Affiliate/LAT Request Form

Affiliate/LAT Request Form

Please consider the appropriate access needed prior to filling out the form:

Affiliate Access: Staff, Students, and Visitors for access to basic UNM systems

LAT Access: Faculty access, usually for visiting instructors or PIs on grants (these must be approved by Faculty Committee)

Please note that the timeline that these requests are reviewed and completed is fully dependent upon Affiliate Services at HR.

Is this an Affiliate or LAT Request?*

Faculty Letter of Academic Title (LAT) Request

Affiliate Request

What type of request is this?*

New Request

Renewal

Requester Email

If you wish to be notified when the request has been submitted please include your email here

Does the nominee have a UNM Banner ID?*

Yes

Nominee Banner ID #*

Nominee First Name*

Nominee Last Name*

SSN #*

Note: if the nominee does not have a SSN, enter 999-99-9999. The nominee will be provided with a “dummy” SSN number to use for establishing their UNM NedID/email

address

Date of Birth*

Gender*

Female

Male

Other

Email*

Phone Number *

Phone

Address*

Street, City, State, Zip Code

Nominee Job Title*

Current Affiliation *

(National Laboratory, Outside Organization, or UNM Department):

Type of Role*

Contractor - Learning Central (425 day max)

Contractor - Medical (425 day max)

Learning Central (185 days max)

UNMJobs Performance Review (185 days max)

UNMJobs Search Committee (185 days max)

UNM Foundation (425 days max)

Visiting Colleague (425 days max)

Faculty LAT (1200 days max)

Requested Start Date*

End Date*

Please base this on type of role maximum days allowed

Will the Nominee be listed as the Instructor of Record?*

Yes

Does the request (subject to approval) include authorization to serve as PI on grants submitted through Sponsored Projects?*

Yes

Reason for Role*

Please provide an explanation of what access is needed and why (400 word limit)

Be sure to include any specific system access that is required - such as Learning Central, Email, Powerchart, RedCAP, UNMJobs, or LoboWeb for supervisor or timesheet approval.

Approved by Name*

Supervisor Name that will be approving this request

Approved by Title*

Supervisor Title that will be approving this request

Please upload required documents pertaining to request*

Demographic Form (for NEW Affiliate Request)
CV (for LAT)

Drag and drop files here or

Send me a copy of my responses

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