Same-day Request for
Test Score Reports
Student Information (Print Clearly)
Name:
Former Last Name (if any):
Student ID # or last 4 digits of Social Security #:
Current Address:
Phone:
(
)
City:
State:
Zip:
Email Address:
Order Information
Same-day Request for Test Score Reports
(Tested at NGTC, didn’t attend - Test scores ONLY )
$25.00 per copy
Number of test score reports requested:__________
Total payment enclosed:__________
Student Signature (Required by Federal Law)
Date
Same-day requests for test score report requires in person delivery of completed forms and payment to the Registrar’s Office (Clegg
building on the Clarkesville Campus) between 7:30am and 5:00pm, Monday through Thursday.
Printed test score reports will be available within one hour from the Clarkesville receptionist in the Clegg building lobby.
Photo ID is required for pickup of test score report.
Make checks or money orders payable to NGTC.
Exact change in cash is accepted.
NGTC Use Only
Paid (amount)
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. 2/8/2017
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