CENTRAL NEW MEXICO COMMUNITY COLLEGE (CNM)
OCCUPATIONAL OR ACADEMIC UPGRADING APPLICATION 

Submit to Dean prior to start of activity.                                                 Date: ______________ 

Name: _________________________________________                SSN: ______________
           (Last)                           (First)                           (MI)

Department: _______________ Teaching Assignment: _______________ Years with CNM: _____

Date(s) of Activity:  From: ______________                    To: __________________

Time of Activity:     From:  ______________ AM/PM      To: __________________ AM/PM

Field Experience credit desired (TOE  495/595)?  Yes _____  No _____

Number of credit hours desired (3 to 6):     ___________

Application for admission/readmission filed with UNM?  Yes _____  No ______

(If No, file immediately.)

Describe occupational or academic upgrading desired: _________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Name of institution where upgrading will be obtained: __________________________________________

Address: _____________________________________________Phone: ________________________

Name of immediate supervisor: __________________________________________________________

Title: ______________________________________________________________________________

Job description of upgrading assignment:____________________________________________________
__________________________________________________________________________________

Objectives:
1. ________________________________________________________________________________
2. ________________________________________________________________________________
3. ________________________________________________________________________________

Explain how upgrading will benefit CNM:____________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Personal gain expected:________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Describe how upgrading experience will be evaluated: _________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

APPROVALS

______________________                            ______________________________________________
Date Submitted                                                Signature of Applicant

______________________                            ______________________________________________
Date                                                                 Dean

_______________________                          ______________________________________________
Date                                                                 Supervisor in Business/Industry

_______________________                          ______________________________________________
Date                                                                 Vice President for Instruction

_______________________                          ______________________________________________
Date                                                                 Project Director (when applicable)

When approvals have been obtained, distribute copies to:

Dean
Supervisor in Business/Industry
Cooperating Employer (if different from supervisor)
Project Director (if applicable)