American Heart Association

International Training Center

Application Form

This form is to be completed by the prospective International Training Center (ITC) and
submitted to the American Heart Association (AHA) office. Please complete the entire
application and any attachments in English. Incomplete or handwritten applications will
not be accepted.

Refer to the Program Administration Manual (PAM) International Version for questions
concerning ITC operations. The PAM was included in your application packet.

Country: PAKISTAN
Date: May 12, 2024
Full legal name of ITC: KING EDWARD MEDICAL UNIVERSITY
Initials of ITC (if desired): ITC_KEMU
Legal Physical Address of ITC:
Address Line 1: NILA GUMBAD ( THE BLUE DOME)
Address Line 2: New Anarkali Bazaar
City: LAHORE
State/Province (if applicable): PUNJAB
Postal Code: 54000
Is Mailing Address the same as the Legal Address  Yes ☐No
Address Line 1: NILA GUMBAD ( THE BLUE DOME)
Address Line 2: New Anarkali Bazaar
City: LAHORE
State/Province (if applicable): PUNJAB
Postal Code: 54000
Special Instructions:
Phone Number with Country Code: +92 (42) 99211145-54
Fax Number with Country Code:
Name of Training Center Coordinator (TCC): Hafiz Muhammad Sajid Jehangir
Primary Email Address* (required): ITC_KEMU@kemu.edu.pk
*This email must be accessed on a daily basis and only the TCC can have access to this email inbox.

Secondary Email Address (recommended) ahmaduzairq@kemu.edu.pk

Website Address (if applicable) : https://kemu.edu.pk/

AHA ITC Application January 2023 Page 1 of 15

This application is for the following disciplines (check all that apply):
Note: All AHA International Training Centers must include BLS. Applicants that plan to
offer only Heartsaver programs should select “BLS.”

 Basic Life Support (BLS)

☐ Advanced Cardiac Life Support (ACLS)
☐ Pediatric Advanced Life Support (PALS)
☐ Advanced Stroke Life Support (ASLS)
☐ Neonatal Resuscitation Program (NRP)

SECTION I: ITC Information

1. Establishment Date of Parent Organization: May 1861

2. ITC type of Organization:

☐Corporation ☐Partnership

☐Association ☐Member Organization ☐Sole Proprietorship

 University ☐ Political Organization ☐Government Agency*

☐Other: Enter Description

*Is ITC considered a federal, state, provincial, municipal or other government

authority, ministry, body, agency or instrumentality, or a company or entity owned or
controlled by any governmental authority, ministry, body, agency or instrumentality (a
“Governmental Authority”)? If yes, then select “Government Agency.”
*Government Agencies MUST also complete this box

Organization is regulated by
☐Local Government (State, Emirate, Province, Shire, County, City, Town, etc.)
 National Government (Country, Kingdom, Sultanate, Republic, etc.)
Describe Government Connection:

1. Are there any laws or regulations that would apply to the agreement because a
Governmental Authority is a party, such as procurement or other laws that regulate
any of the following or other matters?  Yes ☐No

Most of the policies are inline with the Agreement. University has to follow these rules and
regulations but most of them do not obstruct delivery of essential health care courses.

AHA ITC Application January 2023 Page 2 of 15

The rules and regulations do not hinder in provision of training to doctors and other
medica staffs.

2. What processes and procedures must be followed for the Government Authority to
enter into the agreement, such as necessary approvals, notices to the public or
third parties, open bidding or other competitive requirements?

None of the above mentioned documents are required. University is

independent of making the decision to establish centers for training young doctors and
other medical staff.

3. Can the agreement be executed on behalf of the Governmental Authority only by

certain specified officers or officials?  Yes ☐No

Vice chancellor of King Edward Medical University has the authority to sign all
such agreements along with the hierarchy of academic council, senate and syndicate of
the university. ( please see the organogram for the university which clearly shows the
system in place to complete such tasks) .

4. Are there any medical licensing or other medical regulations restricting the ability of
a Governmental Authority to carry out the terms of the agreement?

☐Yes  No
5. Are there any special accounting, record keeping or auditing requirements that
could apply to the AHA because it is signing an agreement with a Governmental
Authority? ☐Yes  No
If the answer to any of the above is “yes,” please explain:

3. Is any high-ranking government official or any relative of a high-ranking

government official directly or indirectly involved in the ITC? (For example, is the
ITC under the patronage of a royal or ruling family member?) ☐Yes  No

4. Will the AHA be required to participate in a formal bidding process with your
organization for the training agreement?

 No
5. Is there an internal review or approval process required before the ITC can enter
into an agreement with the AHA?  Yes ☐No

If answered “yes,” please explain:

AHA ITC Application January 2023 Page 3 of 15

 The process of scoping review and approvals from the university
administration was required. All the formalities have been completed and the documents
sent to the AHA have been initiated after approval from the competent authority. ( Vice
Chancellor of the University )

6. What countries do you plan to conduct training in? PAKISTAN only

7. Is the ITC a Subsidiary of a larger Organization? ☐Yes  No

a. If yes, provide the name and complete address of parent organization.

8. If ITC or parent organization has offices in any other location, list all locations,
otherwise check the box.  No other locations

Other Locations

9. Purpose or Mission of ITC or applicable parent organization:

King Edward Medical University will prepare health professionals in

accordance with highest professional standards to practice evidence-based
medicine maintaining international quality of patient-centered care in health
care delivery system and will produce research scholars demonstrating
excellence in knowledge, skills, and ethical values empowered with community
oriented self-directed learning and professional development.
https://kemu.edu.pk/mission

10. Complete Description of ITC and applicable parent organization:

King Edward Medical University (Punjabi, Urdu: ‫;کنگ ایڈورڈ میڈیکل یونیورسٹی‬
commonly abbreviated as KEMU) is a public medical university located
in Lahore, Punjab, Pakistan. It was established as Lahore Medical School during
the British Raj in 1860 and is named after King Edward VII .[1]
In 1868, Trinity College Dublin granted students of the Lahore Medical School
"privilege similar to the granted to students from English schools". In 1871, the
university added Mayo Hospital as an affiliated hospital, replacing the existing
Anarkali Dispensary. The same year the college became an affiliate of University of
the Punjab, while in 1887, the university added Lady Aitchison Hospital as a
second teaching hospital.[2]
After Pakistan's independence , the university became the only medical college in
the province and in 2005 became a charter to award degrees in its own right. It has
since gone through expansion, and oversees seven tertiary referral
hospitals including the Lady Willingdon Hospital .[3]

AHA ITC Application January 2023 Page 4 of 15

The university has a rich history of producing great physicians that have served not
only in Pakistan but also in US, UK and many other parts of the world. Rest of the
detail is attached in the file 10. KEMU History Book 2nd Edition.

11. Business Plan for Development of ITC (Business plan may be attached as a
separate document, if necessary):

12. Other Relevant Information:

13. Organizational Chart: Submit with this application. Include all positions with
names of the people occupying each position. Please ensure that the full
names (Not initials) of the people in the following positions are included.

a. CEO/Chairman/Owner/ VICE CHANCELLOUR : PROF. Mahmood Ayyaz

b. CFO/Financial Officer/ TREASURER : PROF. MUSTEHASAN BASHEER

c. President/Managing Director/REGISTRAR: Prof. Muhammad Imran

14. Give the full name and job title of the authorized person who will be signing the
finished agreement with the AHA.
a. Please indicate your signature preference: ☐ Electronically  Manually
b. If you prefer electronically, please provide the e-mail address of the duly authorized
signatory Prof. Mahmood Ayyaz vc@kemu.edu.pk

15. Provide ownership information of the ITC. For Corporations please provide the list
of the Board of Directors, or Leadership Committee, and a list of the Officers. List
the Owners and include the following information – Name, title, address, and
percentage of ownership. This can be a separate attachment.

16. ITC is (Choose one): ☐For Profit  Not for Profit

17. Does the Government need to approve the establishment of an ITC?
☐Yes  No
18. Is the ITC or parent organization affiliated or related in any way to any tobacco or
pharmaceutical company or subsidiary? ☐Yes No

AHA ITC Application January 2023 Page 5 of 15

SECTION II: Training Information

1. Are you currently functioning as a Training Site under an existing ITC?

☐Yes  No
If Yes, what is the ITC name?
If Yes, please list the number of students you have trained in AHA courses
in the last full year: BLS ACLS PALS NRP
ASLS

2. Will AHA training materials require Government approval? ☐Yes  No

3. Are you currently teaching any non-AHA Emergency Cardiovascular Care (ECC)
courses? (For Example, non AHA CPR, ACLS or PALS)  Yes ☐No
If Yes, list all non-AHA ECC courses currently taught and current annual
number of students.

4. Describe where the ITC will conduct courses. Submit photographs (digital or
scanned) of the instructional area.
Attached

AHA ITC Application January 2023 Page 6 of 15

 5. The equipment list for each AHA program is attached at the end of this application.
Fill out each list with the quantity of all equipment available. Attach photographs
(digital or scanned) of all equipment.

Are the lists completed?  Yes ☐No

6. Does the ITC agree to use all equipment according to the manufacturer’s
recommendations, ensure equipment is clean, disinfected and functioning
properly?  Yes ☐No
File name : 12.ITC equipment list _2020
7. List how many AHA instructors do you have with current AHA Instructor Cards, if
any. BLS 4 ACLS PALS NRP ASLS
Please submit an addendum with the following information:

a. Name of each instructor that will be aligned with your center:

b. Which discipline(s) they teach

c. The expiration date of each instructor credential.

d. Submit copies of both sides of any Instructor Cards with application. Credit
will only be given for instructors with attached card copies.

 The list is attached. : 9_Instructor_list_June 2020.

AHA ITC Application January 2023 Page 7 of 15

 8. Fill out the table with the anticipated number of providers (students) and instructors
to be trained per yeaffr. ITCs that plan to offer only training for non-healthcare
students should enter training numbers under “BLS.”
BLS ACLS PALS NRP ASLS
Students 1200
Instructors 6

9. Explain how the ITC plans to grow their training programs (this can be included in
your business plan).

10. What is the primary language spoken/used by your country?

The language of instruction and education is English Other primary Languages

include Urdu, Sindhi, Pashto and several other regional languages but all the health care
personnel can read, write and comprehend English

11. Can the ITC use AHA course materials in English to teach healthcare providers?
 Yes ☐No

12. Can English be used for community training?

 Yes ☐No

13. Are you interested in offering AHA’s eLearning programs?

 Yes ☐No

AHA ITC Application January 2023 Page 8 of 15

SECTION III: Agreements

If “No” is checked for any question in this section, an explanation must be given in the
“Notes” field at the end of the section. Failure to include an explanation will result in a
rejection of the application.

Does the ITC agree to: Yes No

1. Open your courses to the community and all healthcare
providers?
 ☐
2. Purchase and issue AHA Course Completion Cards to every
student who successfully completes an AHA course?
 ☐
3. Ensure that each students has individual possession of an
authorized Course-specific textbook before, during, and after
 ☐
training?
4. Conduct all AHA courses according to AHA Guidelines without
modifications or revisions?
 ☐
5. Use only the current AHA exams without editing or translating
them?
 ☐
6. Submit semiannual (2x/yr) training reports to the AHA?  ☐
7. Maintain required records for at least 3 years?  ☐
8. Notify the AHA immediately of any ITC status change?  ☐
9. Adhere to all guidelines in the AHA ECC Program Administration
Manual (PAM) International Version?
 ☐
10. Maintain the security of AHA Exams, Course Completion Cards
and records?
 ☐
11. Pay all costs (travel, accommodations, meals) for AHA faculty to
travel to ITC for initial site visit and training ITC faculty?
 ☐
12. Pay all costs (travel, accommodations, meals) for AHA faculty to
conduct site reviews and course monitoring as outlined by the
 ☐
Program Administration Manual International Version?
13. Send a representative to all mandatory AHA meetings and
updates? (Usually held locally or regionally except major
 ☐
Guideline changes)
14. Respect the copyright of all AHA Materials and the AHA Logo?  ☐
15. Review the equipment list for the discipline that is being added
and confirm that the ITC has all the required equipment?
 ☐

Notes:

SECTION IV: Financial Information

AHA ITC Application January 2023 Page 9 of 15

 1. Will the ITC have adequate funding? Yes ☐No

2. Thoroughly describe the source of your funding.

The University has two sources of funding for the academic courses. One is the
annual budget being released by the higher education commission of Pakistan for
teaching and training, second major source is budget allocated by the Government which
is at the discretion of university to dispense. Third major source is the university’s own
endowment fund and donations by the alumni. However, the courses expenditures will be
met by charging students fee for purchase of materials needed for the course.

3. Give 3 business references. Provide name, complete contact information and

relationship (i.e. client, supplier, former business associate, etc.) References must
be outside of your organization.

Not Applicable

4. Liability insurance information:

Insurer:
Policy Number:
Limit of Liability:
The AHA requires all International Training Centers to have general liability
insurance. ITC should contact their Territory Director for specific liability
insurance requirements for their country. A copy of your insurance policy
including coverages and limits must be submitted. No application will be
processed without it.
When providing documentation to the AHA, please make sure documentation
is valid for a period of one year. Insurance policies expiring within a month, will
not be processed until updated policy has been provided.

SECTION V: Completion and Submission

1. I have reviewed the equipment list for the discipline I am adding and I confirm that
my ITC has all the required equipment  Yes ☐No

Have you submitted: Yes No

Organizational Chart ☐ 
Instructional Area Photos  ☐
Equipment Lists and Photos  ☐
Copies of Instructor Cards ☐ 
Copy of Insurance Policy  ☐

*Application Package will be processed only when all required documents were submitted.
AHA ITC Application January 2023 Page 10 of 15
*Submission of an ITC Application package does not guarantee approval.

AHA ITC Application January 2023 Page 11 of 15

Signature and Confirmation

Thank you for completing this application. Email is required for all International Training
Centers. This application must be emailed. The AHA Email system has a size limitation
of 10MB. If the total size of your photographs and scans are more than 10MB, please
send in separate emails. We will acknowledge receipt of your application within 5
business days.

EMAIL THE SIGNED AND COMPLETED APPLICATION AND ALL SUBMISSIONS TO

YOUR TERRITORY DIRECTOR:

Your Territory Director is . The email is:

If you haven’t received an acknowledgement within 5 business days, please contact us at

ECC.International@Heart.org

I understand that a false statement on this application may be grounds for rejection of
any application/proposal or termination of any agreement with the AHA.

If you sign this document, you give permission to the American Heart Association and its
employees to use, collect, transfer, and process the information contained herein to process your
application in our systems, which are located and operated in the United States. You authorize that
the ITC you represent will in all ways comply with all privacy and data laws when you provide any
confidential or restricted information to the AHA. Please note that you do not have to sign this
Authorization, but if you do not, the AHA will not process this application.

AHA ITC Application January 2023 Page 12 of 15

 AHA International Training Center
Application Form
Appendix 1: Equipment List
(Not all course equipment is listed here. See Instructor Manuals for a complete list)

BLS Equipment
Description Minimum Quantity Available Quantity scheduled
Quantity to be Purchased
Required
Adult CPR 1 per 3 4 6
Manikins students
Child CPR Optional 2 6
Manikins
Infant CPR 1 per 3 5 6
Manikins students
Pocket Mask 1 per 3 5 20
students
Bag Mask, Adult 1 per 3 5 6
students
Bag Mask, Child Optional 0 6
Bag Mask, Infant 1 per 3 5 6
students
A/V system with 1 per 1 one
ability to play course
DVD for entire
class
AED Trainer 1 per 3 4 6
students

AHA ITC Application January 2023 Page 13 of 15

 ACLS Equipment
(in addition to BLS equipment)
Description Minimum Quantity Quantity scheduled
Quantity Available to be Purchased
Required
A/V system with 2 per course
ability to play DVD
for entire class
ECG Simulator or 1 per 6 students
Rhythm Generator
Monitor/defibrillator 1 per 6 students
w/ cardioversion
and TCP
ALS Manikins1 1 per 6 students
Airway Manikins2 1 per 3 students

1. ALS Manikins are defibrillatable and accept oral, nasal and tracheal airways
2. An ALS Manikin can serve as one of the airway manikins

PALS Equipment
(in addition to BLS equipment)
Description Minimum Quantity Available Quantity scheduled
Quantity to be Purchased
Required
A/V system with 2 per
ability to play DVD course
for entire class
ECG Simulator or 1 per 6
Rhythm Generator students
Monitor/defibrillator 1 per 6
w/ cardioversion students
and TCP
Pediatric/Infant 1 per 6
ALS Manikins1 students
Pediatric/Infant 1 per 3
Airway Manikins2 students
1. ALS Manikins are defibrillatable and accept oral, nasal and tracheal airways
2. An ALS Manikin can serve as one of the airway manikins

AHA ITC Application January 2023 Page 14 of 15

 ASLS Equipment

Description Minimum Quantity Available Quantity scheduled

Quantity to be Purchased
Required
A/V system with 2 per
ability to play DVD course
for entire class
ECG Simulator or 1 per 6
Rhythm Generator students
Monitor/defibrillator 1 per 6
w/ cardioversion students
and TCP
Adult ALS 1 per 6
Manikins1 students
Airway Manikins2 1/station
Pediatric/Infant 1 per 3
Airway Manikins2 students

1. ALS Manikins are defibrillatable and accept oral, nasal and tracheal airways
2. An ALS Manikin can serve as one of the airway manikins

NRP Equipment
Refer to the NRP Equipment list that will be sent separately

AHA ITC Application January 2023 Page 15 of 15