New Mexico Concealed Handgun Carry Class Student Registration and Information Sheet
This information is required by the New Mexico Department of Public Safety in accordance with the New Mexico Concealed Handgun Carry Act. This record must be maintained by me for a period of five (5) years.

This is a secure form and data will be encrypted when you hit the "Submit" button. Your sensitive information is safe.

The fields marked with a red asterisk are required fields.

Please contact me at mrg@wyor.com if you have any questions, thanks.

Michael R. Grimler
NM CCW DPS Instructor #21
Today's Date *
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Types of Permit Classes and Activities
New: Select this if you want to obtain an initial permit, or your prior permit expired more than 120 days ago and you want to obtain a new permit, you must take the 2-day, 15-hour NM CCW class. The fee is currently $180.

Renewal: Select this if you are within 60 days ahead of your permit expiration date, or within 120 days after your permit expiration date. The fee is currently $77.

Endorsement: Select this if you are a current permit holder and you want to add a higher caliber or add a category. For example, if you originally qualified with a 9mm semi-auto and want to upgrade to a .45 semi-auto. You will just shoot the COF. The fee is $51.
Type of Class Desired
Current Permit Number Information
If you are renewing your current permit NM DPS asks for your permit number. This helps them ensure you receive proper credit for your renewal class and makes their administrative effort more efficient.
Current Permit Number
Readiness Assessment - Initial, Renewal, and Endorsement
The shooting portion of my initial class, renewal class, or endorsement activity is designed for those who have obtained INTERMEDIATE shooting skills; this is not a "Learn to Shoot" class.

If you are taking the initial permit class, please go to this site: https://bit.ly/nmccwready and complete the readiness assessment. I will evaluate your answers and if I have any concerns, I will contact you about them.

If you are signing up for a permit renewal or permit endorsement - and you have not taken any NM CCW classes from me before, you also need to complete the readiness assessment form. If you have taken the initial or renewal classes from me in the past, the assessment is not necessary.

The Readiness Assessment is located at: https://bit.ly/nmccwready
Below, select the start date of the NM CCW class desired
Information found in the "Class Schedule" section at www.wyor.com
Start date *
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First Name *
Middle Initial or Name
Last Name *
Mailing Address *
City *
Zip Code *
Email address *
Please ensure you indicate the correct year of birth
Date of Birth *
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Firearm Information
Enter the firearm(s) (up to two) with which you want to qualify and have shown on your New Mexico CCW permit.

NM DPS recognizes two "categories" of firearms; Semi-Automatics, and Non-Semi Automatics. The Non-Semi Automatics category covers firearms such as revolvers and derringers.

If you want a semi-automatic and a revolver on your license, you must shoot the qualification course with a firearm of each category

It is advisable to shoot the largest caliber of each category with which you wish to qualify. You will then be able to carry concealed any firearm that matches the caliber qualified with, and any smaller caliber within that category.

NOTE: If you have a magnum firearm, such as a .44 magnum, or a .357 magnum...you can shoot the "specials" within that category for qualification - you do not have to shoot the magnum rounds.
Below, indicate the Category for Firearm #1
SA = Semi-Auto
NSA = Non-Semi Auto (Revolver)
Firearm #1 Category *
Required
Firearm #1 Caliber Information
NOTE: For .50 cal, bullet weight cannot exceed 230 gr, and velocity cannot exceed 2,200 fps.
Firearm #1 Caliber *
Indicate Category for Firearm #2
No#2 = I am not going to qualify with a 2nd firearm
SA = Semi-Auto
NSA = Non-Semi Auto (Revolver)
Firearm #2 Category
Firearm #2 Caliber Information
NOTE: For .50 cal, bullet weight cannot exceed 230 gr, and velocity cannot exceed 2,200 fps.
Firearm #2 Caliber
Affirmation
I do hereby affirm that the information I have entered above is true and correct. I understand that when I click the "SUBMIT" button below for this form that it is the same as if I had signed my name in person and carries the full legal weight of a personal signature.

By submitting this Student Information Sheet, I certify that I have read and understood the information contained within NMAC 29-19-4, titled "Applicant Qualifications," including sub-sections A. and B. As such, as of the signing of this document, I also certify that I am eligible for a New Mexico Concealed Handgun permit. I understand that if I am denied a permit by the State of New Mexico for whatever reason, I shall not hold Michael R. Grimler, the Los Alamos Sportsmen's Club, the County of Los Alamos, or the US Department of Energy responsible for such denial.

I understand that these NM CCW classes are designed for shooters of at least an INTERMEDIATE skill level. As such, I affirm that I am familiar with withdrawing my firearm safely from a strong-side hip or strong-side "Inside the Waistband" (IWB) holster, safely re-holstering, the fundamentals of marksmanship to include sight picture, sight alignment, stance, grip, trigger pull, and I am familiar with the proper and safe loading, safe unloading and safe and efficient reloading of any firearm in my possession, to include the firearm(s) with which I will shoot the qualification course of fire.

I further understand that I may be asked to leave the class, if directed by the instructor, for any firearm safety violations observed or reported. If I am asked to leave the class for such safety violations, I may forfeit all or part of my paid class fee. I acknowledge that Michael R. Grimler, Firearm Instructor reserves the right to refuse instruction to anyone before the class starts. If I am refused instruction, I am entitled to a full refund of any class fee paid to date before the class.

I also certify that I have reviewed the NM DPS "qualifiers" and "disqualifiers" in the official NM DPS CHC permit application and law and have self-determined that I am qualified to possess an NM CHC permit following training and NM DPS processing.

I understand that class fees are non-refundable. ‚ÄčIf I have pre-paid for a class and am not able to attend, my fee will be applied to the next available class that is offered. If I decide to not use the pre-paid class fee for an NM CCW class, I may apply it towards private firearm lessons at the rate of $45/hour. I understand that private firearm lessons will be given at a mutually-agreeable date and time at the Los Alamos Sportsmen's Club facility.
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