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Course Catalog
Current Students
About Great Brook
Help Desk

MENUMENU

Course Catalog
Current Students
About Great Brook
Help Desk

Course Request

Course Request Form

to request ECSI courses

Instructor Name(Required)

First Last

Instructor Email(Required)

Phone(Required)

What course are you requesting(Required)

What type of course presentation will you provide?(Required)

Start Date of Training(Required)

MM slash DD slash YYYY

End Date of Training(Required)

MM slash DD slash YYYY

Start Time of Training(Required)

Hours

:

Minutes

AM/PM

How many students in the class?(Required)

Will students pay for their own access to the online course?(Required)

YES

NO

What will you need for supplies?

No Supplies needed

Adult Manikins

Infant Manikins

AED Trainers

BVMs

First Aid supplies

Textbooks (for initial Certification students)

Guidebooks (for refresher students)

Are these initial certification or refresher students?

Initial Certification

Refresher Certification

No Certification - Informational only

How would you like to pick up your class materials?

What else do we need to know about your course?

Instructor Resources Page

Instructor Resources

Great Brook Academy 286 Henniker Street Hillsborough, NH 03244