Please complete the form below to refer a Texas 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 ID#

Student Date of Birth

Referring School

Referral Reason

Is the student active or inactive?

ActiveInactive

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.)