(cache)Register Training Center

Basic Informations

SHA Life Support

Training Center Name *

Training Center Address

Coordinator First Name

Coordinator Last Name

Email Address *

Password

Country

Region

City

District

Street Name

Building Number

Postal Code

VAT Number

Phone Number

Website URL

Google Map Link

Accreditation Plan

Upload CR Copy (*.pdf)

Upload Saudi commission file (*.pdf)

Training Center Details

Establishment Date of the Organization

Sun	Mon	Tue	Wed	Thu	Fri	Sat
30	1	2	3	4	5	6
7	8	9	10	11	12	13
14	15	16	17	18	19	20
21	22	23	24	25	26	27
28	29	30	31	1	2	3
4	5	6	7	8	9	10

TC type of Organization (check all that apply)

Corporation

Partnership

Hospital

University

Organization

Government Agency

Other

Is the TC a Subsidiary of a larger Organization?

Yes No

If Yes, please give name of parent organization

Please give full address of parent organization

If TC or parent organization has offices in any other location, list locations

No other locations

Organizational Chart: Submit with this application. Include all positions with names of the people occupying each position. Please ensure that the full names (Not initials) of the people in the following positions are included. (To be uploaded as pdf)

CEO/Chairman/Owner:

CFO/Financial Officer:

President/Managing Director:

1. Describe where the TC will conduct courses? Submit photographs of the TC.

List how many SHA instructors do you have with current SHA Instructor Cards, if any.

Agreements

If “No” is checked for any question in this section, an explanation must be given in the “Notes” field at the end of the section. Failure to include an explanation will result in a rejection of the application.

	Does the TC agree to:	Yes	No
1	Open your courses to the community and all healthcare providers?	Yes	No
2	Issue SHA Course Completion Cards to every student who successfully completes an SHA course?	Yes	No
3	Conduct all SHA courses according to SHA Guidelines without modifications or revisions?	Yes	No
4	Use only the current SHA exams without editing?	Yes	No
5	Submit semiannual (2x/yr) training reports to the SHA?	Yes	No
6	Maintain required records for at least 3 years?	Yes	No
7	Notify the SHA immediately of any TC status change?	Yes	No
8	Adhere to all guidelines of SHA?	Yes	No
9	Maintain the security of SHA Exams, Course Completion Cards and records?	Yes	No
10	Pay all costs for SHA faculty for initial site visit of the TC?	Yes	No

Equipment List

Description	Minimum Quantity Required	Quantity Available	Quantity scheduled to be Purchased
SHA BLS Equipment
Adult CPR Manikins*	1 per 3 students
Child CPR Manikins	Optional
Infant CPR Manikins	1 per 3 students
Pocket Mask	1 per 3 students
Bag Mask, Adult	1 per 3 students
Bag Mask, Child	Optional
Bag Mask, Infant	1 per 3 students
AED Trainer	1 per 3 students

Description	Minimum Quantity Required	Quantity Available	Quantity scheduled to be Purchased
SHA ACLS Equipment (in addition to BLS equipment)
ECG Simulator or Rhythm Generator	1 per 6 students
Monitor/defibrillator w/ cardioversion and TCP	1 per 6 students
ALS Manikins1	1 per 6 students
Airway Manikins2	1 per 3 students

1. ALS Manikins are defibrillatable and accept oral, nasal, and tracheal airways.

2. An ALS Manikin can serve as one of the airway manikins.

Description	Minimum Quantity Required	Quantity Available	Quantity scheduled to be Purchased
SHA PALS Equipment (in addition to BLS equipment)
ECG Simulator or Rhythm Generator	1 per 6 students
Monitor/defibrillator w/ cardioversion and TCP	1 per 6 students
Pediatric/Infant ALS Manikins1	1 per 6 students
Pediatric/Infant Airway Manikins2	1 per 3 students