CPE Compliance Orientation (PTA)

Orientation Registration Form

Congratulations, you have successfully registered for a Coordinated Entry Program.

Students who register in a Coordinated Entry Program will have to complete pre-clinical requirements. As a result, students must attend a mandatory compliance orientation. Please complete the form below in order to register for an orientation date.

In order to prepare students for clinicals, the following information is required to complete the NM Department of Health Caregivers Criminal History Screening.

All required fields are marked with a red box, indicating you must provide a response in order to successfully submit the form.

NOTE: After you click submit, please print a copy of the ???thanks page??? as proof that you submitted the form. You may be asked to provide this during your orientation.

Students who do not attend this mandatory orientation may lose their spot in the program.

Orientation Date   Please select the orientation date for your program.

Program   Please select the program you have registered to begin in Fall 2021.

Registration   Please indicate if you are registered or on the waitlist

Permanent/Physical Address
Mailing Address   Please indicate Yes if mailing address is the same as Permanent Address Please indicate No if Mailing address is different than Permanent Address. You will have to provide your mailing address below

US Citizen   Please indicate if you are a US Citizen

Aliases/Prior Names (Includes all names by which an applicant is currently known or has been identified as)