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American Red Cross Authorized Provider Request for Blended Learning Offering American Red Cross Authorized Providers should use this form when requesting a "Blended Learning course". This form will provide the American Red Cross Team the information necessary to create the offering and provide customers with a link to access the online training. One Class Request Per Form. All fields must be completed. Email completed form to: firstname.lastname@example.org Requestor's Information First Name: Last Name: Title: Phone Number E-mail Authorized Provider Information Business/Organization Name: Organization ID (if known): Billing Address: Billing City: Billing State: Billing Zip: Authorized Provider Contact Name: Contact Phone Number Contact e-mail address Contact Fax Number Offering Request Information Course offering being requested: Start date (earliest date for students to access training): Date of Skill Session Start Time of Skill Session End Time of Skill Session Number of students who wil be attending offering: Where will training take place? Name of Site Address: City: State: Zip: County: Directions to request Blended Learning Class When completed, e-mail form to email@example.com with "Blended Learning TSC Use Only Request" in the subject line. Please allow 2 business days for processing of all requests. Agent Name Once the class is set up, the contact on the request will receive an Offering ID and a deep Date Processed at TSC link that students can use to enroll in this class. You may request one offering per form. After your organization has completed the classroom portion of this offering, please email Offering ID your course record to firstname.lastname@example.org with "Completed Blended Learning Date ID sent to Customer: Class Info" in the subject line. NOTE: You will need to reference the Offering ID number Agent Comments: on course record and any correspondence referencing this class.
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