Refer a Student
Please complete the form below to refer a 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 ID#
Student Date of Birth
Student Phone Number
Student Email Address
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 this student currently active or inactive?
Please select...
Active
Inactive
Is the referral a first-time GA student or a re-enrollment?
Please select...
First-time Graduation Alliance student
Re-enrolling Graduation Alliance student
Does this student have an IEP?
Please select...
Yes
No
Has a transition IEP been completed, indicating this change of placement?
(Please note: IEP must be completed before enrollment.)
Please select...
Yes
No
Please upload the student’s transcript to ensure accurate scheduling
Please upload the student's credit audit 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