Fillable Change Of Campus Request (North Georgia Technical College)

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Change Of Campus Request (North Georgia Technical College)

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Change of Campus Request
Name:
Student ID # or Last 4 Digits of Social Security #:
Date of Birth:
Mailing Address:
PO Box or Street Address
City, State, Zip
Day Phone:
Evening Phone:
Blairsville
Clarkesville
Currahee
I will be changing campus locations:
Program of Study:
Blairsville
Clarkesville
Currahee
Fall
Spring
Summer
Year:
Signature:
Date:
North Georgia Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or belief, genetic information,
disabled veteran, veteran of the Vietnam Era, or citizenship status (except in those special circumstances permitted or mandated by law). For complaints or information, contact Mike King, VP of
Student Affairs (706- 754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500 HWY 197 N, Clarkesville, GA 30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form,
found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information
requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W.,
Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. 9-2-15
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Change Of Campus Request (North Georgia Technical College)

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Completed 25 July 2020

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