Revised 6.2019
Completed Roster and support documents sh ould be mailed or emailed to hcc.tc.instructor@gmail.com
LeAnn Bravi, TC Director, Hutchinson Community College,
1809 Essex, Hutchinson, KS 67501
*Checking the no books box verifies that the students own and possess a book before, during and after class.
Name:
Course Date (s):
Instructor ID:
Course Times:
Address:
Feedback Device Used
ACLS Heartcode ACLS
Email:
Basic Life Support BLS Renewal Heartcode BLS
Phone:
Family/Friends
Course Location:
Other Course Name:
Number of students:
Bloodborne Pathogens
Assistant Instructor Name:
Heartsaver CPR AED
Child CPR Infant CPR Exam
Bill to:
Heartsaver First Aid
Exam
Heartsaver First Aid CPR AED
*No Books or Replacement Books to:
Child CPR Infant CPR Exam
Heartsaver for K-12 Schools (must include adult)
Child CPR Infant CPR Exam
First Aid
Heartsaver Pediatric First Aid and CPR AED
Manikin to student ratio:
First Aid Child and Infant CPR Adult CPR Exam
Asthma Care Video
Hutchinson Community
College
AHA Training Center
Revised 6.2019
Instructor name: Course Roster Must be typed Course:
Date: Participant Information Location:
First and Last Name
Individual Email
Phone number
Test
Score
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Revised 6.2019
Instructor name: _ Course Roster Course: _
Date: _ Participant Information Location: _
First and Last Name
Print clearly!
Individual Email
Phone
number
Test
Score
1.
2.
3.
4.
5.
6.
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12.
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