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Course Type
Important information

Select the course in which you are currently afiiliated with as an instructor. 


Enter the course approval number of your affiliated course. This can be obtained from the course coordinator if the course is already regionally approved. (i.e. 23-AEMT-R3-999)
This is the name of the organization conducting the course.

Contact information

It is suggested that you use a personal email address that you will always have access to.

Employer information

Instructor Role

Check all that apply. Please verify that you meet all instructor requirements for your designated role.

Certification Level

Check the box of your certification levels. (Must provide a copy of the certificate)

Primary and Secondary Instructor Certification

(Must provide a copy of the certificate)

Education Certifications

(Must provide copies of certificates)

Pre-Hospital Care (Field) Experience

Documentation

Upload all supporting documentation
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
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
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

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