HPLRP Application Information

Employee Verification Letter (EVL)

EVL must contain the following items:
  • Applicants full name
  • Contact information of employer
  • Dates of employment and employment status (part time/full time)
  • Brief summary of responsibilities and duties of the employee
  • Patient Services
  • Geographic area (counties served)
  • Medicare/Medicaid provider numbers (if applicable)
  • Must be signed by employer on official letterhead

Governmental ID

  • Official Drivers License or Official Photo ID.

Medicare/Medicaid Acceptance

  • Provide Medicare NPI# and/or Medicaid Provider #. (if applicable)

Governmental/Federal Affiliation Documentation

  • Proof of Federally Qualified Health Centers, Community Health Centers, Migrant Health Centers, Health Care for the Homeless, and Health Centers for Residents of Public Housing.

Tribal Affiliation Documentation

  • Proof of Tribe, Tribal Organizations and/or Urban Indian Health Centers.

501(C)(3) Documentation of Non-Profit Status

  • Proof of 501(c)(3) Non-Profit Form.

Sliding Fee Scale Documentation

  • The health center’s sliding fee scale document and/or related policies and procedures for determining sliding fee eligibility and applying sliding fee discounts.

Policy To Treat Patients Regardless of their Ability To Pay Documentation

  • Brief documentation outlining this policy within the health center.


  • Student loans must be dated within the last 90 days.
  • Loans eligible for repayment assistance are any educational loans obtained for tuition, educational expenses, or living expenses from a college, university, government, or commercial source.


  • Current New Mexico Professional License. (mandatory)
  • Additional certifications may be uploaded to your HPLRP application.