Student Success Support Request
This form provides a mechanism to identify students who may need additional support in order to make progress/be retained. Submission of this form initiates a process of outreach and referral intended to support the student and help them access the resources they need or take the actions necessary to be successful.

This form should NOT be used in place of existing tools including Confirming Rosters and Early Progress Reports, nor should it be used for behavioral concerns (review the Behavioral Intervention Team website for instructions on reporting behavioral issues: https://www.gcc.mass.edu/biteam/report-a-concern/).

Each submission will be reviewed by a team in the Advising Center to determine the appropriate outreach and next steps. Referrals will be made to campus and community resources. Students may be assigned a Success Coach for ongoing support.

Questions about this form should be directed to Tonya Blundon, Director of Advising & Transfer, blundont@gcc.mass.edu or (413) 775-1170.

Email *
Your Name *
What is your relationship to the student?
Clear selection
Student Name *
Student ID
Reason outreach is needed (check all that apply) *
Required
Please describe the issue: *
What, if any, efforts have you already made to address this with the student? *
Degree of Need *
Required
What are this student's strengths? *
Can we share with the student that you have made this referral? *
A copy of your responses will be emailed to .
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