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ONLY complete and return this form to request (North Georgia Technical College)

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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.
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. 8/17/17
Withdrawal Form
North Georgia Technical College
Office of the Registrar
PO Box 65, Clarkesville, GA 30523
Phone: 706-754-7768 Fax: 706-754-7777
Email: registrar@northgatech.edu
ONLY complete and return this form to request TOTAL WITHDRAWAL from ALL courses.
Contact your instructor(s) to withdraw from individual courses while maintaining enrollment in others.
NGTC’s Withdrawal Policy and Deadlines are published in the College Catalog available on www.northgatech.edu.
Any withdrawal, and the timing of the withdrawal, may impact:
Enrollment status
Satisfactory academic progress
Student account balances
Federal, state, and institutional grants, loans, scholarships and third-party sponsorships
Last Name:
First Name:
Student ID # or last 4 digits of Social Security #:
Date of Birth:
Address:
City:
State:
Phone:
(
)
NGTC Email:
Zip Code:
I request withdrawal from ALL classes for the year and term indicated below:
Year:
20
Term:
Fall
Spring
Summer
Check AT LEAST ONE of the following options (required):
I have consulted with my program advisor and/or instructor(s) and understand the impact of withdrawal.
I have consulted with my financial aid advisor and understand the impact of withdrawal.
I have NOT consulted with my advisor, instructor(s), or financial aid advisor, but understand the impact of withdrawal.
This form is not valid without your signature. Your signature affirms your request to withdraw from your North Georgia
Technical College courses listed above and that you understand the impact of the withdrawal. The official date of the
withdrawal will be verified with the instructor by the Registrar’s Office.
Student’s Signature:
Date:
Office Use Only
Keyed in Banner
Registrar’s Office Representative
Date Received
CRN (s)
Date Last Attended
CRN (s)
Date Last Attended
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Completed 25 July 2020

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