Refer a Student
Please complete the form below to refer a student to ENGAGE New Mexico Program.
Form Submitter
Form Submitter First Name
Form Submitter Last Name
Form Submitter Phone
Form Submitter Email
Student Details
Student First Name
Student Last Name
Student ID#
Student Date of Birth
Referring School
Referral Reason
Please select...
No longer attending school
At risk of dropping out (i.e., chronically absent, behind on credits, behavior challenges, life circumstances, etc.)
Past cohort year
Pregnant and/or parenting
Suspended or expelled
Referred by a court
Is the student active or inactive?
Active
Inactive
Please upload the student's transcript and credit audit:
Parent/Guardian Details
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone
Parent/Guardian Email
Relationship to Student
Please select...
Mother
Father
Grandparent
Guardian
Notes (optional)
I verify that district enrollment forms are in hand (birth certificate, proof of residency, etc.)