Instructor Alignment Request

Full name

Phone number

Email address

Current instructor status

Active Instructor

Instructor Candidate

Expired Instructor

Instructor discipline

BLS Instructor

Heartsaver Instructor

Both

Other

Current training center or training site

State of residence

Are you transferring from another training center or training site?

Yes

No

Instructor experience and alignment needs

Upload instructor card

Upload your file

Choose a file or drag and drop one here.

Please upload an image or document of your instructor card.

Upload state ID or driver's license

Upload your file

Choose a file or drag and drop one here.

Please upload an image or document of your state ID or driver's license.

Instructor Alignment Request