four classes in the selected dicipline every two years. Please provide the details of four of these classes on your instructor renewal checklist. (Please do not ask for us to look classes up- we do not maintain these records).
Step 2: Take the Provider level written exam for the dicipline that you wish to renew. Please scan and upload the answer sheet. You will be asked to demonstrate your provider level skills at your monitoring session. (When the renew packet is proccesses, we will issue you a provider level card as well.).
*

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Step 3: You must be monitored teaching a class in each dicipline you wish to renew by a CTC Training Center Faculity Member within 2 years of your renewal date. Please scan and upload the completed and signed monitoring form,
*

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Cancel of
Step 4: Complete and upload the AHA Instructor/Training Center Faculty Renewal Checklist. Please ensure that all applicable fields are filled out, and that you have signed the form.
Upload Completed Instructor/Training Center Faculty Renewal Checklist *

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Step 5: By clicking the submit button below, I swear/affirm that all of the information I have supplied in this renewal package is truthful and accurate, that I will continue to abide by the rules and regulations set forth by the American Heart Association in the Program Administration Manual (PAM) as welll as the policies of the Clinical Training Center at Boston medical Center.

Additionally I confirm that for all classes that include adult CPR that I will utilize Adult CPR manikins that provide instrumented feedback.
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