Forms

These forms may be downloaded and copied
for use by instructors.

AHA Course RosterEffective July 1, 2011:
Page 1              (Note: You must always turn in Page 1 & Page 2
Page 2               regardless of how many participants you have.)
***Your rosters will be returned if you do not turn in Page 2 with signature***

Important Information for Our Instructors

It is imperative that all participants in a class receive a card upon successful completion (except for CPR-Family & Friends where no cards are issued).  Only then should their names appear on a roster.  If a participant needs only to refresh his skills for his employer/agency, and will not receive a card, do not add his/her name to the roster.  Instructors will receive credit for the class taught and the number of participants who are issued cards.

Page 1 Supplement - List of extra instructors (May be used in conjunction with Page 1, but not on its own) Strongly recommended for ACLS & PALS Courses
Page 2 Supplement - List of additional students (May be used in conjunction with Page 2, but not on it’s own.)

Instructor Monitoring Form – Must be completed by TC Faculty or TC Coordinator

Instructor Candicate Application

Instructor/TCF Teaching Activity Notice to Primary TC

Instructor Records Transfer Request

New Affiliation Application

BLS Course Evaluation Form

First Aid Course Evaluation Form  

Heartsaver Evaluation Form

  Alternate Course Evaluation (for Students to contact ECC)


***INSTRUCTORS MUST HAVE EACH STUDENT TO COMPLETE A COURSE EVALUATION IN EVERY CLASS.  A SUMMARY OF THE EVALUATIONS, ON ONE PAGE, MUST BE INCLUDED WITH EACH ROSTER.*********

The above link contains an alternate form that students can submit with comments to the Instructor at course end, or if they prefer, they can mail this form directly to the TrainingCenter and/or the Regional ECC Office at:

ECC-AHA
1100 East Campbell Road
Suite 100
Richardson, TX  75081

ACLS, PALS & Instructor Course Requirements

You must submit a Course Approval Form no later than 30 days prior to an ACLS, PALS or Instructor course.

 Course Approval Form – Please note tabs at bottom of screen.  Fill out appropriate form for ACLS, PALS or BLS Instructor Courses

Once you have received approval for your course you must turn in the following or your rosters will be returned:

•  AHA Rosters Pages 1 & 2
•  Complete list of instructors and topics taught (we
    strongly recommend you use the Page 1 Supplement  
    for this)
•  Summarized Course Evaluation - please do not send us
    individual evaluations from your students (See sample
    evaluations below)
•  Course agenda if different from agenda turned in with
    original Course Approval Form

********CALLTRAININGCENTER FOR SAMPLES**************

Quick Reference

Community Training Center
Kathy Nelson
Regional Training Center Coordinator

336-716-7847

Daphne Southard
Program Assistant

336-716-6457

Fax

336-716-6467

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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.