Official Withdrawal Form
Last Name First Middle
StudentID# (preferred) or Social Security
Address City State Zip
Employment Status: Unemployed Unavailable for Employment Military
Employed? Where? Job Title
Continued Education Where?
Do you plan to return to Georgia Northwestern Technical College in the future?
Financial Aid Signature:
Return this form in one of the following ways: Email to the Registrar’s Office, fax
to 706-295-6944 or 706-764-3707 or deliver/mail to a Student Help Center listed
below. Call 866-983-4682 if you have questions or need assistance.
• Catoosa County Campus; 120 College Park Drive; Ringgold, GA 30736
• Floyd County Campus; One Maurice Culberson Drive; Rome, GA 30161
• Gordon County Campus; 1151 Highway 53 Spur SW; Calhoun, GA 30701
• Polk County Campus; 466 Brock Road; Rockmart, GA 30153
• Walker County Campus; 265 Bicentennial Trail; Rock Spring, GA 30739
• Whitfield Murray Campus; 2310 Maddox Chapel Road; Dalton, GA 30721
Georgia Northwestern Technical College is a Unit of the Technical College System of
Georgia and an Equal Opportunity Educational Institution.