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ACA Upgrade/Removal of Continuation Certification Report
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This form is to be submitted with all associated fees by the IT/ITE of record.  Only one instructor candidate can be certified per report.

All Instructor candidates must be current ACA Members and must be registered with SEIC to receive certification.
Please indicate below the initial certification course dates when the instructor candidate was continued or was initially certified.
As the ACA Instructor Trainer/ITE in charge of this course, I hereby agree that the course was conducted in accordance with all ACA Requirements, risk management, and all other rules, guidelines and conditions established by the ACA. I have read and I fully understand all insurance requirements (if applicable) established by the ACA. I personally inspected the event site(s) and I attest to the fact that such site(s) is/are appropriate for use in this course and free of undue hazards.

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