Refer a Student
Please complete the form below to refer a
New Mexico student to the Graduation Alliance program.
Form Submitter
Form Submitter First Name
Form Submitter Last Name
Form Submitter Phone Number
Form Submitter Email Address
Student Details
Student First Name
Student Last Name
Student Email Address
Student Phone Number
Student Date of Birth
District ID #
Referring School
Please select...
Las Cruces High School
Centennial High School
Organ Mountain High School
Mayfield High School
Arrowhead Park Early College High School
Rio Grande Prep Institute
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
Other
Other Referral Reason
Incoming Grade Level
Please select...
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Is this student currently active or inactive?
Active
Inactive
Is the referral a first-time GA student or a re-enrollment?
First-time Graduation Alliance student
Re-enrolling Graduation Alliance student
Does this student have an IEP?
Yes
No
Has a transition IEP been completed, indicating this change of placement?
(Please note: IEP must be completed before enrollment.)
Yes
No
Please upload the student’s transcript to ensure accurate scheduling
Please upload the student’s IEP if available
Please upload the student’s credit audit and/or course list if available.
Parent/Guardian Details
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Phone Number
Parent/Guardian Phone Number 2
Parent/Guardian Email Address
Relationship to Student
Please select...
Mother
Father
Grandparent
Guardian
I verify that district enrollment forms are in hand (birth certificate, proof of residency, etc.)
Additional Notes, Comments, or Questions