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The University of New Mexico

Background Check

All offers of admission are contingent upon satisfactory criminal background investigation results.

Contact UNM Speech and Hearing Sciences (505-277-4453) to make arrangements for the New Mexico Department of Health background check. For information on the New Mexico Department of Health background check, please visit the Caregivers Criminal History Screening Program (CCHSP) website.

Instructions for out-of-state students

1. Carefully read the background check and fingerprint card instructions on this page
2. Contact UNM Speech and Hearing Sciences (505-277-4453)
3. UNM Speech and Hearing Sciences will mail three (3) fingerprinting cards to you
4. Take the three (3) fingerprint cards to a local agency for processing and completion
5. Mail the following items to UNM Speech and Hearing Sciences no later than June 30, 2016:
     a. One (1) completed CCHSP Authorization for Release of Information form
     b. Three (3) completed fingerprint cards
     c. One (1) legible copy of your driver’s license
     d. One (1) cashier’s check or money order in the amount of $73.30 to: NM Department of Health

Fingerprint card instructions

The applicant’s fingerprints are used to check criminal history records of the Federal Bureau of Investigation (FBI). Procedures for obtaining a change, correction, or update of your criminal history record are set forth in Title 28, Code of Federal Regulations (CFR), Section 16.34s.

Please keep the information within the blocks provided. The FBI has indicated that its card scanners cannot scan the required information if such information overlaps the blue border of the block.

The following blocks must be completed (type or print all information in black ink only):

  • EMPLOYER: University of New Mexico Speech & Hearing Sciences, 1700 Lomas Blvd. NE Suite 1300, Albuquerque, NM 87131
  • SIGNATURE OF APPLICANT
  • RESIDENCE: street (mailing) address, including city, state and zip code (no P.O. Box)
  • DATE: MM DD YY; January 4, 2012 is 01 04 12
  • SIGNATURE OF PERSON TAKING PRINTS
  • NAME: last, first, middle (include your full middle name)
  • ALIASES: include maiden names or previous names
  • CITIZENSHIP: country (example: United States)
  • SSN#: Social Security Number
  • SEX: one (1) letter; M (male) / F (female)
  • RACE: W or C (White) / H (Hispanic) / B (Black) / A (Asian) / AI (American Indian)
  • HGT [height]: three (3) digits; 6 feet 2 inches is 602 / 5 feet 10 inches is 510
  • WGT [weight]: three (3) digits; 210 pounds is 210 / 145 pounds is 145
  • EYES: three (3) letters; BLU (blue) / BRO (brown) / HZL (hazel) / GRN (green) / GRY (gray) / BLK (black)
  • HAIR: three (3) letters; BLK (black) / BLN (blond) / BRN (brown) / GRY (gray) / RED (red) / WHT (white) / XXX (bald)
  • DOB [date of birth]: MMDDYY; January 4, 1980 is 010480
  • POB [place of birth]: state (if within the United States) or country

Instructions for Authorization for Release of Information form

  • Box 6. [Date of Employment] Enter the date that you will enter graduate school
  • Box 7. [Care Provider Agency Name] UNM Speech and Hearing Sciences
  • Box 8. [Applicant’s Position] Student
  • Boxes 9-12. [Care Provider Address] 1700 Lomas Blvd. NE Suite 1300, Albuquerque, NM 87131
  • Box 13. Answer yes or no (if yes, please provide additional information)
  • Box 14. [Employee Abuse Registry Screening] Check yes
  • Box 15. Leave this box empty
  • Box 16. Check Nationwide and Statewide Screening
  • Box 17. [Authorized Representative] Sandra Nettleton
  • Box 18. [Title] Clinic Director

Dr. Sandra Nettleton will sign and date accurate and completed forms