For Information, contact Marisa Aguirre - email - maguirre@hprec.com 

Are you a graduate-level licensed school-based behavioral health provider currently working in or planning to work in an identified EOP school/district?  
For more information, please visit our website: 
www.nmeop.com

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* 1. First and Last Name

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* 2. Email

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* 3. a) Name of master's or doctoral level program/degree b) Date of initial enrollment in program, c) Date of graduation, d) Confirmation that your program/degree resulted in licensure as a school-based behavioral health provider.

Please provide all information, to avoid a delay in the review of your eligibility.

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* 4. I understand that a requirement of the EOP employment stipend of up to $2,000 is verification that your current or upcoming employment is in an EOP identified school/district.

(Please note that the following districts are not part of the grant funding - Albuquerque Public Schools, Farmington Municipal Schools, Las Cruces Public Schools, and Santa Fe Public Schools.)

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* 5. I understand if the number of eligible participants exceeds the available grant funding, preference will be given to providers in LEAs identified with the highest needs, as per grant guidelines (ex, poverty, student-to-mental health provider ratio, etc). 

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* 6. Please provide your job title, date of hire, and current contract dates.

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* 7. Please provide the LEA name and contact information for the LEA person who can confirm your employment status (district/charter).

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* 8. Secondary email (optional)

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* 9. Mobile phone (optional)

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* 10. Do you have any other information to share or any questions?

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* 11. I understand that if I am approved, an official transcript showing your date of graduation will be required to be sent to High Plains REC.

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* 12. I understand the following:
- Stipends may be considered taxable income
- If I have questions, I should consult a tax specialist, as High Plains REC does not have this expertise

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* 13. I understand that I will be contacted, by email, regarding the status of my application after the window for this cohort closes on December 31, 2021.

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* 14. Please upload a copy of your current NMPED license.

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