AHA Instructor Candidate Application

This form is to be used by those who want to become an American Heart Association instructor under Love Health Service. Please note this is a competitive process because instructors are to be role models in their chosen discipline. Not everyone who submits an application will be approved.Though approved applications are kept on file for up to six months.

It is important for you to fill in as much information as possible (and upload a copy of your current provider card) or your submission will be outright rejected. Please note there is a non-refundable fee associated with this process and the fee is charged for each submission. We will send you additional information upon successful submission and payment.

Current Experience(*)
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Choose the content/topic area that most applies to your current experience.

Current Experience Other Information
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First Name(*)
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Last Name(*)
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Credentials (MD, RN, EMT, etc.)
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Street Address(*)
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Street Address 2
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City(*)
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State(*)
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Zip Code(*)
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Main Phone(*)
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Fax
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Email(*)
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Email is our primary communication method with you.

Type of Instructor You Want To Become(*)
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Push and hold ctrl key to choose several choices. Generally we teach both Heartsaver and BLS in the same instructor course.

Please share how the instructor role will fit into your goals(*)
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What is the expiration date of your AHA CPR Card
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A current provider card (issued by the AHA) is required if you want to become an Heartsaver and/or BLS Instructor.

What is the expiration date of your AHA ACLS Card
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A current provider card (issued by the AHA) is required if you want to become an ACLS Instructor.

What is the expiration date of your AHA PALS Card
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A current provider card (issued by the AHA) is required if you want to become an PALS Instructor.

Upload Heartsaver/BLS CPR Provider Card
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A current provider card (issued by the AHA) is required if you want to become a Heartsaver or BLS Instructor.

Upload ACLS Provider Card
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If you are choosing this discipline, a current provider card (issued by the AHA) is required to become an instructor.

Upload PALS Provider Card
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If you are choosing this discipline, a current provider card (issued by the AHA) is required to become an instructor.

Testing Policy(*)
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Instructor potential is verified by various methods. One of those methods is by taking the provider written exam or showing you know your stuff. If you cannot truly show you know the provider level content, Love Health Service reserves the right to deny the completion of your instructor status and send you home.

Instructor Status(*)
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I understand there is no guarantee I will receive Instructor Status and our Training Center has the final authority to approve or disapprove your application. I also understand there may be a charge to become an instructor and this fee is not associated with the American Heart Association, nor does the American Heart Association make a profit off of the fees charged.

AHA Instructor Application Fee

$15.00

Total
0.00 USD

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