School Application Form

THE FORM IS ONLY SHOWING ONE SCHOOL PER DISTRICT CURRENTLY AND WILL BE REPAIRED SOON

IF YOU WOULD LIKE TO SIGN UP, PLEASE CONTACT benjamin.wear@env.nm.gov

School Application

Lead Testing in Schools and Child Care Facilities Drinking Water (LWSC) Program School Application Form.

School District and Name(Required)

Select the school district to select your school.

Physical Street Address

Street Address City ZIP / Postal Code

Mailing Address

Street Address City ZIP / Postal Code

Superintendent Name

First Last

Superintendent Phone Number

Superintendent Email Address

Principal Name

First Last

Phone Number

Principal Email Address

Maintenance Sampling / Coordinator Name

First Last

Maintenance Sampling / Coordinator Phone

Maintenance Sampling / Coordinator Email