HWPS Compliance Class Visit Form

Congratulations on successfully registering for a HWPS course that contains a clinical component.

You are not expected to complete any compliance requirements until the Office of Verification and Compliance has visited your class, typically during the first week of the term.

In order to prepare you for clinicals, the following information is required to complete your 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 class visit.

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)
Identification Information   Please select the appropriate issuing authority for the document you uploaded.

If you have specific compliance questions please visit the Office of Verification and Compliance's website.