System-Impacted Interest Form

System-Impacted Interest Form

If you or someone you know has a criminal record—with or without convictions or is in or has aged-out of foster care and wants to finish a high school or college education, CNM’s FIRST or THRIVE programs can help put you on the path to receiving a diploma, certificate or license.

Please use the form below to get started in CNM’s FIRST or THRIVE program. A representative will respond within 2-3 business days.

Today's Date*

Are you an Individual or Organization?*

Select

Which program are you interested in?*

Select

Organization Name*

Name (First and Last)*

Contact Name*

Phone Number*

Contact Phone*

Email Address*

Contact Email*

Please explain:*

Do you have a high school diploma or GED?*

Select

Are you currently enrolled at CNM?*

Select

CNM ID Number

Probation/Parole Status*

Organization: Is the person you are referring on probation or parole?

Individual: Are you currently on probation or parole?

Select

Foster Care Status*

Organization: Has the person you are referring aged out of the foster care system?

Individual: Have you aged out of the foster care system?

Select

Fostering Connections*

Organization: Is the person you are referring to a participant of Fostering Connections?

Individual: Are you a participant in Fostering Connections?

Select or enter value

Name of Person You Are Referring*

Phone Number of Person You Are Referring*

Email of Person You Are Referring*

How did you hear about CNM's System-Impacted programs?*

Comments/Additional Information

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