Request for
Change of Address/Name/Phone
USE THIS FORM to correct personal information for North Georgia Technical College records.
Complete, print, and sign this form.
Submit by:
Email: r e g i s t r ar @ n o r t h g a t e c h . e d u
Fax: 7 0 6 . 7 5 4 . 7 7 7 7
Mail: NGTC Registrar’s Office, PO Box 65 Clarkesville, GA 30523
Hand: Deliver to the receptionist on any NGTC campus
Student Information As Shown NOW:
Student ID # or Last 4 Digits of Social Security #:
CORRECT Student Information:
*For name changes, attach a copy of a state driver’s license or state issued photo ID in the correct name.
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
County:
