Request for Change of Status
Student ID# (preferred) or Social Security #: Date:
Semester requesting the change: Fall Spring Summer Year
Last name: First Middle
Student Signature:
Complete only the section(s) you are changing:
Address Change:
New Address: City:
State: Zip: County: New Phone:
Name Change:
I am currently registered under the name:
And my name has now changed to:
(name as is appears on new Social Security Card)
Major Change: Students are encouraged to speak with their current and new advisor when changing a major
Current Major: Major Code:
Specialization for Major (if applicable):
Level of Major: Associate Degree Diploma Technical Certificate of Credit
New Major: Major Code:
Specialization for Major (if applicable):
Level of Major: Associate Degree Diploma Technical Certificate of Credit
Return this form for processing to any campus or email the Registrar's Office.
• Catoosa County; 120 College Park Drive; Ringgold, GA 30736
• Floyd County; One Maurice Culberson Drive; Rome, GA 30161
• Gordon County; 1151 Highway 53 Spur SW; Calhoun, GA 30701
• Polk County; 466 Brock Road; Rockmart, GA 30153
• Walker County; 265 Bicentennial Trail; Rock Spring, GA 30739
• Whitfield Murray County; 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.
