{"id":6,"date":"2025-04-09T15:18:57","date_gmt":"2025-04-09T15:18:57","guid":{"rendered":"https:\/\/www.env.nm.gov\/lwsc\/facility-nomination-form\/"},"modified":"2025-04-09T15:18:58","modified_gmt":"2025-04-09T15:18:58","slug":"facility-nomination-form","status":"publish","type":"page","link":"https:\/\/www.env.nm.gov\/gtlo\/facility-nomination-form\/","title":{"rendered":"Facility Nomination Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_1'>Type of Facility<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_3_1' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please Select<\/option><option value='School' >School<\/option><option value='Child Care' >Child Care<\/option><\/select><\/div><\/div><div id=\"field_3_3\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_3'>Facility Name<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_3_3' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_6\" class=\"gfield gfield--type-chainedselect gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_3_6_1'>Select District and School name<\/label><div class='ginput_container ginput_complex gform-grid-row horizontal large gfield_chainedselect' id='input_3_6'><span id='input_3_6_1_container' class='gform-grid-col--size-auto gform-grid-col'>\n\t\t\t\t\t<select name='input_6.1' id='input_3_6_1' class='gform-grid-col--size-auto'   ><option value='' selected='selected' class='gf_placeholder'>DISTRICT<\/option><option value='ALAMOGORDO PUBLIC SCHOOLS' >ALAMOGORDO PUBLIC SCHOOLS<\/option><option value='ALBUQUERQUE PUBLIC SCHOOLS' >ALBUQUERQUE PUBLIC SCHOOLS<\/option><option value='ANIMAS PUBLIC SCHOOLS' >ANIMAS PUBLIC SCHOOLS<\/option><option value='ARTESIA PUBLIC SCHOOLS' >ARTESIA PUBLIC SCHOOLS<\/option><option value='AZTEC MUNICIPAL SCHOOLS' >AZTEC MUNICIPAL SCHOOLS<\/option><option value='BELEN CONSOLIDATED SCHOOLS' >BELEN CONSOLIDATED SCHOOLS<\/option><option value='BERNALILLO PUBLIC SCHOOLS' >BERNALILLO PUBLIC SCHOOLS<\/option><option value='BLOOMFIELD SCHOOLS' >BLOOMFIELD SCHOOLS<\/option><option value='CAPITAN MUNICIPAL SCHOOLS' >CAPITAN MUNICIPAL SCHOOLS<\/option><option value='CARLSBAD MUNICIPAL SCHOOLS' >CARLSBAD MUNICIPAL SCHOOLS<\/option><option value='CARRIZOZO MUNICIPAL SCHOOLS' >CARRIZOZO MUNICIPAL SCHOOLS<\/option><option value='CENTRAL CONSOLIDATED SCHOOLS' >CENTRAL CONSOLIDATED SCHOOLS<\/option><option value='CHAMA VALLEY INDEP. SCHOOLS' >CHAMA VALLEY INDEP. SCHOOLS<\/option><option value='CHARTER SCHOOLS' >CHARTER SCHOOLS<\/option><option value='CIMARRON MUNICIPAL SCHOOLS' >CIMARRON MUNICIPAL SCHOOLS<\/option><option value='CLAYTON MUNICIPAL SCHOOLS' >CLAYTON MUNICIPAL SCHOOLS<\/option><option value='CLOUDCROFT MUNICIPAL SCHOOLS' >CLOUDCROFT MUNICIPAL SCHOOLS<\/option><option value='CLOVIS MUNICIPAL SCHOOLS' >CLOVIS MUNICIPAL SCHOOLS<\/option><option value='COBRE CONSOLIDATED SCHOOLS' >COBRE CONSOLIDATED SCHOOLS<\/option><option value='CORONA MUNICIPAL SCHOOLS' >CORONA MUNICIPAL SCHOOLS<\/option><option value='CUBA INDEPENDENT SCHOOLS' >CUBA INDEPENDENT SCHOOLS<\/option><option value='DEMING PUBLIC SCHOOLS' >DEMING PUBLIC SCHOOLS<\/option><option value='DES MOINES MUNICIPAL SCHOOLS' >DES MOINES MUNICIPAL SCHOOLS<\/option><option value='DEXTER CONSOLIDATED SCHOOLS' >DEXTER CONSOLIDATED SCHOOLS<\/option><option value='DORA MUNICIPAL SCHOOLS' >DORA MUNICIPAL SCHOOLS<\/option><option value='DULCE INDEPENDENT SCHOOLS' >DULCE INDEPENDENT SCHOOLS<\/option><option value='ELIDA MUNICIPAL SCHOOLS' >ELIDA MUNICIPAL SCHOOLS<\/option><option value='ESPANOLA PUBLIC SCHOOLS' >ESPANOLA PUBLIC SCHOOLS<\/option><option value='ESTANCIA MUNICIPAL SCHOOLS' >ESTANCIA MUNICIPAL SCHOOLS<\/option><option value='EUNICE MUNICIPAL SCHOOLS' >EUNICE MUNICIPAL SCHOOLS<\/option><option value='FARMINGTON MUNICIPAL SCHOOLS' >FARMINGTON MUNICIPAL SCHOOLS<\/option><option value='FLOYD MUNICIPAL SCHOOLS' >FLOYD MUNICIPAL SCHOOLS<\/option><option value='FORT SUMNER MUNICIPAL SCHOOLS' >FORT SUMNER MUNICIPAL SCHOOLS<\/option><option value='GADSDEN INDEPENDENT SCHOOLS' >GADSDEN INDEPENDENT SCHOOLS<\/option><option value='GALLUP-MCKINLEY CTY SCHOOLS' >GALLUP-MCKINLEY CTY SCHOOLS<\/option><option value='GRADY MUNICIPAL SCHOOLS' >GRADY MUNICIPAL SCHOOLS<\/option><option value='GRANTS-CIBOLA COUNTY SCHOOLS' >GRANTS-CIBOLA COUNTY SCHOOLS<\/option><option value='HAGERMAN MUNICIPAL SCHOOLS' >HAGERMAN MUNICIPAL SCHOOLS<\/option><option value='HATCH VALLEY PUBLIC SCHOOLS' >HATCH VALLEY PUBLIC SCHOOLS<\/option><option value='HOBBS MUNICIPAL SCHOOLS' >HOBBS MUNICIPAL SCHOOLS<\/option><option value='HONDO VALLEY PUBLIC SCHOOLS' >HONDO VALLEY PUBLIC SCHOOLS<\/option><option value='JAL PUBLIC SCHOOLS' >JAL PUBLIC SCHOOLS<\/option><option value='JEMEZ MOUNTAIN PUBLIC SCHOOLS' >JEMEZ MOUNTAIN PUBLIC SCHOOLS<\/option><option value='JEMEZ VALLEY PUBLIC SCHOOLS' >JEMEZ VALLEY PUBLIC SCHOOLS<\/option><option value='LAKE ARTHUR MUNICIPAL SCHOOLS' >LAKE ARTHUR MUNICIPAL SCHOOLS<\/option><option value='LAS CRUCES PUBLIC SCHOOLS' >LAS CRUCES PUBLIC SCHOOLS<\/option><option value='LAS VEGAS CITY PUBLIC SCHOOLS' >LAS VEGAS CITY PUBLIC SCHOOLS<\/option><option value='LOGAN MUNICIPAL SCHOOLS' >LOGAN MUNICIPAL SCHOOLS<\/option><option value='LORDSBURG MUNICIPAL SCHOOLS' >LORDSBURG MUNICIPAL SCHOOLS<\/option><option value='LOS ALAMOS PUBLIC SCHOOLS' >LOS ALAMOS PUBLIC SCHOOLS<\/option><option value='LOS LUNAS PUBLIC SCHOOLS' >LOS LUNAS PUBLIC SCHOOLS<\/option><option value='LOVING MUNICIPAL SCHOOLS' >LOVING MUNICIPAL SCHOOLS<\/option><option value='LOVINGTON MUNICIPAL SCHOOLS' >LOVINGTON MUNICIPAL SCHOOLS<\/option><option value='MAGDALENA MUNICIPAL SCHOOLS' >MAGDALENA MUNICIPAL SCHOOLS<\/option><option value='MAXWELL MUNICIPAL SCHOOLS' >MAXWELL MUNICIPAL SCHOOLS<\/option><option value='MELROSE PUBLIC SCHOOLS' >MELROSE PUBLIC SCHOOLS<\/option><option value='MESA VISTA CONSOLIDATED SCHOOLS' >MESA VISTA CONSOLIDATED SCHOOLS<\/option><option value='MORA INDEPENDENT SCHOOLS' >MORA INDEPENDENT SCHOOLS<\/option><option value='MORIARTY-EDGEWQOD SCHOOL DISTRICT' >MORIARTY-EDGEWQOD SCHOOL DISTRICT<\/option><option value='MOSQUERO MUNICIPAL SCHOOLS' >MOSQUERO MUNICIPAL SCHOOLS<\/option><option value='MOUNTAINAIR PUBLIC SCHOOLS' >MOUNTAINAIR PUBLIC SCHOOLS<\/option><option value='PECOS INDEPENDENT SCHOOLS' >PECOS INDEPENDENT SCHOOLS<\/option><option value='PENASCO INDEPENDENT SCHOOLS' >PENASCO INDEPENDENT SCHOOLS<\/option><option value='POJOAQUE VALLEY PUBLIC SCHOOLS' >POJOAQUE VALLEY PUBLIC SCHOOLS<\/option><option value='PORTALES MUNICIPAL SCHOOLS' >PORTALES MUNICIPAL SCHOOLS<\/option><option value='QUEMADO INDEPENDENT SCHOOLS' >QUEMADO INDEPENDENT SCHOOLS<\/option><option value='QUESTA INDEPENDENT SCHOOLS' >QUESTA INDEPENDENT SCHOOLS<\/option><option value='RATON PUBLIC SCHOOLS' >RATON PUBLIC SCHOOLS<\/option><option value='RESERVE PUBLIC SCHOOLS' >RESERVE PUBLIC SCHOOLS<\/option><option value='RIO RANCHO PUBLIC SCHOOLS' >RIO RANCHO PUBLIC SCHOOLS<\/option><option value='ROSWELL INDEPENDENT SCHOOLS' >ROSWELL INDEPENDENT SCHOOLS<\/option><option value='ROY MUNICIPAL SCHOOLS' >ROY MUNICIPAL SCHOOLS<\/option><option value='RUIDOSO MUNICIPAL SCHOOLS' >RUIDOSO MUNICIPAL SCHOOLS<\/option><option value='SAN JON MUNICIPAL SCHOOLS' >SAN JON MUNICIPAL SCHOOLS<\/option><option value='SANTA FE PUBLIC SCHOOLS' >SANTA FE PUBLIC SCHOOLS<\/option><option value='SANTA ROSA CONSOLIDATED SCHOOLS' >SANTA ROSA CONSOLIDATED SCHOOLS<\/option><option value='SILVER CONSOLIDATED SCHOOLS' >SILVER CONSOLIDATED SCHOOLS<\/option><option value='SOCORRO CONSOLIDATED SCHOOLS' >SOCORRO CONSOLIDATED SCHOOLS<\/option><option value='SPRINGER MUNICIPAL SCHOOLS' >SPRINGER MUNICIPAL SCHOOLS<\/option><option value='TAOS MUNICIPAL SCHOOLS' >TAOS MUNICIPAL SCHOOLS<\/option><option value='TATUM MUNICIPAL SCHOOLS' >TATUM MUNICIPAL SCHOOLS<\/option><option value='TEXICO MUNICIPAL SCHOOLS' >TEXICO MUNICIPAL SCHOOLS<\/option><option value='TRUTH OR CONSEQUENCES MUNICIPAL SCHOOLS' >TRUTH OR CONSEQUENCES MUNICIPAL SCHOOLS<\/option><option value='TUCUMCARI PUBLIC SCHOOLS' >TUCUMCARI PUBLIC SCHOOLS<\/option><option value='TULAROSA MUNICIPAL SCHOOLS' >TULAROSA MUNICIPAL SCHOOLS<\/option><option value='VAUGHN MUNICIPAL SCHOOLS' >VAUGHN MUNICIPAL SCHOOLS<\/option><option value='WAGON MOUND PUBLIC SCHOOLS' >WAGON MOUND PUBLIC SCHOOLS<\/option><option value='WEST LAS VEGAS PUBLIC SCHOOLS' >WEST LAS VEGAS PUBLIC SCHOOLS<\/option><option value='ZUNI PUBLIC SCHOOLS' >ZUNI PUBLIC SCHOOLS<\/option><\/select>\n\t\t\t\t<\/span><span id='input_3_6_2_container' class='gform-grid-col--size-auto gform-grid-col'>\n\t\t\t\t\t<select name='input_6.2' id='input_3_6_2' class='gform-grid-col--size-auto'   ><option value='' selected='selected' class='gf_placeholder'>SCHOOL<\/option><\/select>\n\t\t\t\t<\/span><span class=\"gf_chain_complete\" style=\"display:none;\">&nbsp;<\/span><\/div><\/div><fieldset id=\"field_3_4\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Facility Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_3_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 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