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 NRP Instructor Registration Form 

The NRP Instructor is designed for the NRP Provider that has demonstrated excellence in NRP concepts and has a desire to achieve instructor status. The NRP Instructor course consists of two parts.  Part 1 includes completing online lessons and simulations.  Part 2 consists of coming to a NRP Provider course and being monitored as you teach.  You must be monitored twice and pass both sessions before you receive Instructor status.  


1.  Have an active NRP Provider Card for all lessons (required).

2.  Be a physician, registered nurse, nurse practitioner, respiratory care practitioner, or physician assistant with experience in the hospital care of newborns in the delivery room (required).

3.  Have current maternal-child educational or clinical responsibility within a hospital setting (required).

4.  Have ongoing delivery room neonatal experience (recommended).

 Required to Gain Admittance to the Course:


  •  Copy of current NRP provider card.  This card copy must be received before materials can be given out. 
  •  Evidence of current training and experience in the hospital care of newborns in a delivery room, newborn, or critical care nursery setting. The ideal instructor will have ongoing delivery room experience.  Those who may qualify for hospital based instructor include: MD, DO, PA, RN, RT. 
  • Have educational or clinical responsibilities within a hospital or other appropriate medical facility (medical school or nursing school). 



Employees  $150

*Refunds will not be given if you are unable to attend this class. Please do not pay for a class unless you are prepared to attend the class date that you have scheduled. If unable to attend your scheduled date, we will gladly move you to a different day that will work with your schedule.

Are you an Employee?
If YES, are you a NCBH, WFUHS, Cornerstone, Community Physicians, Wilkes, or Travel Nurse?
If NO, place of employment?
Last Name  
First Name  
Middle Initial  
Employee ID  
Credentials (MD, RN, etc)  
City and State  
Zip Code  
Phone Number  
If an Employee, Manager Name / Department  
E-Mail Address  
Method of Payment:

Employee  $150
If payment will be by check, please mail to: 

Department of Life Support Education 
Wake Forest Baptist Medical Center 
Medical Center Boulevard 
Winston-Salem, NC 27157
If paying in cash, please deliver in person to the Department of Life Support Education on the 3rd floor South Building. 
If paying by credit card, please call 336-716-2800 or stop by Life Support Education.  
We will notify you of your acceptance as an instructor candidate through the email address you provided.




Quick Reference

Life Support Education
Kathy Nelson

Phone 336-716-2005
Fax 336-716-5927

Contact Kathy

Mikell White
Education Systems Specialist

Phone 336-716-2800
Fax 336-716-5927

Contact Mikell


3rd Floor South Building

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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.

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