GSS Student Support Request Form
It is important for GSS students to know the supports available to them, and be able to self-refer in a discrete way.
Please select your requested support from the list below and they will call you down from class as soon as they are able.
(Your request will be confidential to the In-School Student Success Team Staff)
THIS IS NOT AN EMERGENCY SERVICE - if you are in an emergency situation, please call 911 immediately. This service will lead to an appointment/conversation with student supports staff.
Please list a phone number where you and/or your parent can be contacted. Guidance appointments will be largely conducted by telephone to maximize health and safety for all.
Reason for Guidance Appointment - please list the reason you are requesting a guidance appointment, if you are requesting one (e.g. summer school credit earned, post secondary requirements, course level change)
Name (First and Last):
I would like to speak with:
Student Success (Ms. Zombolas - Start here if unsure where to go for support!)
Guidance (Mrs. Walton, Ms. Ebert, Mr. Bosnic - eg. timetable changes, course inquiries)
Youth Counsellor (Sue - social/emotional supports and counselling)
Social Worker (Sarah - Select if you have seen her already, otherwise select Youth Counsellor)
Community Addiction Services Counsellor (CASON)
School Nurse (Joanne M.)
Resource Support (Mrs. Lebeau, Mme. Vasko)
Principal/Vice-Principal (Mr. Miller/Mrs. Folino)
Peer Mediation - student leaders who are available to assist with difficulties between students
Optional: Period you would like to be called down
Optional: Brief Description of Issue
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This form was created inside of District School Board of Niagara.