Please complete the form below to refer a North Carolina student to the Graduation Alliance 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 Phone

Student Email

District ID #

Student Date of Birth

Referring School

Referral Reason

Is the student active or inactive?

ActiveInactive

Does this student have an IEP (Mark NO for Gifted Only)?

YesNo

Is the referral a first-time Graduation Alliance student or a re-enrollment?

First-time GA student

Re-enrollment

Incoming Grade Level

Are you uploading the student's transcript?

Upload Transcript

Parent/Guardian Details

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Parent/Guardian Email

Relationship to Student

Additional notes (optional)

I verify that district enrollment forms are in hand (birth certificate, proof of residency, etc.)