Facility Nomination Form Lead Testing in Schools and Child Care Facilities Drinking Water (LWSC) Program Facility Nomination Form Type of Facility(Required)Please SelectSchoolChild CareFacility NameSelect District and School name DISTRICTALAMOGORDO PUBLIC SCHOOLSALBUQUERQUE PUBLIC SCHOOLSANIMAS PUBLIC SCHOOLSARTESIA PUBLIC SCHOOLSAZTEC MUNICIPAL SCHOOLSBELEN CONSOLIDATED SCHOOLSBERNALILLO PUBLIC SCHOOLSBLOOMFIELD SCHOOLSCAPITAN MUNICIPAL SCHOOLSCARLSBAD MUNICIPAL SCHOOLSCARRIZOZO MUNICIPAL SCHOOLSCENTRAL CONSOLIDATED SCHOOLSCHAMA VALLEY INDEP. SCHOOLSCHARTER SCHOOLSCIMARRON MUNICIPAL SCHOOLSCLAYTON MUNICIPAL SCHOOLSCLOUDCROFT MUNICIPAL SCHOOLSCLOVIS MUNICIPAL SCHOOLSCOBRE CONSOLIDATED SCHOOLSCORONA MUNICIPAL SCHOOLSCUBA INDEPENDENT SCHOOLSDEMING PUBLIC SCHOOLSDES MOINES MUNICIPAL SCHOOLSDEXTER CONSOLIDATED SCHOOLSDORA MUNICIPAL SCHOOLSDULCE INDEPENDENT SCHOOLSELIDA MUNICIPAL SCHOOLSESPANOLA PUBLIC SCHOOLSESTANCIA MUNICIPAL SCHOOLSEUNICE MUNICIPAL SCHOOLSFARMINGTON MUNICIPAL SCHOOLSFLOYD MUNICIPAL SCHOOLSFORT SUMNER MUNICIPAL SCHOOLSGADSDEN INDEPENDENT SCHOOLSGALLUP-MCKINLEY CTY SCHOOLSGRADY MUNICIPAL SCHOOLSGRANTS-CIBOLA COUNTY SCHOOLSHAGERMAN MUNICIPAL SCHOOLSHATCH VALLEY PUBLIC SCHOOLSHOBBS MUNICIPAL SCHOOLSHONDO VALLEY PUBLIC SCHOOLSJAL PUBLIC SCHOOLSJEMEZ MOUNTAIN PUBLIC SCHOOLSJEMEZ VALLEY PUBLIC SCHOOLSLAKE ARTHUR MUNICIPAL SCHOOLSLAS CRUCES PUBLIC SCHOOLSLAS VEGAS CITY PUBLIC SCHOOLSLOGAN MUNICIPAL SCHOOLSLORDSBURG MUNICIPAL SCHOOLSLOS ALAMOS PUBLIC SCHOOLSLOS LUNAS PUBLIC SCHOOLSLOVING MUNICIPAL SCHOOLSLOVINGTON MUNICIPAL SCHOOLSMAGDALENA MUNICIPAL SCHOOLSMAXWELL MUNICIPAL SCHOOLSMELROSE PUBLIC SCHOOLSMESA VISTA CONSOLIDATED SCHOOLSMORA INDEPENDENT SCHOOLSMORIARTY-EDGEWQOD SCHOOL DISTRICTMOSQUERO MUNICIPAL SCHOOLSMOUNTAINAIR PUBLIC SCHOOLSPECOS INDEPENDENT SCHOOLSPENASCO INDEPENDENT SCHOOLSPOJOAQUE VALLEY PUBLIC SCHOOLSPORTALES MUNICIPAL SCHOOLSQUEMADO INDEPENDENT SCHOOLSQUESTA INDEPENDENT SCHOOLSRATON PUBLIC SCHOOLSRESERVE PUBLIC SCHOOLSRIO RANCHO PUBLIC SCHOOLSROSWELL INDEPENDENT SCHOOLSROY MUNICIPAL SCHOOLSRUIDOSO MUNICIPAL SCHOOLSSAN JON MUNICIPAL SCHOOLSSANTA FE PUBLIC SCHOOLSSANTA ROSA CONSOLIDATED SCHOOLSSILVER CONSOLIDATED SCHOOLSSOCORRO CONSOLIDATED SCHOOLSSPRINGER MUNICIPAL SCHOOLSTAOS MUNICIPAL SCHOOLSTATUM MUNICIPAL SCHOOLSTEXICO MUNICIPAL SCHOOLSTRUTH OR CONSEQUENCES MUNICIPAL SCHOOLSTUCUMCARI PUBLIC SCHOOLSTULAROSA MUNICIPAL SCHOOLSVAUGHN MUNICIPAL SCHOOLSWAGON MOUND PUBLIC SCHOOLSWEST LAS VEGAS PUBLIC SCHOOLSZUNI PUBLIC SCHOOLS SCHOOL Facility Address Street Address City ZIP / Postal Code Which of the following best describes you?(Required) Parent / Guardian of child at facility Concerned member of the community Public water system representative Staff member at facility (not Director / Superintendent / Principal) Other
