Previously Accepted? ____ Meet Requirements? ____ Application: ____ Registration:____
Advisor:______ Emailed:______
Notes: ______________________________________________________________________________
Equal Opportunity Institution Revised 1/21/2020
The completed form may be emailed to dualdocs@laniertech.edu or brought to the Student Affairs office at any Lanier
Technical College campus location.
This form is to be completed if a student is currently enrolled or has a current application and would like to change
their program of study or request for their application to be processed for a different semester after the desired
semester’s application is no longer accessible. Students should consult with their high school counselor, home study
official, or Dual Enrollment office before making any changes.
Name: ____________________________________________________ LTC Student ID #:_______________________
High School: ________________________________________________________________ Grade Level __________
Date of Birth: _______________________________Telephone #: _________________________________________
Email Address: ___________________________________________________________________________________
I request for my application to be processed for the _____________________ semester and would like my program
of study to be the __________________________________________________ Degree __ Diploma __ Certificate __.
Please select the campus below you are interested in attending. If the program you have applied for is not offered at the campus
you have indicated, it will be processed for the campus where it is offered. Please check the website for campus availability.
Barrow Campus __ Dawson Campus __ Forsyth Campus __ Hall Campus __ Jackson Campus __
Signing below acknowledges the student has verified the form is complete in its entirety and accurately reflects the
student’s academic desire while at Lanier Technical College. In addition to the form, the student may need to provide
a readiness document indicating they meet the program requirements (i.e. SAT, ACT, PSAT, Accuplacer scores). A
change to program of study may result in the need for additional documentation or retesting as admissions
requirements vary by program. Notification of the request having been processed is not a guarantee of acceptance.
Applications must be completed in time for registration in order to finalize the admissions process.
_________________________________________________ ______________________________
(Signature) (Date)
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