New Independent Instructor Application

CITY OF CORAL SPRINGS TRAINING CENTER

Independent Instructor Application

Tell Us About Yourself

An Independent Instructor is a single instructor who operates outside of the TC with any two (2) of the following:
• Has own equipment
• Develops, advertises and conducts most, if not all, courses at a location separate from the TC
• Is a separate business, organization, etc. from the TC

The major difference between the Training Site and the Independent Instructor is the number of employees. An Independent Instructor is just that; a single instructor who conducts his/her own business solo. The roster will have a minimum of 3 students but never exceed 6 students and another instructor will never appear on the roster.

Program

First Name

Last Name

Cell Phone

Street

Unit #

City

State/Province

Zip/Postcode

Tell Us About Your Business

Please complete all information below.

Business Name

Liability Insurance Declaration Page

Instructor ID #

BLS Instructor Card

BLS Instructor Expiration Date

PALS Instructor Card

PALS Instructor Expiration Date

ACLS Instructor Card

ACLS Instructor Expiration Date

Is the City of Coral Springs Training Center your Primary Alignment?

Yes No Not Selected

If we are not your Primary Alignment, please indicate who you are aligned with.

Date of Application

Thank You

Submitting this application does not constitute a binding agreement. This is only an application.

Thank you for requesting alignment with the City of Coral Springs Training Center. Upon submittal of this application, the Training Center Coordinator will review your application and respond back to you. Please allow up to 3 business days for a response.

Should you be accepted, you will be required to complete an Instructor Alignment Agreement in which you will complete detailed information about your business, your materials, and your equipment. You will have a 72 hour window in which to complete the agreement before it expires.

4180 NW 120th Avenue ♦ Coral Springs, Florida 33065