Change of Campus A student should complete this form when he or she requests a change from one campus to another. Program verification* I have verified that the program is offered at the campus I wish to attend!Name* First Last Student ID:* Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Campus* Barrow Campus Dawson County Forsyth Campus Hall Campus Jackson Campus New Campus* Barrow Campus Dawson County Forsyth Campus Hall Campus Jackson Campus Program of Study* Program Level*--Select One--CertificateDiplomaDegreeSignature*Date* MM slash DD slash YYYY *IMPORTANT NOTE* This form is not to be used for a change of program. Please use the Change of Program form or contact the office of admissions if you wish to change your program of study. As set forth in its student catalog, Lanier Technical College does not discriminate on basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or belief, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). Title IX Coordinator: Nancy Beaver, 2535 Lanier Tech Dr, Gainesville, GA 30507, Breeden-Giles, 1131 G, Ph: 770-533-7001 or Email: nbeaver@laniertech.edu Section 504/ADA Coordinator: Veronica Bowermaster, 2535 Lanier Tech Dr, Gainesville, GA 30507, Breeden-Giles, 1130, Ph: 770-533-7003 or Email: vbowermaster@laniertech.eduNameThis field is for validation purposes and should be left unchanged. Tags:Student Affairs