Nursing (AAS), NMNEC Concentration Pre-Registration Screening Form

Last Name

First Name

CNM ID Number Nine-digit number only, no hyphens or spaces.

Primary Phone Please include area code when entering phone number (XXX) XXX-XXXX

CNM E-Mail Address NOTE: This is the ONLY way we will contact you regarding your screening form. Make sure the address is working properly and check your account frequently. If you are experiencing any difficulties, contact Information Technology Services (ITS) at (505) 224-4357.

HESI Test Date Enter the date you successfully completed the HESI exam. Enter the testing date in which you scored at least a 75% in all six areas: Reading, Vocabulary, Grammar, Math, Biology and Chemistry. If you met this requirement on more than one testing date, choose the exam with the highest cumulative score. Exam dates must be from the past year. Future test Dates are NOT acceptable. Results must be no later than the date of screening form submission.

VA National Education for Employees Program (VANEEP) Applicant? (Current VA Employees ONLY)

Yes No

Substitutions/Transcript Issues Please note if you have received a Official Substitution for any of the required coursework for the Nursing Program.

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Information and Acknowledgements

For each of the following statements click the box to acknowledge you understand that you have met/will meet the following requirements. If you have any questions on any of these statements, please contact (505) 224-4111 or email [email protected] before submitting this form.

I understand that I must meet the minimum requirements for this program as listed below: Minimum GPA requirements (2.0 cumulative and 2.75 calculated), Required Prerequisite Courses(finished or in progress), Minimum HESI scores.

I understand that there are limited seats for this program. I am responsible for registering for courses at the assigned date and time given to me if I am approved for registration. Enrollment in this program is not guaranteed.

I understand that failure to submit transcripts or meet program requirements will delay the approval of my Pre-Registration Screening form. I also understand that it is my responsibility to resolve any holds that may appear on my student account.

I understand the information listed regarding re-entry into Term 1 of the CNM Nursing program. It is my responsibility to review my unofficial transcripts through myCNM for previous NRSG course attempts. For more information, visit the Re-Entry page.

I understand and verify that I meet the technical requirements to participate in the clinical education portion of this program and understand that if reasonable accommodations are needed I am to contact the Disability Resource Center. To view the technical requirements for the Nursing program, please visit O*NET OnLine.

I understand that if I register for this program, I must complete pre-clinical requirements by a deadline. For more information on specific compliance requirements for this program visit the Office of Verification and Compliance.

I understand that admittance into this clinical program is dependent upon acceptable results from a New Mexico Department of Health Background Screening, Urine Drug Screening and proof of specific immunizations. Failure to meet these compliance expectations will result in your removal from this program.

I understand that I am responsible for securing my seat by meeting payment deadlines. If you are dropped from your courses due to non-payment, we will not be able to re-add you back into the program classes. Payment plans are available, and more information is located through the CNM Cashiers Office.

I understand that I must become familiar with the School of Health, Wellness, and Public Safety Handbook. The School of Health, Wellness, and Public Safety Handbook.

Signature My signature confirms that I have read and agreed to all of the terms and conditions required to qualify to register for this program.

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Nursing (AAS), NMNEC Concentration Pre-Registration Screening Form

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