Kickin' Asthma Recertification Registration Form

Thank you for your interest in becoming recertified as a Kickin' Asthma facilitator!

Upon completion of this form, you will receive an access code to participate in the KA Recertification online course. The steps to become recertified are as follows:

1. View the course in its entirety.
2. Agree to the terms of the KA Facilitator Agreement.
3. Complete the post course evaluation.

For questions, email us at KickinAsthma@Lung.org.

1. First and Last Name: *This question is required.

2. Email: *This question is required.

3. Organization: *This question is required.

4. Position Title: *This question is required.

5. Credentials: *This question is required.

6. Do you receive the KA Facilitator announcement? *This question is required.

Yes, I get it and I read it
Yes, I get it but I don't read it
No, I don't get it
No, I don't get it but I would like to

7. Within the past 3-years of your certification, have you facilitated a KA program (either in-person or virtually)? *This question is required.

Yes, I have hosted an in-person group
Yes, I have hosted a virtual group
No, I have not hosted any groups
No, but I intend to host one within the next year