CPL Event Registration Form

The University of New Mexico School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of New Mexico School of Medicine designates this live activity for a maximum of 1.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Thank you for your interest in this CPL offering. This form has two parts.


Part One requests demographic information and describes any registration fees and payment associated with this event. This page must be completed in order for your registration to be confirmed.


Part Two is optional and requests information which assists CPL in better understanding the reasons for your interest, and in evaluating our program offerings and marketing methods for improvement.


Please answer all questions and click the "Submit" button at the end of the form to ensure a complete registration. Review CPL's General Workshop Requirements here: https://bit.ly/CPLWorkshopRequirements

Advancing Inclusive Teaching and Learning

Date: Monday, May 19, 2025


Time: 1:30 - 3:30 pm


Registration Deadline: May 5, 2025


Registration Fee:


  • UNM/HSC Employee: $140.00
  • Non-UNM/HSC Employee: $160.00

As you would like it to appear on your attendance certificate:

As you would like it to appear on your attendance certificate:

As you would like it to appear on your name badge:

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The category that best describes my Position Title is:

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Please add your department (example: Internal Medicine, Pediatrics, etc.). If you are not affiliated with UNM/HSC please write "None."

(If a UNM/HSC employee, please provide your @Salud or @ UNM address):

Phone

If you are not affiliated with UNM/HSC, please provide the following information:

Please select from the list below:

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Registration fees for this event are as follows:

Regular UNM/HSC Employee (Faculty/Staff)


1. Tuition Remission Benefit


Upon submission of this registration form, you will receive an email with additional workshop information.

THIS SECTION FOR EMPLOYEE PROFESSIONAL DEVELOPMENT

NOTE: Tuition Remission is applicable to benefits eligible employees as defined in Section 2.2 of UAP 3700, "Education Benefits"

I acknowledge that I have reviewed UAP 3700, “Education Benefits” and certify this request for Tuition Remission Benefit is within the maximum allowable benefit per semester as provided in the Policy.


I understand that I am responsible to repay all costs that exceed the maximum allowable benefit. I acknowledge the University will bill me for any excess tuition costs that have been paid. If the bill is not paid, UNM may collect any excess through payroll deductions


I acknowledge that the amount of tuition benefits for certain courses are considered taxable under current published IRS regulations. I understand that any taxable tuition benefit I receive will be added to my wages as taxable income and will be subject to income tax withholding.


Additionally, I understand that if the amount of tuition benefits I receive during the calendar year exceeds the published IRS maximum amount, the amount in excess of the IRS maximum will be added to my wages as taxable income and will be subject to income tax withholding.


Information regarding Tuition Rates and the Taxability of Tuition Remission my be viewed at: http://bursar.unm.edu/index.html


Check here to indicate that you acknowledge each of the above statements.

Check here to indicate that you have read and agree to the terms of the the UNM Employee Tuition Remission Benefit Form.

Supervisory approval is required if any of the following apply:

•A credit course taken during the employee’s regular work schedule (approval is to authorize the absence from work and to approve an alternate work schedule); or


•A non-credit professional development course taken during the employee’s work schedule that is related to the employee's job or a UNM job to which the employee may reasonably aspire (approval is to authorize absence from work and approve an alternate work schedule); or


•A non-credit health and fitness course taken during the employee’s work schedule (approval is to authorize the absence from work and to approve an alternate work schedule).



If you require supervisory approval based on the list provided above, kindly submit the form.


To obtain the tuition remission form, please copy and save the link below. This form requires appropriate supervisory approval before submission. Once completed, email the form to the Office for Continuous Professional Learning (CPL) at HSC-cpl@salud.unm.edu.


https://bit.ly/CPLTRForm


Please get in touch with CPL if you have any questions regarding the tuition remission form.

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Registration fees for this event are as follows:

UNM/HSC Employee or Non/UNM HSC Employee


2. Credit Card or Debit Card


Upon submission of this registration form, you will receive an email with additional workshop information and instructions regarding remitting payment.

Sponsored SOM

Please selected one of the following:


3. UNM/HSC Volunteer or Community Preceptor, Volunteer, or Adjunct Faculty member

4. UNM/HSC Resident, Fellow, or Post-Doctoral

5. UNM/HSC Student of any level (and not also a regular benefited employee).


UNM Students, residents, fellow, post-doc, volunteer preceptors, and volunteer or adjunct faculty will be sponsored by the UNM School of Medicine Office of Education, and may register to attend (and receive continuing education credit, if eligible) without incurring a registration fee.


Upon submission of this registration form, you will receive an email with additional workshop information.


For cancelation, please reach out to CPL at HSC-CPL@salud.unm.edu. If possible up to one week before to the event.

1. Full refunds are available to those providing written or emailed cancelation request up to one week prior to the event date.


2. Refunds less a $40 administration fee will be available to those who provide written or emailed cancellation notice within one week of the event date.


3.No refunds will be provided to those who register but fail to attend, or who cancel their registration on the day of the event.


Acknowledgement of CPL's Refund Policy

I am attending this workshop because:

The workshop material or technology is new or interesting to me.

(1= Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

The workshop presents an opportunity to meet people and share ideas with colleagues.

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

The workshop provides training on concepts or skills related to personal goals.

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

This workshop has been recommended by a colleague.

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

The workshop is required by my department.

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

This workshop fulfills a requirement within the Achievement in Medical Education Program (AMEP).

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

How did you hear about this event?*

(Please check all that apply.)

COVID Precautions

The UNM Health & Health Sciences encourages conference participants to mask indoors. Continuous Professional Learning (CPL), the conference organizers do not conduct contact tracing and advise participants to follow the CDC guidelines for social interaction.   

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html 

Upon submission of this registration form, you will be notified of the location of the event.

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