BHP Blended Registration Form | Woodfords Family Services

BHP Blended Learning Curriculum Registration Form

Name(Required)

Please type in your full legal name, indicating how it should appear on your certificate.

First Middle or Middle Initial Last

Email(Required)

Phone(Required)

Date of Birth(Required)

You must be at least 18 years old to obtain your BHP certificate.

Last 4 of SSN(Required)

Mailing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Please indicate your highest level of education by selecting an option below:(Required)

You must possess a minimum of a High School Diploma or equivalent to obtain BHP Certification. You will be asked to provide proof of your education below.

School Name(Required)

Graduation Date(Required)

Degree Awarded or Number of Credit Hours Earned(Required)

College Major/Area of Focus (if applicable)(Required)

Additional BHP Training Requirements: Adult & Child/Pediatric CPR/First Aid & Blood Borne Pathogens (BBP)(Required)

If you do not currently posses these trainings, Woodfords will provide you with more information and support in obtaining them.

I am certified in CPR/First Aid and BBP

I am certified in CPR/First Aid

I am certified in BBP

I am NOT certified in CPR/First Aid or BBP

Are you interested in seeking employment as a BHP?(Required)

Yes

Not at this time

Please let us know how you heard about the BHP Training & Certificate Program(Required)

(i.e. social media, adult education, word of mouth, etc.)

Please upload your proof of education documents below. Documents may include a copy of your diploma/GED, transcript, or degree.(Required)

Drop files here or

Max. file size: 700 MB, Max. files: 4.

Signature

Date