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LAVECCS 2022 Instructor Certification Application Form
Thank you for your interest in certifying as a RECOVER Certified BLS and ALS Instructor. Due to the high demand on this workshop and the need to maximize every opportunity to increase our reach, the instructor certification sessions have an application process.
The process follows these steps:
1. Submit your basic information (this form) by July 10.
2. A RECOVER Guidelines knowledge assessment will be sent out to eligible candidates by July 12, and will be due by July 26.
3. Registrants that qualify for the instructor certification session will be notified on steps to complete the registration process by Aug 1st.
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First Name
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Your answer
Last Name
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Your answer
Credentials
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Your answer
Email Address
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Your answer
Please confirm your Email Address
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Your answer
Secondary Email Address
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Your answer
Confirm your secondary email address
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Your answer
Primary Organization
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Your answer
Secondary Organization (if any)
Your answer
Certification Status (You must be a BLS and ALS Rescuer to qualify)
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Online BLS and ALS Completed
RECOVER Certified BLS and ALS Rescuer
None of the above
License/Credential Status
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You must be a licensed or credentialed as a veterinary professional to qualify
Licensed Veterinarian or Veterinary Surgeon in your country
Credentialed Veterinary Nurse or Technician in your country
Licensure/Credential Jurisdiction (State, Province, etc)
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You must be a licensed or credentialed as a veterinary professional to qualify
Your answer
Licensure/Credential Number
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You must be a licensed or credentialed as a veterinary professional to qualify. Enter "N/A" if your country does not have an ID system
Your answer
Previous Teaching/Training Experience
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Academic Institution Instructor
Clinical Trainer
Other:
Required
How many years of previous Teaching/Training Experience above?
Your answer
Affiliation with any groups of relevance
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Any affiliated organizations you may conduct training for (e.g. practice groups, academic institutions, veterinary organizations, etc)
Your answer
Planned frequency of holding workshops
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1-2 times a year
3-4 times a year
5-8 times a year
More than 8 times a year
Do you have any existing plans to hold workshops in 2022?
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Your answer
Any other relevant information
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Your answer
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