Training Site Application

Comments

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Training Site Contact Information

Training Site Business Name:

Legal Structure*

Training Site Coordinator*

First Last

AHA Instructor Status:*

Training Site Coordinator Instructor ID Number:*

Go to http://ahainstructornetwork.americanheart.org – login using your username and password. Your Instructor ID number will appear on left side of page. If you do not have a login, please create one.

Email*

Enter Email Confirm Email

Work Phone*

Mobile Phone*

Physical Address*

Street Address Address Line 2 City State ZIP Code

Billing Address

Billing Address Different from Physical Address

Billing Address

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

Sales Tax

Training site is exempt from sales tax.

Upload Sales Tax Certificate

Max. file size: 256 MB.

Certificate of General Liability Insurance:*

Max. file size: 256 MB.

Courses and Equipment

Requested Disciplines:*

Heartsaver

Basic Life Support

Advanced Cardiac Life Support

Pediatric Advanced Life Support

CPR AED Equipment

Indicate Quantity of Equipment Training Site Currently Possesses:

Adult CPR Manikins

Child CPR Manikins

Infant CPR Manikins

AED Trainers

Pocket Masks / Valves

Adult manikins provide audio and visual feedback of compression rate and depth as required by AHA:*

Heartsaver Equipment

Indicate Quantity of Equipment Training Site Currently Possesses:

Heartsaver First Aid CPR AED DVD (2025 Edition)

Heartsaver Instructor Manual (2025 Edition)

Epinephrine Pen Trainers

Heartsaver Student Manuals (2025 Edition)

BLS Equipment

Indicate Quantity of Equipment Training Site Currently Possesses:

BLS Provider DVD (2025 Edition)

BLS Instructor Manual (2025 Edition)

Adult BVMs

Child BVMs

Infant BVMs

BLS Provider Student Manuals (2025 Edition)

ACLS Equipment

Indicate Quantity of Equipment Training Site Currently Possesses:

ACLS Provider DVD (2025 Edition)

ACLS Instructor Manual (2025 Edition)

Adult Airway Manikin (intubation)

Intubation Kit

ALS Monitor / Simulator

ACLS Provider Student Manuals (2025 Edition)

PALS Equipment

Indicate Quantity of Equipment Training Site Currently Possesses:

PALS Provider DVD (2025 Edition)

PALS Instructor Manual (2025 Edition)

Pediatric Airway Manikin (intubation)

Pediatric Intubation Kit

ALS Monitor / Simulator

IO Needle / Drill Sets

PALS Provider Student Manuals (2025 Edition)

Will the Training Site distribute AHA student workbooks to each student?*

Affiliated Instructors

List All Instructors (exclude Training Site Coordinator)

First Name

Last Name

Instructor ID

HS / BLS / ACLS / PALS

Forecast, Values, Growth Plan

Code One only aligns with Training Sites that share the same values for quality programming and superior customer service. We seek Training Sites that can demonstrate these values through established business plans, policies, procedures, and favorable growth forecasts. Code One wants to help its Training Sites grow, meet customer needs, and exceed their expectations.

Forecast*

If your Training Site is already operating, how many participants have you trained each quarter for the past year? If your Training Site is new, how many participants do you expect to train in the next year? What assumptions have you made to determine this number?

Market*

What is your target market? Who are your primary and secondary customers? What geographical area will you cover?

Quality*

What policies and procedures do you have in place to assure quality of program delivery and to ensure a positive customer experience?

Growth Plan*

Briefly describe your plans to grow your Training Site. How will you accomplish these plans? Include any measurable goals your Training Site has established.