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AIHCP, Inc. 2400 Niles-Cortland Rd. SE, Suite # 3 Warren, Ohio 44484

I, the undersigned, verify that this application is complete, and to the best of my knowledge, all information provided is factual and true. I understand that failure to provide the needed information and required documentation could likely lead to delays in the review of this application. By clicking the "submit" button below, I acknowledge that I understand that this application demonstrates my willingness to be reviewed for consideration as course author/course instructor for continuing education courses, hosted by the American Institute of Health Care Professionals, Inc. I understand that this is a request for review at this time and does not imply actual acceptance as a course author/instructor or a contract. I also understand that following review of my application and any other requested documents, I will receive follow up and communication by the administrative staff of AIHCP, Inc.