INSTRUCTOR APPROVAL TO TRAIN AUTODESK PRODUCTS

REQUEST FORM

THIS APPROVAL REQUEST IS FOR (Select one)

☐ New Instructor seeking approval to train specific Autodesk Product(s)
☐ Current ACI Instructor requesting approval to train additional Autodesk Product(s)

THIS REQUEST IS SUBMITTED BY THE FOLLOWING AFFILIATED ATC OR AAP:

Authorized ATC or AAP Site Name Country ORG ID Number Site ID Number

Instructions to complete this INSTRUCTOR APPROVAL TO TRAIN AUTODESK PRODUCTS REQUEST FORM

This completed Instructor Approval to Train Autodesk Products Request Form (“Request Form”) is part of the
Autodesk Authorized Training Center (ATC®) and Autodesk Authorized Academic Partner (AAP) authorization
process. An Instructor with advanced expertise of specific Autodesk products (“Autodesk Products”) seeking
approval to train Autodesk Products on behalf of an ATC or AAP, or an instructor requesting additional product
approval to train, must complete the Request Form. Instructor must be a current instructor for an Autodesk
ATC or Autodesk AAP (“Affiliated ATC or AAP”) at the time they submit the Request Form. Prior to making the
request, the Instructor must review the ATC Global Program Guide or the AAP Global Program Guide
(“Program Guides”), as applicable, to confirm they meet the Approved Instructor requirements. A copy of the
applicable Program Guide can be obtained from the ATC or AAP with which you are affiliated or from the
Learning Partner Distributor (“Distributor”).

The Instructor will sign and return this completed Request Form to the affiliated ATC or AAP Partner for which
Instructor is a current instructor. The affiliated ATC or AAP, and the Instructor, will maintain a copy of the
completed Request Form to allow for future updates.

The following information is required for completion of this Request Form:

✓ Instructor’s contact information, including a business e-mail address; and
✓ Instructor’s CV or professional Resume; must include Autodesk Product(s) experience, industry knowledge,
teaching experience; and
✓ Certiport or PearsonVue Credential Identification Code, copy of Autodesk Certification certificates earned, or
other relevant certificates earned, for completion of Autodesk certification exam(s).
✓ Customer references are provided ONLY upon request from Autodesk or the Distributor

FY21—FY22 Program Year—Instructor Approval to Train Autodesk Product(s) Request Form Version: 20 SEPTEMBER 2020

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SECTION 1—INSTRUCTOR PROFILE INFORMATION
INSTRUCTOR CONTACT INFORMATION
First Name
Middle Name or Initial
Last Name
Preferred Salutation Ms., Mrs., Mr., Dr., other
Job Title (Example: Director of Training, AEC Instructor, etc.)
Business E-Mail Address Business E-Mail address provided to affiliated ATC or AAP
Autodesk Instructor ID Number If Instructor is currently an Approved Instructor

How many years has Instructor been in the training business? ______________ (Number of years)

Was instructor previously employed by, or currently, an instructor for an ATC or AAP?
YES ☐ NO ☐

If YES, Instructor will list all affiliated Autodesk ATCs or AAPs, that employ or previously employed this Instructor, or for
which Instructor otherwise provides or provided training services. This affiliation will be confirmed with the ATC or AAP
listed here: (Complete table)
Authorized ATC or AAP Site Name(s) Country Previous or Current? ORG ID Number Site ID Number

Is Instructor a current Autodesk Certified Instructor (ACI)? ☐ YES ☐ NO

If Instructor is not currently an Autodesk Certified Instructor, and Autodesk approves Instructor’s request to provide
authorized training for Autodesk Products specified in this Form, Approved Instructor understands they must become an
Autodesk Certified Instructor—Standard Tier, within ninety (90) days of receiving Autodesk approval to train pursuant to
this Request Form. Please review the requirements to earn an Autodesk Certified Instructor—Standard Tier certification
and the Autodesk Certified Instructor Program Agreement here: aci.autodesk.com

If Instructor does not become an ACI within ninety (90) days of Autodesk approval, Autodesk’s approval for Instructor to
provide authorized training as described in this Request Form, shall automatically be revoked and Instructor must cease all
training for Autodesk Products with Affiliated ATCs or AAPs, unless Autodesk has provided an extension in writing to
Instructor allowing the Instructor additional time to complete the ACI requirements at a later date. Extension will not
exceed thirty (30) days.

INSTRUCTOR’S AUTODESK CERTIFICATION CREDENTIAL INFORMATION

ATC or AAP is only allowed to train on the Autodesk Products approved by Autodesk and Approved Instructor or ACI can
only seek approval in this Request Form for those approved Autodesk Products. Instructors seeking Approved Instructor
status will provide evidence of their earned Autodesk Certification credentials for the Autodesk Products for which they
have received certifications. These materials, and other required information, will enable Autodesk’s review and
consideration of the Instructor’s credentials and approval to train individual Autodesk Products. Instructor will include the
Certiport or PearsonVue certificate Verify Number in the grid below. If Instructor earned an Autodesk Certified User (ACU)
or Autodesk Certified Professional (ACP) credential prior to 2016 they must include a copy of proof of certification with this
Request Form. The certification Verification Number is provided by Certiport or PearsonVue.
AUTODESK ACU OR ACP CERTIFICATIONS ATTAINED BY INSTRUCTOR
Certificate Type of Training or
Product Name & Version # Certification Verify Number Course Level
Training Date Certification Course
Basic,
Example: Certificate Date: Certiport or PearsonVUE Classroom, ALC, Online, E-
Advanced,
Autodesk® [AutoCAD 2017] 18-Apr-17 Verify # w*55w-M1BX Learning
ACU or ACP

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INDUSTRY AND TRAINING BACKGROUND
Indicate Instructor’s training and services key focus areas (Check all that apply).
☐ Authorized Training Center or Authorized Academic Partner Site Management
☐ E-Learning training delivery or facilitation (Autodesk-defined E-Learning criteria)
☐ Instructor–led training & knowledge development delivered online
☐ Instructor–led training & knowledge development delivered in training facility
☐ Training on-site at a customer’s business location; customized for customer
☐ Non-training and production activities
☐ Technical Consulting and services
☐ Other Activities (Describe here)

What specific industry (or product) does Instructor have advanced experience to train?
☐ Architecture ☐ Fusion 360
☐ BIM 360 ☐ Games/Animation
☐ Civil Engineering or infrastructure ☐ Manufacturing
☐ Construction ☐ Media & Entertainment
☐ Engineering ☐ Digital Manufacturing (Delcam or Netfabb products)

Explain how Instructor’s training experience was gained.

☐ Adjunct Faculty or Faculty at Academic Institution; teaches Autodesk Products
☐ Instructor at Academic Institution; teaches Autodesk Products
☐ Instructor at commercial training company; teaches Autodesk Products
☐ Industry Professional; history of Autodesk Product use while employed
☐ Trade Skills Union School Instructor; teaches or uses Autodesk Products
☐ Completed Autodesk Product-related courses at an Academic Institution
☐ Completed courses offered by an Autodesk ATC or Autodesk AAP

Approved Instructor Requirements

Has Affiliated ATC or AAP reviewed the Autodesk ATC Global Program Guide or the Autodesk AAP Global Program Guide, as
applicable, with the Instructor, including without limitation, review of compliant use of Autodesk Products subscribed to by
ATC or AAP pursuant to the ATC Program or AAP Program, ATC or AAP Site requirements, Mobile Lab requirements, course
requirements, and E-Learning Course requirements?
YES ☐ NO ☐

FY21—FY22 Program Year—Instructor Approval to Train Autodesk Products Request Form Version: 20 SEPTEMBER 2020

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REFERENCES FROM TRAINED DELEGATES
Autodesk reserves the right to request from the Instructor, at least three (3) Trained Delegate Customer References of
recently trained customers of Autodesk Products.

REQUEST FORM & SUPPORTING DOCUMENT CHECKLIST

Before submitting this form, Instructor will review checklist to ensure form submission is complete:
✓ All requested information has been provided in each section of the Request Form, including a business e-mail address
and Autodesk Instructor ID Number (if applicable)
✓ Instructor’s CV or Professional Resume is included
✓ Certiport or PearsonVue Certification certificate or Credential Identification Code number is provided
✓ Copies of other training certificates available upon request
✓ Customer References available upon request

SECTION 2—DEFINITIONS
“AUTODESK APPROVED INSTRUCTOR” shall mean a person serving as an instructor for an Autodesk Authorized Training
Center (ATC) or an Autodesk Authorized Academic Partner (AAP)g and approved by Autodesk, pursuant to the terms set
forth in the Autodesk ATC or AAP Global Program Guide(s), to provide training and instruction on the use of one or more
Autodesk Products. In the case of E-Learning courses delivered electronically, Approved Instructor shall mean person(s)
approved by Autodesk to serve, as an E-Learning instructor/facilitator to answer training participant’s questions, and
oversee the E-Learning course(s) offered for Autodesk Products, and that meets all Qualifying Criteria as defined in the ATC
or AAP Global Program Guide(s), Exhibit 2.

“AUTODESK CERTIFIED INSTRUCTOR” or “ACI” shall mean a person meeting the requirements established in the Autodesk
Certified Instructor Program pursuant to the terms specified by Autodesk (“ACI Program”) and who is a credentialed
instructor in the Autodesk Certified Instructor Program. ACI Instructor is required to be an Autodesk Approved Instructor
actively providing instructor services to an ATC or AAP when representing their ACI credential to customers.

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SECTION 3—DECLARATION SIGNATURE
Instructor must complete and return all required documents to the Affiliated ATC or AAP. The applicable ATC or AAP will
submit the Request Form to Autodesk or Autodesk’s designated Distributor. Meeting the requirements of an Approved
Instructor does not guarantee Autodesk’s approval of this instructor Request Form. Autodesk reserves the right to not
approve any applicant at its sole discretion, including without limitation, if Autodesk is aware of any applicant (i) actions
that do not comply with the Autodesk Partner Code of Conduct, (ii) breach of the Autodesk Terms of Use, (iii) unauthorized
use of Autodesk trademarks or other violation or infringement of Autodesk intellectual property rights or (iv) actions that
could negatively impact Autodesk’s reputation or brand.

Instructors are not allowed to copy or duplicate information from another Instructor’s form. ONLY the Instructor
completing the Request Form will sign this Signature page.

Instructor agrees this information, and all course-related information associated with the Instructor, will be maintained in
the Autodesk Partner Database and Autodesk Training Evaluation System, in the Affiliated ATC or AAP’s records. Please see
the Autodesk Privacy Statement for additional information: https://www.autodesk.com/company/legal-notices-
trademarks/privacy-statement

I, the undersigned, have read the Authorized Training Center Global Program Guide and/or Authorized Academic Partner
Global Program Guide, as applicable. I understand the requirements for compliant use of Autodesk Products by customers
who are participating in training activities for Autodesk Products when courses are offered by an Autodesk ATC, an
Autodesk AAP, or delivered by the Approved Instructor.

I, the undersigned, understand that I must become an Autodesk Certified Instructor—Standard Tier, and agree to the
terms of the Autodesk Certified Instructor Program Agreement, which applies when I become an ACI.

I the undersigned hereby declare the information given in this Autodesk Approved Instructor Global Request Form is
correct and complete to the best of my knowledge and belief.

Instructor Name: ________________________________________ (Printed here)

Title: ________________________________________

Signature: ________________________________________ (Sign here)

Date Signed: ________________________________________

FY21—FY22 Program Year—Instructor Approval to Train Autodesk Products Request Form Version: 20 SEPTEMBER 2020

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SECTION 4—SUPPORTING DOCUMENTS
Instructor’s CV or Professional Resume, Autodesk ACU or Autodesk ACP Certificates, copies of other training certificates,
Instructor’s show-reel or URL for web site can be added on the remaining pages of the Request Form.

FY21—FY22 Program Year—Instructor Approval to Train Autodesk Products Request Form Version: 20 SEPTEMBER 2020