ATL Program Acceptance

Alternative Teacher Licensure Program Acceptance Form

In order to accept your seat and receive registration permission for ATL Program coursework, please complete this form.

Last Name Enter your last name.

First Name Enter your first name.

CNM Email Address FERPA guidelines indicate that electronic communication can only be sent via student’s @cnm.edu account. You must check this account regularly. Please contact the CNM ITS Service Desk at (505) 224-4357 if you are unable to access your CNM e-mail.

District or Personal Email Address

Student ID # Enter your CNM student ID number (numbers only, no dashes)

Beginning Semester Students may NOT defer coursework in the Program. Students are REQUIRED to begin coursework the semester for which they accept their seat. Please indicate the semester you will begin your coursework in the ATL Program.

CNM Campus Preference Please indicate which campus you would prefer to take coursework.This information is used for data collection only and does not guarantee campus availability.

Main campus: 900 University SE
Westide campus: 10549 Universe Blvd. NW

NM PED license Do you currently hold a NMPED issued license (teaching, EA, coaching, or substitute)?

Yes
No

If you answered yes, provide your license number. Please use this link to look up your most current NMPED issued license: http://164.64.166.12/Licensure/Default.aspx

Date of Birth

Gender This information is for reporting use only to provide statistical information requested by various State and Federal agencies.

Ethnicity This information is for reporting use only to provide statistical information requested by various State and Federal agencies. (hold down "Ctrl" and select all that apply)

Is English your first language? This information is for reporting use only to provide statistical information requested by various State and Federal agencies.

If you answered No, please note your first language

Mailing Address Enter your mailing address.

Street Address

City

State

Zip Code

Phone Number Example: 5052243000 (numbers only, no dashes).

Agreement #1 By submitting this form I am accepting my “seat” in the Alternative Teacher Licensure Program.

Agreement #2 I understand that the Program does not allow for students to defer their coursework and that I am REQUIRED to begin coursework the semester for which I have accepted my seat.

Agreement #3 I understand that I must attend an Alternative Teacher Licensure Program Orientation, and failure to do so will result in removal from the program.

Agreement #4 I understand that I am required to pass a criminal background check in order to conduct field based assignments.

Spam Check

By clicking "Submit" you are accepting your seat for the ATL Program. You will be contacted within 5 business days regarding registration permission. Students are required to use their CNM email while in the Alternative Teacher Licensure Program. Please remember to check this account often.

ATL Program Acceptance

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