CPR Instructor Interest Form
Please complete this form if interested in attending one of our CPR Instructor Courses.
Sign in to Google to save your progress. Learn more
Email *
Name (First, Last) *
Phone Number *
Current occupation? *
Which Instructor Course are you Interested in? *
Do you have teaching experience? If yes how long? *
Are you currently 18 years or older? *
Do you have prior experience with Health, Safety, or Emergency Preparedness Teaching?
Clear selection
Do you have a current AHA, ARC or HSI CPR Card? (Please note that you will be required to have a valid card prior to your Instructor Course) *
Why do you want to become a CPR Instructor?
Upon receipt of this form we will contact you to schedule a short Instructor eligibility review with Training Center Faculty member. In order to schedule faster you can copy and paste the link below in browser to schedule. Otherwise, list 2 options for times to call you. https://calendly.com/kcunclex/kcu-coaching-consultation *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Paula Glynn. Report Abuse