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UnityPoint Health - Des Moines
Regional & Training Center Faculty Forms

Submit within 2 weeks following an instructor course:

New Instructors

  • Copy of current Provider card (in the appropriate discipline)

  • Course Roster  
  • Participant Form (BLS, Heartsaver Instructor) 

  • Participant Form (ACLS, PALS, PEARS Instructor) 

  • Instructor Candidate Application - on the AHA Instructor Network

  • Alignment Form 

  • Exam Release Form 

  • Monitoring Form - on the AHA Instructor Network

  • Course Evaluation Summary

  • Card Order Form (pdf) or Card Order Form (Word) 

     

    Additional course forms for each discipline's provider skills and written exam answer sheet (if applicable) should also be submitted (i.e. ACLS Provider skills forms, PALS, HCP or Heartsaver).

    * An additional letter of recommendation is no longer required.  The verification of instructor potential can be found on the instructor Candidate application. 

     Note: instructors will have access approved on the AHA Instructor Network when all of the documentation has been received by the Training Center (including initial monitoring).

Renewing Instructors

  • Course Roster  

  • Instructor Renewal Checklist (Instructors only) - on the AHA Instructor Network

  • Training Center Faculty Renewal Checklist  (Training Center Faculty only)- on the AHA Instructor Network

  • Participant Form (BLS, Heartsaver Instructor)

  • Participant Form (ACLS, PALS, PEARS Instructor)

  • Monitoring Form - on the AHA Instructor Network

  • Course Evaluation Summary

  • Card Order Form (pdf)  or Card Order Form (Word) 

Additional course forms for each discipline's provider skills and written exam answer sheet (if applicable) should also be submitted (i.e. ACLS Provider skills forms, PALS, HCP or Heartsaver).


Additional Tools

AHA Course Matrix 

ECC Course Card Reference Guide (New-11/2016)

Meeting Monitoring Requirements for Instructor Renewal - Instructors may now be monitored during online skills sessions.  This can be for new or renewing instructors.  (See November 2016 Newsletter.)

Program Administration Manual - on the AHA Instructor Network 

Resource Sheet  (CTC & AHA contacts, websites, etc.)

Instructor Course Completion Notice to Primary TC



Instructor Alignment

Instructors requesting alignment or transfer of instructor records to UnityPoint Health - Des Moines CTC will need to contact the CTC for further information.