Contract Course Enrollment Form

Thank you for your interest in enrolling in coursework at Nicolet College. Please complete this form in order to start the enrollment process. If you have any questions, please consult the following contacts:

High School contracts/Summer bootcamps:
Sarah Gruber, Educational Partnership Coordinator
715.365.4565

Employer & Tribal community contracts:
Tom Fox, Business Development Specialist
715.365.4424
or
Melissa Warner, Operations Specialist
715.365.4593

For questions related to billing or third-party payment, please contact the Nicolet College Business Office at 715.365.4458.

Personal Information

Legal First Name

Middle Initial

Last Name

Suffix

Former Last Name (if applicable)

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.

Pronoun(s):

Other Pronoun(s):

Social Security Number (no dashes)

If you would like to not provide your Social Security Number, please contact the Welcome Center for a paper application at 715.365.4493 ext. 0 or admissions@nicoletcollege.edu.

MM/DD/YYYYDate of Birth MM/DD/YYYY

Are you currently under 18 years old?

YesNo

Parent/Guardian Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Citizenship

If you are in the US on a Visa, please provide the following: * Not Required

Visa Number

Visa Country Issued

Visa Expiration Date

MM/DD/YYYY

Contact Information

Email Address

Home Phone Number

Mobile Phone Number

Text Opt-In:

Yes, I would like to receive text messages from Nicolet College about my enrollment status and process. 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.**

***Please ensure that you opt in for texting on this form and provide a mobile number.***

** Please note that Nicolet College may attempt to contact you in multiple ways, including mail regarding your student record.

Mailing Address Street

Mailing Address City

State

Mailing Address Zip/Postal Code

County

Township, City, or Village

School District in which you Reside

Education History

Are you currently enrolled in high school?

YesNo

Select your current high school

Have you earned a high school diploma?

YesNo

Have you earned a GED or HSED?

GEDHSEDNo

Name of last high school attended

High School City

High school state

Name of GED/HSED Granting Institution

GED/HSED Granting Institution City

GED/HSED Granting Institution State

High school graduation year

What is the highest grade you've completed?

What is the highest level of credential you've earned?

Emergency Contact Information

Name

Phone Number

Relationship

Add Another Emergency Contact?

Second Contact Name

Second Contact Phone Number

Second Contact Relationship

Responses to the following questions are confidential, and will not affect admission to the college.

Legal Sex

Gender Identity

Other Gender Identity

Are you Hispanic or Latino/a?

Ethnicity (to select more than 1, hold "Ctrl" button while selecting)

Tribal Affiliation

Current Work Status

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.

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

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?