Documentation of Experience Form ATL

							                                Central New Mexico Community College
                                   Office of Limited Entry Programs
                Documentation of Experience Form: Alternative Teacher Licensure Program


Dear supervisor or organization official:

The following individual: ___________________ is applying for the Alternative Teacher Licensure Program, which is a
Limited Entry Program at Central New Mexico Community College. Individuals can earn points in the application process
for having relevant experience (volunteer or work) related to their field, provided their supervisor or organization official
submit this form to document that they completed the experience. When complete, this form may be submitted in any of
the following ways: 1) scanned and emailed to olep@cnm.edu, 2) faxed to 505-224-4120, or 3) mailed to:
                                         CNM Office of Limited Entry Programs
                                                    104 PPD Building
                                                 525 Buena Vista Dr. SE
                                                Albuquerque, NM 87106

Forms must be received by 5 p.m. on the applicant’s admission deadline date, and must include your signature. It is the
applicant’s responsibility to provide you with this form and enough time to complete it prior to the deadline for the
program.

Please provide information below to document the applicant’s experience with your organization. Note that this form does
not constitute a reference for the applicant; rather, it is meant to document relevant experience the applicant gained related
to the education field. Other criteria in the application process assess individuals’ readiness and personal skills/interests
related to their potential to succeed in the program.

If you have questions, please contact the Office of Limited Entry Programs at 505-224-4103, or visit our website at:
www.cnm.edu/limitedentry. Thank you for your time.

Sincerely,
Kelsey Gross
Coordinator for the Office of Limited Entry Programs, Central New Mexico Community College

    DOCUMENTATION OF EXPERIENCE FORM – To be filled out by a supervisor or organization official

    1.) Name of individual applying to CNM program: ____________________________________________________

    2.) Your name, title, and employer/organization: _______________________________________________________

    3.) Your phone number and email: __________________________________________________________________

    4.) Dates the individual worked/volunteered with the organization:
        __________________________________________

    5.) Please describe the individual’s role, and duties/activities:

        ___________________________________________________________________________________________

        ___________________________________________________________________________________________

        ___________________________________________________________________________________________

        ___________________________________________________________________________________________

    6.) Signature: __________________________________________________________Thank you for your assistance!