Section 4 - Certification Information
By signing below, you certify that all information provided is correct and that you agree to the statements on this page.
I understand that as a participant in the Dual Enrollment program at Nicholls State University that I may enroll in courses at a rate established by the
I understand that I am enrolling as a Visiting/Guest Student at Nicholls State University. Upon graduation from high school, if I desire to enroll at
State University, I will apply for admission as a regular student and must meet Nicholls State University’s admission requirements.
I understand that the high school and college grades earned in those courses in which I enroll through the Dual Enrollment program
will be on my permanent high school and college academic records.
I understand that the grades I earn on college courses in which I enroll through the Dual Enrollment program will be used by other
programs, including TOPS, to determine my continuing eligibility for those programs. See TOPS Q&A Q. 150-151 located in TOPS
section of www.losfa.la.gov.
I authorize Nicholls State University, my high school, my school district, the Louisiana Board of Regents, the Louisiana Department
of Education, and the Louisiana Office of Student Financial Assistance access to my high school and college academic record. I
further authorize my high school and Nicholls State University to exchange my academic information (i.e. transcript) for any
purpose related to my eligibility or participation in this program.
I acknowledge that (1) I am enrolling in the course(s) listed in this application; (2) it is my responsibility to OFFICIALLY WITHDRAW or DROP a
class I decide not to complete by Nicholls State University’s published deadline, and (3) if I withdraw from the college course or earn a college grade
other than A, B, C, or P in the course, I may not be eligible to enroll as an Dual Enrollment student in a future semesters.
Nicholls State University Assumption of Risk, Release and Liability Waiver Form for Enrollment of Minor Students
REQUIRED FOR ALL HIGH SCHOOL MINORS (under age 18)
(“the minor student”) and (“the parent” or “the
legal guardian”) want the min
student to take classes at Nicholls State University. The parent represents that the minor student is not yet 18
years of age; that the parent is the parent or legal guardian of the minor student; and that the parent is legally competent to sign this form on
behalf of the minor student. The parent and minor student (collectively “we”) agree to the following
We understand that the law and culture of higher education generally presume that college students are mature adults capable of independently
evaluating their environment and
attending to their needs. We understand that the minor student will voluntarily enter into an adult
that Nicholls State University will treat the minor student as an adult within that environment; and that the minor student accepts
fully the rights and responsibilities of an adult within that environment. We understand that expectations that we may have for support and
service(s) that may arise from the minor student’s experience in
secondary education will often not be appropriate or available in the collegiate
setting. In particular, we understand that the minor student will be taking college level courses and that the academic environment will encourage
free discussion and open inquiry of sometimes controversial subjects.
We represent that the minor student has the emotional and intellectual maturity necessary to participate beneficially in the collegiate
environment. We have access to, and agree to follow, all Nicholls State University policies and procedures and, if the minor student indicates
that he or she cannot adapt to that environment, we agree to withdraw, and/or permit Nicholls State University to remove, the minor student from
Nicholls State University.
We understand that Nicholls State University will have specific rules that will apply to the minor student’s ability to enroll and attend. These rules
may include, but are not limited to, certain enrollment prerequisites, registration requirements, placement tests, and matriculation status. For a
complete understanding of like
we agree to consult with Nicholls State University and we agree to accept their application to the
On behalf of ourselves, our family, heirs and personal
we understand and agree that Nicholls State University will treat the
minor student as an adult; that we have had a reasonable opportunity to consider the risks of a minor student participating in the adult and
learning environment of Nicholls State University; and that we assume all such risks regarding the minor student’s participation at
Nicholls State University. On like behalf, we further release, hold harmless, indemnify and covenant not to sue the University of Louisiana
System, Nicholls State University, and their governing boards, trustees, employees and any agents from and against an
y and all liability for harm,
injury, damage, claims, demands, actions, causes of action and expenses of any kind that we may have or that may hereafter accrue to us, directly
or indirectly, related to any loss, damage or injury that we may sustain from the minor student’s participation at Nicholls State University.
We have both read this form; we both understand its terms and conditions; and we both intend to be bound by it from the date of signature
below until the student reaches his or her 18th birthday and are no longer a minor.
Student Signature Date
Parent Signature Date