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Social Security Number: ______________________________ (optional)
Date of Birth: _________________________
Date: __________________________________
Name: __________________________________
Address: _______________________________
City: __________________________________
State: _________________________________
Zipcode: _______________________________
County: ________________________________
Home #: ________________________________
Work #: ________________________________
Ethnic Background: Native American ( ) Asian/Pacific Islander ( )
Prefer Not To Respond ( ) Black/Non-Hispanic ( ) Caucasian ( ) Hispanic ( )
Education Highest Level: 9, 10, 11, 12 GED College: 1, 2, 3, 4
Course Title: ______________________________ CRN #: __________ Cost: ___________
Course Title: ______________________________ CRN #: __________ Cost: ___________
(Make Check or Money Order Payable To: Augusta Technical College)
Please Mail To: Augusta Technical College, 216 Highway 24 South, Waynesboro, GA 30830
OR register in person at the Waynesboro/ Burke Campus Questions: (706) 437 - 6808
Refunds or Withdrawals:
- 100% - If student withdraws two business days prior to first class meeting.
- 0 % - after first class meeting.
- Course Cancellations: 100 % - If course is cancelled. After cancellation date, the Business Office mails checks in approximately 10-12 business days.
A post-secondary educational institution, operated under the supervision of the State Department of Technical and Adult Education, serving the needs of business, industry, and the public in a five-county area in east-central Georgia. Augusta Technical College does not discriminate in its educational programs, activities, employment policies on the basis of age, race, color, ethnic or national origin, creed, religion, sex, marital status, veteran status, disability, academic, or economic disadvantage. Qualified individuals with a disability who wants this or any publication in an accessible format should make their request known to the:
Disability Counselor
3200 Augusta Tech Drive
Augusta Georgia 30906
706-771-4067 (TTY/TDD)
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