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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