Instructor Candidate Application

Instructions:  To be completed by the instructor candidate with appropriate signatures.  Complete 1 application for each discipline.

SECTION 1: 

Application for Instructor Status:  Select the discipline you are applying for (select only 1)

Renewal Date of Provider Card:

SECTION 2:

Instructor Commitment:  As an AHA Instructor, I agree to the following:

Thank you for submitting. A member from our staff will be in touch shortly.