Regional Faculty Application - Checklist
American Heart Association Training Center
1818 Brigham Young
Casper, WY 82604
307-265-2131
Name: _______________________________________________________________
Instructor Candidate Name
Instructor Discipline applying for:
______BLS ______HS _____ACLS ______PALS
YOUR APPLICATION PACKET MUST INCLUDE ALL OF THE FOLLOWING ITEMS:
____ Letter of intent
____ Instructor Candidate Application
____ HUE Instructor Application
____ Instructor Candidate recommendation form
____ Copy (front and back) of your current provider card
____ This Checklist Form as a cover sheet
Send complete application packet to:
Healthy U Educators AHA Training Center
Attn: Karen Merback, TC Coordinator
1818 Brigham Young
Casper, WY 82604
If you have any questions please contact Karen Merback at the Healthy U Educators AHA Training Center, 307-265-2131 or you can email her at karenmerback@
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