Accelerate Application & Release
Eligibility Questions
1. To participate in Accelerate you must declare one of the following certificates/degrees. You can also declare a second major or bachelor
degree but you must agree to complete one of the required certificates or associate degrees before working on any other degree. Failure
to declare one of the following degrees will result in a hold on stipends until your degree is declared.
Please check the qualified degree you are seeking:
Certificates:
__ Administrative Assistant
__ Bookkeeper
__ Electrical Technology
__ Environmental Monitoring
__ Film Technician
__ Radiation Control Technician
__ Welding
__ Wildland Fire Science
Associates:
__ Biology
__ Business Administration
__ Computer Aided Drafting
__ Construction Trades Management
__ Construction Trades Technology
__ Electrical Technology
__ Environmental Science
__ Film & Digital Media
__ Information Engineering Technology
__ Mathematics
__ Natural Resources – Science and Management
__ Office Administration
__ Pre-Engineering
__ Radiation Protection
__ Renewable Energy
__ Science
__ Software Engineering
__ Welding Technology
2. To qualify for Accelerate, you must answer “Yes” to at least one of the following questions in italics:
Yes
NO
Are you Hispanic/Latino?
___
___
Are you American Indian?
___
___
Are you Black/Afro American?
___
___
Are you of mixed Black, American Indian, or Hispanic heritage?
___
___
Did or will you start college more than 12 months after high school graduation
___
___
Did you obtain a GED?
___
___
Do you or will you work 35 hours or more per week while attending school?
___
___
Are you an honorably discharged veteran?
___
___
Is your income low enough to qualify for a Pell Grant?
___
___
Are you a single parent of children under 18?
___
___
N/A
___
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3. I am working toward my first degree at any college?
Yes
___
No
___
4. I am retraining after a layoff or because I have outdated skills?
___
___
5. When I begin the Fall 2014 semester, it will take at least two semesters for me to graduate.
___
___
6. I agree to take at least 12-15 credits each fall and spring semester between now and graduation. ___
___
7. I agree to graduate within 3 years of the date I started college at any school.
(Depending on your major/placement this might require taking 16-18 credits per semester)
___
___
8. I agree to graduate with a certificate or associate degree from Northern New Mexico College.
___
___
___ (Not possible)
9. My start date at NNMC was in _____________________of __________________.
Fall Spring Summer
year
10. I expect to complete my degree by ________________of __________________.
Fall Spring Summer
year
Qualified Student Questions
1.
Full Name (First)__________________(Middle)__________(Last)__________________________________________________
2.
NNMC Student ID 0000 __ __ __ __ __
3.
Male___ Female___ Age ____ Birthdate_________ No. of Tax Dependents You Support in Your Home_____________
4.
How many of your tax dependents are children under 18? _______
5.
Married___ Single___ Divorced___ Widow(er)___
6.
7.
Graduation from High School _______ ___________ OR Date Passed GED _______ __________
Month
Year
Month
Year
Home Phone ________________________________Cell Phone __________________________________________________
8.
NNMC e-mail Address____________________________________________________________________________________
9.
Personal e-mail address___________________________________________________________________________________
10.
Yes No
___ ___ You have my permission to send text messages to me. My phone service provider is: ________________________
11. Postal Address _____________________________________________ City __________________State ______Zip_________
12. Physical Address ___________________________________________ City __________________State ______Zip _________
13. Compass Scores for Math ________ English ________ Reading _________
(To sign up for classes you must take the Compass test in the Student Success Center 747-2164. If you took another test, such
as ACT/SAT/Accuplacer your scores will be converted to a Compass Score to place you into math and English classes)
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14. I have the following scholarships or grants
___Bridge
___Lottery
___Pell
___Other (Please name and provide annual amount) ____________________________________________________________
15. List any special requirements you must meet to keep your scholarship/grant, such as GPA, major, credits taken per
semester._______________________________________________________________________________________________
Yes No
16. ___ ____ I want to take Math 100____ Math 102____ or Math 130____ (choose only one class) this summer at no charge and
receive a $150 stipend for passing? Classes will be in the evening and will require about 5 hours of weekly work in the classroom
and about five hours of outside study. The class will have its own tutor. Your Compass scores determine your level in math.
17. Name of person who does NOT live with you but who will have your contact information if you move:
(First) ________________________(Middle) ________________(Last)_____________________________________________
18. Phone no. for this person ____________________ City _____________________________State________________________
Career Information
1.
Job title desired after graduation ___________________________________________________________________________
2.
Companies where you might like to intern ____________________________________________________________________
3.
Companies where you would like to work after graduation________________________________________________________
4.
Plans after graduating with certificate/associates:
___Continue in school to get a higher degree
___Get a full-time job
___Other (Please elaborate) _______________________________________________________________________________
Yes NO
5. ___ ___ I need a part-time job while I am in school?
6. ___ ___ I need special help finding a job because I have been arrested or convicted of a misdemeanor or felony.
(Answering “Yes” to this question will not influence program eligibility. Your counselor is trained to maintain
confidentiality and assist in this area.)
7. ___ ___ I think or others have told me that they think I have a drinking or substance abuse disease.
(Answering “Yes” to this question will not influence program eligibility. Your counselor is trained to maintain
confidentiality and assist in this area.)
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Agreements
GRANT REQUIREMENTS
NNMC, its grant manager, the Regional Development Corporation, and the Department of Energy need student information to comply with
DOE funding requirements. This includes grades, graduation status, WorkKeys test scores, job status, and other information. You will NOT
be personally identified in this information unless an audit is performed and your file is selected.
Yes
___
No
___ I give permission for my information to be shared with the above entities.
PROGRAM REQUIREMENTS
1. Meet with my Career Technical Advisor (CTA) for academic advising before the start of each semester while I am pursuing an
associate degree or certificate.
2. Attend five two-hour Friday workshops or schedule workshop makeups with my CTA while I am pursuing an associate degree or
certificate.
3. Attend a fall and spring mixer involving students from six Northern New Mexico colleges each year.
4. Alert my CTA if I miss more than two class days or expect to receive a grade lower than a C in a class.
5. Ask my CTA for assistance if an emergency will interfere with my grades or attendance.
6. Seek tutoring, meet with instructors, and contact my CTA if I am having difficulty with a class.
7. Advise my CTA in confidence of any barriers that might prevent me from engaging in certain careers.
8. Work with my CTA to create an approved resume, cover letter, pitch, and mock interview within my first year in the program.
9. Respond PROMPTLY to Accelerate CTA emails and surveys.
10. Take 3 WorkKeys tests (Applied Math, Reading for Information, and Locating Information) before graduating with a certificate or
associate degree; more than 300 Northern New Mexico employers use these tests to screen employees.
11. Attend the Professional Readiness event in the year that I graduate.
Yes No
___ ___ I agree to meet all of these program requirements.
MEDIA RELEASE
I give permission to NNMC, DOE, the Regional Development Corporation, and the Accelerate Program to release my name or image for
educational or publicity purposes in any and all media. This means my image or name may be used in print, video, film, or on the Website
of NNMC, DOE, the RDC, the Accelerate Program, or any of the colleges participating in Accelerate.
Yes No
___ ___ I agree to these media release terms.
FERPA RELEASE
I give consent to Northern New Mexico College to release records and other information covered by the Family Rights and Privacy Act of
1974 (FERPA) to my Career Technical Advisor without my knowledge from today’s date until I graduate with an associate degree or
certificate from NNMC. Only the following information may be released:






Office of the Registrar – Academic Transcripts/History/Grades, Enrollment Certificates, Major/Degree, Course Schedules,
Internships, Notice of Withdrawal, Test Scores, Holds, Detailed Information about Holds, including total amount owed.
Admissions – Admission Status, Documents Related to Admissions, Contact Information, Demographic Information, Criminal
Record.
Dean of Students – Disciplinary Information.
Faculty and Staff – Student Progress, Grades, Attendance, Strengths and Weaknesses.
Financial Aid – Financial Aid Information, Status, Documentation in File, Awards, Satisfactory Academic Progress Status issues.
Advising – Information Related to Academic/Career Advising Sessions, Progress Toward a Degree, Course Selection,
Application for a Degree Program, or Application for Graduation.
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

Accessibility Resource Center – Accommodations that will Foster School/Career Success.
Counseling Services – Information that will help my CTA support me in my academic and career pursuits.
Yes No
___ ___ I agree to the release of this information to my CTA.
PROOF OF SATISFACTORY EMPLOYMENT
The continuation of the Accelerate program is based on meeting metrics that show the program helps students stay in school, graduate
quickly, find jobs in their field, and perform those jobs satisfactorily. I agree to alert my CTA promptly when I am hired for a job while in
school and following graduation and to provide the name of my employer, my job title, date of hire, level of employer satisfaction with my
performance, and the relationship of the job to my field of study for up to three years following graduation. If I do not provide this
information, I agree that my CTA has permission to receive this information directly from my employer for a period of up to three years
following my graduation.
Yes No
___ ___ I agree to give my CTA permission to receive the above information from my employer(s).
I attest that all of the responses I’ve provided on the five pages of this application are correct and that I will abide by all the commitments I
have made in this application.
_________________________________
Student Signature
_________________________
Date
You will be notified if you are selected for Accelerate between April and October. If you have any questions, please contact Christy
Dammen, cdammen@nnmc.edu, (505) 747-5443, Room AD135C, Northern New Mexico College.
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