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Course Disciplines

Session Information

Candidate Information

It is suggested that you use an email address that can be permanently accessed, i.e, a personal email address.

EMS Affiliation

(First Responder, ECP, EMR, EMT, AEMT, Intermediate EMT, Paramedic)
Choose your current certification level. If your certification is not listed or you are not certified as a healthcare provider, select the "Other" option. If you are not certified please enter "N/A" in the Other field.
County where you perform your primary EMS duties

AHA Instructor Information

Complete this section if you are currently an AHA instructor in other disciplines or if you already have an established AHA Instructor ID number.
This only applys to current and former AHA instructors.
Enter your AHA Instructor ID # if you have already been assigned one, otherwise leave blank.

Company Information

Course Pre-requisites

AHA requires all instructor candidates to be 18 years of age at the time of course participation.
The expiration date on your AHA card shows a month/year. In this field enter the last day of the month indicated on your official AHA certification. If you are not current as an AHA BLS Provider you must obtain your provider certification and provide proof to the BREMSS TC prior to the date of your course.
Allowed file formats: .jpg, .jpeg, .zip, .rar, .png, .bmp, .pdf, .docx, .doc, .pptx, .ppt, .mp4, mp3, m4a, wav, .ics, .webp, .gif, .xlsx, .xls, .csv Maximum file size: 20Mb
Upload a current copy of your AHA BLS Provider Certification. If you are not current as an AHA BLS Provider you must obtain your provider certification and provide proof to the BREMSS TC prior to the date of your course.
The expiration date on your AHA card shows a month/year. In this field enter the last day of the month indicated on your official AHA certification. If you are not current as an AHA ACLS Provider you must obtain your provider certification and provide proof to the BREMSS TC prior to the date of your course.
Allowed file formats: .jpg, .jpeg, .zip, .rar, .png, .bmp, .pdf, .docx, .doc, .pptx, .ppt, .mp4, mp3, m4a, wav, .ics, .webp, .gif, .xlsx, .xls, .csv Maximum file size: 20Mb
Upload a current copy of your AHA ACLS Provider Certification. If you are not current as an AHA ACLS Provider you must obtain your provider certification and provide proof to the BREMSS TC prior to the date of your course.
The expiration date on your AHA card shows a month/year. In this field enter the last day of the month indicated on your official AHA certification. If you are not current as an AHA PALS Provider you must obtain your provider certification and provide proof to the BREMSS TC prior to the date of your course.
Allowed file formats: .jpg, .jpeg, .zip, .rar, .png, .bmp, .pdf, .docx, .doc, .pptx, .ppt, .mp4, mp3, m4a, wav, .ics, .webp, .gif, .xlsx, .xls, .csv Maximum file size: 20Mb
Upload a current copy of your AHA PALS Provider Certification. If you are not current as an AHA PALS Provider you must obtain your provider certification and provide proof to the BREMSS TC prior to the date of your course.
Allowed file formats: .jpg, .jpeg, .zip, .rar, .png, .bmp, .pdf, .docx, .doc, .pptx, .ppt, .mp4, mp3, m4a, wav, .ics, .webp, .gif, .xlsx, .xls, .csv Maximum file size: 20Mb
Candidates must provide either verification of instructor potential or a letter from your employer or agency requesting admission to the AHA Instructor Essentials Course and verifying that you meet the prerequisite skills and knowledge pertaining to the requested discipline. A letter from the AHA lead instructor from the candidates most recent provider course verifying instructor potential may be used to meet this requirement. This must be received by the BREMSS Training Center prior to processing of this application.

Instructor Commitment: As an AHA Instructor, I agree to

All statements must be accepted to continue the application process.
I agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.
By signing this form, I attest that all information submitted is true and accurate to the best of my knowledge. Falsification of any of the above information will result in dismissal from the course as well as revocation of any other certifications aligned with the BREMSS Training Center.
Important information

*Completion of this application does not guarantee acceptance into the BREMSS AHA Training Center, nor does it guarantee availability in your desired course or session date. Your session date is not finalized until you have officially been accepted and you have completed the official course registration. 


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