Standard Request for
Test Score Reports
Student Information Complete All Fields
(Print clearly or type)
Name:
Former Last Name
(if any):
Student ID # or last 4 digits of Social Security #:
Date of Birth:
Current Address:
( )
City:
State:
Zip:
Email Address:
Order Information
Number of Test Score Reports Requested ($7.50 per copy) ____________ Total payment enclosed: ____________
Delivery Options (Choose One)
1.
Mail to address indicated below
2. Deliver to receptionist / I will pickup
_________________________________________
Site/Person
_________________________________________
Address
_________________________________________
City State Zip
Photo ID is required
Indicate Campus:
Clarkesville (Clegg Building)
Blairsville
Currahee
(NGTC will call when report is ready)
4. Email to the following address
____________________________________
3.
Fax to the following:
Name: _______________________________
Fax #: _______________________________
Student
Signature:
Date:
(Required by Federal Law)
Mail form and payment to:
North Georgia Technical College
Office of the Registrar
PO Box 65
Clarkesville, GA 30523
Make checks or money orders payable to NGTC.
Cash is accepted but mailing cash is not recommended.
Sealed envelopes containing forms and payment may be submitted to receptionists on any NGTC campus.
Standard requests for test score reports are processed within 5 business days.
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. 8/29/18
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