Training Center Faculty Application

TCF Candidate Name(Required)

First Last

AHA Instructor ID(Required)

Expiration Date of Instructor Card(Required)

Discipline(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Letter of Recommendation from Current TCF

Max. file size: 256 MB.

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As a Training Center Faculty Member, I agree to:

Teach at least 4 provider courses in 2 years

Monitor instructors/instructor candidates/Course Directors in accordance with the guidelines of the AHA

Strengthen and support the Chain of Survival and the mission of the AHA in my community

Conduct myself in accordance with the ECC Leadership Code of Conduct

Avoid any perception of conflict of interest in accordance with the AHA Statement of Conflict of Interest