Student Information Form

Please select the year you are either enrolled in, or are enrolling in. If both apply, please choose the option for the term farthest in the future:

Summer 2024, Fall 2024 or Spring 2025My Choice is not listedIf you have questions, call the Welcome Center at (715)365-4493.

Legal First Name

Preferred First Name

This is your preferred first name. Please leave blank if your preferred name is the same as your legal name. Preferred name will be used for your email display, schedule, mailings, and class roster.

Middle Initial

Last Name

Pronoun(s):

Other Pronoun:

Student ID

Don't know your student ID? Contact the Welcome Center at 715.365.4493 ext. 1 for assistance.

Social Security Number (no dashes)

If you do not want to provide your social security number, please contact the Welcome Center for a paper form.

Date of Birth (MM/DD/YYYY)

Last High School Attended

High School City

High School State

Year of High School Graduation/GED/HSED

If you have not yet graduated, please enter your expected year of graduation.

Personal Email

Required to receive electronic diplomas/certificates.

Home Phone

Mobile Phone

Work Phone

Text Opt-In

Yes, I would like to receive text messages from Nicolet College about my enrollment, financial aid, and courses. By checking this box, I understand that additional carrier fees may apply per my mobile plan. **Note – a mobile phone number is necessary to receive text messages. Please confirm that you have provided a mobile phone number in the field above.**

Mailing Address

City

State

Zip

County

Township, City, or Village

School District in which you Reside

Emergency Contact 1 Information

Name

Phone

Relationship

Add Another Emergency Contact?

Emergency Contact 2 Information

Name

Phone

Relationship

Confidential Information

Legal Sex

Gender Identity

Other Gender Identity:

Are you Hispanic or Latino/a?

Highest Grade Completed

What is the highest level of credential you have earned?

Do not include any courses/credentials received while still enrolled in high school.

Current Work Status

Are you a US Veteran, active duty Armed Services member, or current National Guard or Reserve member?

Do you have a disability? (optional)

Providing disability status information is voluntary and will be used to determine if special services or accommodations can be provided and to comply with federal reporting requirements.

Are you a single parent?

Select YES if you are single, separated, divorced, or widowed and have primary responsibility for dependent(s) under age 18 (including single pregnant women).

Are you a displaced homemaker?

Select YES if:

your primary role is as caretaker for your home/family AND
you are unemployed/underemployed and are experiencing difficulty in obtaining/upgrading employment AND
you have been dependent on the income of another family member but are no longer supported by that income OR
your family income has been drastically reduced because your Armed Forces spouse recently deployed, died, or was disabled

Are you (or your household) unable to pay for one or more basic living needs? For example: food, bills, rent, childcare.

In the past year, have you experienced homelessness? This could include living in a car, sleeping on a friend’s couch, staying in a shelter, living in temporary housing (like a motel).

Will you be justice involved while enrolled in classes?

Please choose yes if you will be in prison, jail, detention center, halfway house, etc.

Are you age 16-24?

Are you or were you in Foster Care?

Do you have a parent who is a member of the armed forces or active duty?

What is the highest degree earned by either of your parents?

Nicolet College Financial Responsibility Agreement

Payment of Fees/Promise to Pay

I agree that when I register for any class at Nicolet Area Technical College (Nicolet College), I accept full responsibility to pay all tuition, fees and other associated costs assessed as a result of my registration and/or receipt of services. I further agree that my registration and acceptance of these terms constitutes a promissory note agreement (i.e., a financial obligation in the form of an educational loan as defined by the U.S. Bankruptcy Code at 11 U.S.C. §523(a)(8)) in which Nicolet College is providing me educational services, deferring some or all of my payment obligation for those services, and I promise to pay for all assessed tuition, fees and other associated costs by the published or assigned due date.

I understand and agree that if I drop or withdraw from some or all of the classes for which I register, I will be responsible for paying all or a portion of tuition and fees in accordance with the published tuition refund schedule at Withdrawing from a Course. I have read the terms and conditions of the published tuition refund schedule and understand these terms are included in this agreement. I further understand that my failure to attend class or receive a bill does not release me of my financial responsibility as described above.

Financial Hold/ Collection Agency

I understand and agree that if I fail to pay my student account bill or any monies due and owing Nicolet College by the scheduled due date, Nicolet College will place a financial hold on my student account, preventing me from registering for future classes, requesting transcripts, or receiving my diploma. I understand if I fail to make acceptable payment arrangements to bring my account current, Nicolet College may refer my delinquent account to TRIP (Tax Refund Intercept Program) through the State of Wisconsin.

Entire Agreement

This agreement supersedes all prior correspondence between the student and Nicolet College regarding all financial responsibility agreements. This agreement may be modified by Nicolet College or the student as long as the modification is approved and signed by both parties. Any modification is specifically limited to those policies and/or terms addressed in the modification.

Method of Billing

I understand that Nicolet College uses mailing and e-bill as its official billing methods, and therefore I am responsible for viewing and paying my student account by the scheduled due date. I further understand that failure to review my mail or e-bill does not constitute a valid reason for not paying my bill on time. E-bill information is available through your MyNicolet account under financials.

Returned Payments/Failed Sponsor Agreements

If you are sponsored and your sponsor payment is not received by the due date, the student becomes responsible for their tuition. If a payment made to my student account is returned by the bank for any reason, I agree to repay the original amount of the payment plus a returned payment fee of $25.

IRS Form 1098-T

I agree to provide my Social Security number (SSN) or taxpayer identification number (TIN) to Nicolet College upon request as required by Internal Revenue Service (IRS) regulations for Form 1098-T reporting purposes. If I fail to provide my SSN or TIN to Nicolet College, I agree to pay any and all IRS fines assessed as a result of my missing SSN/TIN.

I consent to receive my annual IRS Form 1098-T, Tuition Statement, electronically from Nicolet College. I understand that if I do not consent to receive my Form 1098-T electronically, a paper copy will be provided. I understand that I can withdraw this consent, or request a paper copy by submitting a request in writing to the Business Office.

READ CAREFULLY BEFORE SIGNING. THIS AGREEMENT CREATES A FINANCIAL LIABILITY.

In accordance with the Financial Responsibility Agreement, I accept full responsibility to pay all tuition, fees and other associated costs assessed as a result of my registration and/or receipt of services through Nicolet College.