As set forth in the student catalog, 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 status, 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.
Change of Term Request Form
Name:
Student ID # or Social Security #:
Date of Birth:
Mailing Address:
PO Box or Street Address
City, State, Zip
Day Phone:
Evening Phone:
Campus
Blairsville
Clarkesville
Currahee
I request that the term and/or year indicated on my application for admission to North Georgia
Technical College be changed to the following:
Program of Study:
NEW Entrance Term:
Fall Spring
Summer
Entrance Year:
Signature: Date:
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. 9/14/16
How long have you lived in the state of Georgia?
Less than 12 months? More than 12 months?
Program Level:
Certificate
Diploma
Associate Degree
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