American Red Cross / Advanced Instructor Candidate Application
Part I – Applicant Information
Instructions: Please complete the entire form by downloading and typing or neatly printing the required information. Information provided in this application will be used in the authorization process.
Return the original copy of this application to your point of contact – your State Disaster Officer.
Section 1 – Personal and Professional Data
Name: / Title/Position:
Red Cross Unit: / Dept:
Daytime Mailing Address:
City: / State: / Zip:
Daytime Telephone:
Evening Telephone: / Fax: / e-mail:
Length of service as an American Red Cross employee or volunteer staff member:
I’m applying to become an instructor for the following course: ______
I am currently a basic instructor in the following course(s):
Course / Year Authorized / Number of Times Taught
Education:
 H.S. /  Bachelor's Degree (major) /  Master's Degree (major) /  Other
Section 2 – Background
Please list any courses you are authorized to instruct or facilitate for the American Red Cross, as well as any workshops, orientations, and presentations you may have conducted or facilitated:
Course / Year Authorized / Number of Times Taught
Please list the following information if you have been an educator or trainer/facilitator by profession outside the Red Cross:
Organization / Title / Dates / Location
Disaster Operations Experience:
Date / DR# / Group/Activity/Position
Part II - Instructor Agreement
Performance Improvement Teamagrees to:
  • Act as a consultant to the course sponsors to ensure an effective learning environment for authorized instructor.
  • Ensure course materials are available at FedExOffice DOC Store.

Upon authorization, the instructor agrees to:
  • Actively participate in all course pre-work and training modules.
  • Provide requested feedback to instructor training staff for program evaluation purposes.
  • Instruct at least onetime per year
  • Instruct in the local unit, and other units if requested.
  • Instruct with a co-instructor.
  • Complete all course pre-work and other assignments within deadlines.
  • Complete and submit the training reports toyour Disaster Officer.
  • Actively promote the course.
  • Remain current on Red Cross organizational policies
  • Maintain ready access to CrossNet.
Applicant’s Signature: ______Date: ______
The authorized instructor’s supervisor agrees to:
  • Support the instructor, ensuring availability to instruct at least three courses per year for the next three years and once a year after that.
  • Allow direct contact between the sponsoring unit and the instructor to negotiate teaching assignments. (The instructor will seek appropriate management approval.)
  • Assist the instructor in obtaining ready access to CrossNet.
  • As the supervisor of this applicant, I endorse this candidate’s application to instruct advanced American Red Cross courses.
Supervisor’s Signature: ______Date: ______
Supervisor’s Name and Title: ______
Supervisor’s Endorsement
On your unit’s letterhead, please write a brief statement endorsing the applicant’s potential to successfully function as an advanced instructor. Please describe the applicant’s interpersonal skills, facilitation/presentation skills, sensitivity to diverse populations and attitude in the daily work environment.

Advanced Instructor Candidate Application, 01/09, Page 1