This application must be completed, signed and the required documents submitted prior to certification. It must be filled out by the applicant and only the applicant.
Failure to provide requested documents will result in your application being denied.
Please print or type all information in the spaces provided. Read each section carefully.
I understand that it is my responsibility to read and utilize Policy 24-04, to receive and maintain my instructor certification.
Initial Application | Looking to start your internship? Select this one.
End of Internship | Select this option if you have completed your internship and need to turn in all your documentation.
Renewal | If you are looking to renew your certification, select this one.
Upgrade | If you need to upgrade your certification to ALS level, selection this option.
Reciprocity | If you are looking for reciprocity from another state into New York, select this option.