Request edit access
CPR Instructor Interest Form
Hi! Thank you for your interest in becoming a CPR instructor. This form is primarily to help me decide on which date the instructor class should be held.
Through completion of this instructor class, you will be an American Heart Association (AHA) certified instructor. The class consists of an online component that costs $40 and takes about three hours to complete. After the online component is completed, the in-person class is six hours and costs $200. You will then be monitored by me (Vivian) while teaching as the last step in gaining your certification card. Becoming a CPR instructor is rewarding and looks great on a resume! If you become certified through NUEMS, it is expected that you teach for us/assist at a class twice per month (this is about an 10hr/month commitment).
Once I compile the responses to this form and determine a date for the class, an official application form will be sent. The deadline for completion of this interest form is midnight Sunday, February 2nd.
If you have any questions about becoming a CPR instructor or what the commitment entails please direct your questions to Vivian, Director of Education at
Please enter your first and last name.
What is your year?
What is your expected year of graduation?
2020 - Spring
2020 - Fall
2021 - Spring
2021 - Fall
How many years have you been a member of NUEMS?
Please select all dates that you would be able to attend the in-person instructor class (it will take about six hours, starting in the morning, likely at 9am).
Saturday, February 22nd
Sunday, February 23rd
Saturday, March 14th
Sunday, March 15th
Sunday, March 22nd
Saturday, March 28th
Sunday, March 29th
Saturday, April 4th
Sunday, April 5th
Any questions or comments?
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Northeastern University.