NM Wraparound CARES Facilitator Application for Certification

Download Blank Forms:

  • Please have the following ready before you submit this application:
  • This will be how your name is listed on your Wraparound credential.
  • Usually your work email is your primary
  • This should be a personal email address that we will use if you leave your employer.
  • Some providers serve more than one county, please list all counties that you currently work in.
  • Coach Evaluation & References

    Please provide the name and email for each of your 3 references below. They will be sent an email with the form(s) to complete and submit directly to us. You should let each of your references know to expect an email from NMSU with a form to fill out. If you have any details related to your references you want to provide, please include in space provided.
  • This should be an agency or organization you have interacted with in a Wraparound Setting
  • Please provide any additional information or instructions you want us to know as it relates to your references.
  • Document Upload

    Please upload documents into the corresponding sections below. If you are missing one or two documents you may still submit and send later via email. Your application will not be approved until all supporting documentation has been submitted.
  • Please upload completed FIT Verification Checklist. Include your first initial and last name in the file name.
    Max. file size: 2 MB.
  • Please submit training certificates for all trainings listed on checklist. Include your first initial and last name in the file name.
    Drop files here or
    Max. file size: 2 MB.
    • Include your first initial and last name in the file name.
      Drop files here or
      Max. file size: 2 MB.
      • Include your first initial and last name in the file name.
        Drop files here or
        Max. file size: 2 MB.
        • I verify the information I have provided is true and correct, and typing my name acts as my signature completing my application for NM Wraparound Cares Facilitator Certification