Infant Family Studies Placement Assistance Application

Last Name

First Name

CNM ID Number

Phone Number

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 or if you are experiencing other technical difficulties.

Course Name Use the drop down menu to select the course you are currently enrolled in.

Name of your instructor Please provide the name of the instructor listed.

Type of placement being requested (please only select one, if you need additional placements please complete a new application).

Home-visiting shadowing
Childcare center (infants/Toddler)

Please provide the number of hours required for placement

Please provide the name, and contact information(phone and email) for where you would like me to try and place you.

Days and Times Available to Complete Hours Enter the schedule of days and times you will be available to complete practicum hours. Example: Mondays 12:00pm - 5:00pm Thursdays 8:00am - 3:00pm

Area of Town Select all areas of town you would like to be placed. These options cannot always be guaranteed but will be taken into consideration.

ABQ - Northeast

ABQ - Northwest

ABQ - Southeast

ABQ - Southwest

Rio Rancho

Other (Enter specifics in comments section below. *Please note: Placements in areas outside Albuquerque and Rio Rancho cannot be guaranteed.)

If yes, please list the name of your employer and their contact information (phone and email address) and your title.

If you are not currently employed in the field, you will have to complete the background check process required by the placement site you are put in. Check your CNM email for instructions.

Please enter your work schedule Monday-Friday (Ex: Monday: 8:00-2:00pm)

Comments Please include any additional information you feel is important regarding your placement.

Placement Acknowledgement If you are placed by CNM for a practicum experience, you cannot complete more than 5 hours per a week at a placement site. If you complete more than 5 hours per a week at a placement site, you are required to have a valid and clear CYFD background check on file with CNM. By checking below, you agree to ensure you are not at any placement site for more than 5 hours without a CYFD background check on file with CNM.

Background clearance requirements Regardless of CNM requirements, students are required to meet placement site requirements related to background checks. Students will be held responsible for meeting background check requirements set forth by a placement site.

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