Referrals by GCCS Teachers

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All students at GCCS have access to their school counselor primarily through classroom Character Education instruction. For students you feel require additional school counseling services, please use the forms below:

GCCS Mediation Request Form

GCCS Classroom Incident Counselor Referral Form

GCCS School Counseling Referral Form

Attendance Letter One (1)

Attendance Letter Two (2)


GCCS Mediation Request Form (back to top)

Use this form for conflict resolution between two or more GCCS students. (Tier 1 of School Counseling Pyramid of Interventions).


GCCS Classroom Incident Counselor Referral Form (back to top)

Use this form for students demonstrating ANY concerns that interfere with the student’s educational success or the classroom learning environment. The goal of this referral is to find solutions for both student and teacher that can be implemented in the general education environment. (Tier 1 of School Counseling Pyramid of Interventions).

*Note: Various incidents may be added to the same form.


GCCS School Counseling Referral Form (back to top)

Some students need more school counseling than what is provided during Character Education lessons. Therefore, use this form for students who you believe may benefit from more intentional guidance. For behavioral concerns, this form should come after 1-2 GCCS Classroom Incident Referrals (Form B above). (Tier 2 & 3 of School Counseling Pyramid of Interventions).

Possible outcomes include: 

  1. Beginning a mentoring relationship with a GCCS staff member through the GCCS Student Mentoring Program.
  2. Small group school counseling.
  3. Individual school counseling.

Attendance Letter -Level One (1) (back to top)

Use the GCCS School Counseling Referral Form for SUDDEN changes in attendance. However, use this form for students who have reached 10 absences (excused and unexcused, as required by NYSED Law). The goal of this referral is to assist parents with informed decision making with regard to their child’s attendance.


Attendance Letter – Level Two (2) (back to top)

Use the GCCS School Counseling Referral Form for SUDDEN changes in attendance. However, use this form for students who have reached 18 absences (excused and unexcused, as required by NYSED Law). The goal of this referral is to meet with parents for collaborative solution finding and informed decision making with regard to improving their child’s attendance.

*Note: As stated in the GCCS Student Handbook, two (2) tardies and two (2) early releases equal one (1) absence. This applies for excused and unexcused occurances.

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