Academic Alert Referrals

As an instructor, you can often help a student who is struggling with the material in your course by connecting them with the support services available at GBCC. Faculty and advisors can use this form to refer a student to CAPS in order to provide further academic support.

You may complete and submit this electronically or download the PDF, print it, and bring the completed form directly to CAPS. Please see a member of the CAPS staff if you need assistance with using this form.

Academic Alert Referral Form (Print Version)

Academic Alert Referral Form

Access to this referral, and any follow-up action, is limited to the faculty member/Advisor making the referral, the Program Coordinator/Advisor, the student, and CAPS staff unless legal or safety concerns arise. A copy will be sent to the students Program Coordinator/Advisor.
Please check areas of need (optional)
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Format: 08/28/2016