NIC Housing License Cancellation Request Form

I understand that a hold will be placed on my account until my balance is paid in full. When payment has been received that covers the balance owed, the hold will be removed from my account allowing me to register for spring term.
If I have already registered for spring term, I understand that the Residence Hall cancellation charge is my responsibility and must be paid in full prior to the Tuition & Fees deadline or I will be dropped from my spring term courses.
If the balance owed on my account is not paid in full by the end of spring term, I understand that I could be sent to collections where additional fees may be added to the balance owing.

*First name
*Last name
*Student ID
*Room number
*Cell phone
*Email
Please check the boxes to confirm that you have read and understand the conditions Please check the boxes to confirm that you have read and understand the conditions I understand this is a request for the cancellation of a legally binding agreement. I understand that I will incur the cancellation fee & administrative fees as outlined in the current Residence Hall Handbook and the Housing License agreement. (Section 4. Cancellation/Termination of the Agreement). Please check THIS box, if you are cancelling your contract PRIOR to CHECKING-IN. Please check THIS box, if you are cancelling your contract PRIOR to CHECKING-IN. Your deposit will be processed as outlined in the current Residence Hall Handbook and the Housing License agreement. (Section 4. Cancellation/Termination of the Agreement). *Those that are cancelling PRIOR to check-in, please skip down to the electronic signature authorization.* Please check all boxes that apply to the cancellation Please check all boxes that apply to the cancellation I have submitted the appropriate paperwork by the deadline of December 1, and understand that I am responsible for the cancellation fee that will be placed on my student account. I understand that a hold will be placed on my account until my balance is paid in full. When payment has been received that covers the balance owed, the hold will be removed from my account allowing me to register for spring term. If I have already registered for spring term, I understand that the Residence Hall cancellation charge is my responsibility and must be paid in full prior to the Tuition & Fees deadline or I will be dropped from my spring term courses. If the balance owed on my account is not paid in full by the end of spring term, I understand that I could be sent to collections where additional fees may be added to the balance owing. I will be graduating from NIC at the end of the Fall semester. I have a medical problem that is directly related to living in the residence halls. I am able to provide documentation, which explains why my problem cannot be accommodated by the residence hall. A written statement on official letterhead from a licensed physician must be submitted to and reviewed by the Committee. I have a copy of military orders which includes the dates the resident is required to report for active duty. I have recently gotten married. A copy of the official marriage license will be required. Please fill out the following survey to give us a better understanding of why you are leaving NIC Housing Please fill out the following survey to give us a better understanding of why you are leaving NIC Housing: I have done poorly academically, and I have been suspended for an academic semester/year. I have done poorly this semester, and I have had my financial aid revoked. I am getting an off campus apartment: Cheaper More freedoms Closer to work With my significant other I am quitting college to work. COVID safety measures and anything related are making a terrible college experience I am transferring to a different school, because: The new institution has my major of choice It is closer to people I care about I can live at home and work, as well as go to school I am unhappy with NIC, and in particular, a department/office:(please use box below to elaborate on the issue/concern) I am unhappy with NIC housing (please use box below to elaborate on the issue/concern) Other Please use this box to elaborate any answer above

Supporting documents	Supporting documents 2 Supporting documents 3 Supporting documents 4

	*My signature that follows attest to the fact that the information contained in this Housing License Cancellation Request form as well as all of the attached information represents the truth of my situation. I understand that any misrepresentation of the truth of my situation that is submitted on this form or attached to it will be grounds for disciplinary action on the part of North Idaho College.
*Electronic signature

NIC Housing License Cancellation Request Form

Please check the boxes to confirm that you have read and understand the conditions

Please check THIS box, if you are cancelling your contract PRIOR to CHECKING-IN.

Please check all boxes that apply to the cancellation

Please fill out the following survey to give us a better understanding of why you are leaving NIC Housing: