Certified Instructor Application

Please complete all the questions on this application. This information will be sent to the CIW Certified Instructor (CIW CI) Program Department when you press "Submit".

* = Required fields

 
Applicant Information:

* First Name

 Middle Name

* Last Name

* E-mail address

* Mailing Address 1

   Mailing Address 2

   City

   State/Province
   Country         

   Postal Code

*  Phone Number

   Fax Number
 
Company Information:
CIW ATP ID Number:
(optional)

*  Company Name

   Company Address 1

   Company Address 2

   City

   State/Province

   Country

   Postal Code

   Phone Number

   Fax Number
 

Employer Information:

Current employment status: (select one of the following options) **
I am employed by a CIW Authorized Training Partner (CIW ATP) or CIW Authorized Academic Partner (CIW AAP)
I am employed by a company offering CIW courses (currently not a CIW ATP or AAP)
I am a Contract Instructor
Other

Applicant Class Attendance Status:
Have you attended the CIW Foundations Course? ** Yes No     
Have you attended a CIW Faculty Institute class? (bootcamp, online or hybrid) ** Yes No     
If Yes, please provide the location, instructor name, and date:
Please send proof of course attendance via fax to the CIW Certification Department at +1602-794-4190
This is required of all CIW applicants unless you are a certified technical instructor (for instance an MCT, CTT or CNI) or a CIW Professional. See the CIW CI Program Guide for more details.

Applicant Certification Testing Status:
Have you passed a CIW Exam? ** Yes No     
Which exam(s) have you passed?
We will verify your exam history in the CIW Candidate Information Center

Applicant Certification Agreement Status:
Have you completed the CIW Certification Agreement? ** Yes No     
    If not, you will need to do so after completing this application. We will verify our Agreement in the CIW Candidate Information Center.

Applicant Instructional Skills Status:
Do you have more than 1 year of experience as a Technical Instructor? ** Yes No     
Have you attended a Train-the-Trainer course? ** Yes No     
Do you currently hold an Instructor Certification through another program (e.g. MCT, CTT, CNI)? ** Yes No     
    If yes, please specify: 
Please send proof of your instructional skills via fax to the CIW Certification Department at +1 -602-794-4190.
    This can include a technical instructor certificate or transcript, a Train-the-Trainer Certificate, an accredited teaching certificate, or a combination of a resume, 2 letters of recommendation and 10 student evaluations.

I verify the content of this form to be accurate and complete to the best of my knowledge.

  
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