Before starting this form, be sure you have your unique 9-digit New Mexico PED number. See your advisor for assistance, if needed. Student InformationPlease select whether you have ever been in New Mexico MESA or if you have not ever been in New Mexico MESA before*You have NEVER been in NM MESAYou have been in NM MESAIf yes, most recent year?Please enter a value between 2008 and 2017.Your School for the 2016-2017 school year*Please select a school...Alamogordo HSAlbuquerque HSAlta Vista Early CollegeAmy Biehl HSAnton Chico MSArtesia High SchoolAtrisco Heritage Academy HSBelen HSBelen MSBernalillo HSBernalillo MSBerrendo MSCapshaw MSCarlos F. Vigil MSCarlsbad 6th Grade AcademyCarlsbad HSCarlsbad Intermediate SchoolCC Snell MSCentennial HSChaparral (Gadsden) MSCibola HSCobre HSCochiti MSCrownpoint HSCrownpoint MSDel Norte HSDeming HSDeming IntermediateEast Mountain HSErnie Pyle MSEspanola Valley HSGadsden MSGallup HSGarfield MSGoddard HSGrants HSHolloman MSJefferson MSJimmy Carter MSJohn Adams MSJohn F. Kennedy MS - GallupKennedy MS - AlbuquerqueLas Cruces HSLos Alamitos MSLos Lunas MSLos Lunas HSLynn MSMagdalena HSManzano HSMayfield HSMemorial MSMesa Alta JHSMesa Vista HSMesa Vista MSMiyamura HSMora HSMora MSMt. View (Alamogordo) MSNavajo Preparatory High SchoolnexGen AcademyOnate HSPortales HSPortales Junior HighRed Mountain MSRobertson HSRoswell HSRuidoso HSRuidoso MSSanta Rosa HSSanta Rosa MSSanto Domingo MSSarracino MSSierra (Roswell) MSSocorro HSSouth Valley AcademyTaft MSTaylor MSTest HSTest MSThoreau HSThoreau MSTierra EncantadaTohatchi Middle SchoolTruman MSValley HSVan Buren MSValencia MSValencia HSVista MSWest Las Vegas HSWest Las Vegas MSWest Las Vegas Valley MSWest Mesa HSYour Current Grade for the 2016 -2017 school year*Select6789101112NM PED Student ID*9 digits: no dashes or spaces.Student Date of Birth* Student First Name*Student Last Name*Middle InitialStreet Address*City*Zip Code*County*SelectBernalilloCatronChavesCibolaColfaxCurryDe BacaDoña AnaEddyGrantGuadalupeHardingHidalgoLeaLincolnLos AlamosLunaMcKinleyMoraOteroQuayRio ArribaRooseveltSandovalSan JuanSan MiguelSanta FeSierraSocorroTaosTorranceUnionValenciaStudent EmailThis is very important. We use this email address to let you know how much you are money you are receiving from the Loyalty Award and how to get it. Enter Email Confirm Email Home PhoneStudent Cell PhoneStudent Gender*MaleFemaleStudent EthnicityUndeclaredHispanic (Spanish culture of origin)Anglo (not Hispanic origin)Black (not Hispanic origin)Asian or Pacific islanderAmerican Indian/Alaskan OriginStudent Tribe (if applicable)Does student have a disability?YesNoDoes student participate in a free/reduced lunch program?YesNoParent/Guardian #1 Information1 Name*(first and last)1 Email Enter Email Confirm Email 1 Do you wish to receive MESA related information at this email address?We will be using this email to notify you of your child's Loyalty Award status and how they need to apply for it. Nothing else will be emailed to you.YesNo1 Current Employer1 Work Phone1 Highest level of education you've received?SelectK-8High School/GEDTechnical SchoolAssociates DegreeBachelors DegreeMasters DegreeDoctoratePost DoctoralAdditional parent/guardian?*YesNoParent/Guardian #2 Information2 Name(first and last)2 Email Enter Email Confirm Email 2 Do you wish to receive MESA related information at this email address?YesNo2 Current Employer2 Work Phone2 Highest level of education you've received?SelectK-8High School/GEDTechnical SchoolAssociates DegreeBachelors DegreeMasters DegreeDoctoratePost DoctoralFamily Income RangeInformation gathered for grant purposes only.Income Range$0-10,000$10,000-20,000$20,000-30,000$30,000-40,000$40,000-50,000$50,000 +CommentsThis field is for validation purposes and should be left unchanged.