Academic Support Intake Form
STUDENT ASSOCIATION OF GEORGE BROWN COLLEGE
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] *
Required
Your email address *
Date *
MM
/
DD
/
YYYY
Name *
Last name *
Gender
Clear selection
Student ID number *
Phone number *
Program Code (example: T105) *
Course Code (example: COMM1007 ) *
Professor Name (example: John Smith) *
Program Chair (example: John Smith)
Semester *
Required
I authorize the Student Association Advocacy Staff to contact GBC Faculty/ Administration on my behalf. *
Nature of Issue
Grounds
Issue or concern (Please briefly describe your issue or concern. You will be given the opportunity to add further detail later.) *
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