Academic Support Intake Form
STUDENT ASSOCIATION OF GEORGE BROWN COLLEGE
* Required
I understand that submission of this intake form does not automatically start my academic appeal process and/or any policy action. I need to follow the process as per the respective GBC policy. [This form is used by SA to contact you to help in the process]
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Yes
Required
Your email address
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Your answer
Date
*
MM
/
DD
/
YYYY
Name
*
Your answer
Last name
*
Your answer
Gender
Male
Female
Other
Clear selection
Student ID number
*
Your answer
Phone number
*
Your answer
Program Code (example: T105)
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Your answer
Course Code (example: COMM1007 )
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Your answer
Professor Name (example: John Smith)
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Your answer
Program Chair (example: John Smith)
Your answer
Semester
*
1
2
3
4
5
6
7
8
Required
I authorize the Student Association Advocacy Staff to contact GBC Faculty/ Administration on my behalf.
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Yes
No
Nature of Issue
Final grade (failed)
Unfair grade
Educational complaint
Promotions committee decision
Plagiarism/ academic dishonesty charge
Other: Academic
Other: Non-academic
Grounds
Merit of work
Illness and/ or disability
Compassionate
Course management
Policy violation
Human rights violation
Other:
Issue or concern (Please briefly describe your issue or concern. You will be given the opportunity to add further detail later.)
*
Your answer
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