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Student Profile (A-2)
Is form submitted by student or on student's behalf by advisor or RC?
*
Student
On student's behalf
Submitter Email
*
If form submitted on behalf of student, please enter YOUR EMAIL (NOT student email; student email field is further below).
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Confirm Email
Student Information
Have you ever been in New Mexico MESA before this year?
*
No, I have NEVER been in NM MESA
Yes, I have been in NM MESA
If yes, most recent year?
Please enter a number from
2008
to
2019
.
Your School for the 2020-2021 school year
*
Please select a school...
Alamogordo HS
Albuquerque HS
Alta Vista Early College
Amy Biehl HS
Anton Chico MS
Atrisco Heritage Academy HS
Belen HS
Belen MS
Bernalillo HS
Bernalillo MS
Berrendo MS
Carlos F. Vigil MS
Carlsbad 6th Grade Academy
Carlsbad HS
Carlsbad Intermediate School
CC Snell MS
Centennial HS
Chaparral (Gadsden) MS
Chaparral HS
Chief Manuelito MS
Cibola HS
Cobre HS
Cochiti MS
Crownpoint HS
Crownpoint MS
Del Norte HS
Deming HS
Deming Intermediate
East Mountain HS
Ernie Pyle MS
Espanola Valley HS
Gadsden MS
Gadsden HS
Gallup HS
Goddard HS
Grants HS
Holloman MS
Jefferson MS
Jimmy Carter MS
John Adams MS
John F. Kennedy MS - Gallup
Kennedy MS - Albuquerque
Laguna Acoma HS
Laguna Acoma MS
Las Cruces HS
Los Alamitos MS
Los Lunas HS
Lynn MS
Magdalena HS
Manzano HS
Mayfield HS
Memorial MS
Mesa MS
Mesa Vista HS
Mesa Vista MS
Middle College HS
Miyamura HS
Mora HS
Mora MS
Mt. View (Alamogordo) MS
Mt. View (Roswell) MS
Navajo Preparatory High School
nexGen Academy
Onate HS
Pojoaque Valley MS
Portales HS
Portales Junior High
Red Mountain MS
Robertson HS
Roswell HS
Ruidoso HS
Ruidoso MS
Santa Rosa HS
Santa Rosa MS
Sarracino MS
Sierra (Roswell) MS
Socorro HS
South Valley Academy
Taft MS
Taos MS
Taos HS
Taylor MS
Thoreau HS
Thoreau MS
Tierra Encantada
Tohatchi HS
Tohatchi MS
Truman MS
Valley HS
Van Buren MS
Valencia MS
Valencia HS
Vista MS
West Las Vegas HS
West Las Vegas MS
West Las Vegas Valley MS
West Mesa HS
Zia MS
Your Current Grade for the 2020 -2021 school year
*
Select
6
7
8
9
10
11
12
NM PED Student ID
9 digits: no dashes or spaces.
Student Date of Birth
*
Date Format: MM slash DD slash YYYY
Student First Name
*
Middle Initial
Student Last Name
*
Street Address
*
City
*
Zip Code
*
County
*
Select
Bernalillo
Catron
Chaves
Cibola
Colfax
Curry
De Baca
Doña Ana
Eddy
Grant
Guadalupe
Harding
Hidalgo
Lea
Lincoln
Los Alamos
Luna
McKinley
Mora
Otero
Quay
Rio Arriba
Roosevelt
Sandoval
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San Miguel
Santa Fe
Sierra
Socorro
Taos
Torrance
Union
Valencia
Student Email
*
This is very important. We use this email address to let you know how much money you are receiving from the Loyalty Award and how to get it.
Enter Email
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Home Phone
Student Cell Phone
Student Gender
*
Male
Female
Student Ethnicity
Undeclared
Hispanic (Spanish culture of origin)
Anglo (not Hispanic origin)
Black (not Hispanic origin)
Asian or Pacific islander
American Indian/Alaskan Origin
Student Tribe (if applicable)
Does student have a disability?
Yes
No
Does student participate in a free/reduced lunch program?
Yes
No
Parent/Guardian #1 Information
1 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.
Yes
No
1 Current Employer
1 Work Phone
1 Highest level of education you've received?
Select
K-8
High School/GED
Technical School
Associates Degree
Bachelors Degree
Masters Degree
Doctorate
Post Doctoral
Additional parent/guardian?
*
Yes
No
Parent/Guardian #2 Information
2 Name
(first and last)
2 Email
Enter Email
Confirm Email
2 Do you wish to receive MESA related information at this email address?
Yes
No
2 Current Employer
2 Work Phone
2 Highest level of education you've received?
Select
K-8
High School/GED
Technical School
Associates Degree
Bachelors Degree
Masters Degree
Doctorate
Post Doctoral
Family Income Range
Information 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 +
Email
This field is for validation purposes and should be left unchanged.
Students Overview
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