Address City Zip Code
Last Name First Name
Phone #
State
ID#
Semester Year
Did you received financial aid?
Date
Certificate of Residency (County Waiver)
Personal
Returned books Withdrew Other
Payment plan over payment
Important reminders!
* Dropping below 12 credits could jeopardize your financial aid for the current and up coming semester.
* The address above will only be used when no address is available.
* All refunds will be mailed, no exceptions.
* Credit card payments will be refunded back to the credit card with-in 30 days after original payment.
Business Office Approval Signature
North Idaho College * 1000 West Garden Ave. * Coeur d'Alene, ID 83814 * Fax 208.665.2785 * www.nic.edu/costs
FOR OFFICE USE ONLY
E-mail address:
Cash Check Visa or MC Sponsor Loans
Yes No
Loans Grants ScholarshipsWhat type of financial aid did you receive?:
Original payment made by:
Reason for refund?
Today's Date:
NORTH IDAHO COLLEGE REFUND REQUEST FORM
You must drop a course or all courses (through the Registrar's Office or your NICOnline account) and/or
follow Residence Hall check out procedures before this refund request form can be processed.
North Idaho College
Business Office - Student Accounts
1000 W. Garden Ave. Coeur d'alene, ID 83814
Fax: 208-665-2785
Complete this form and mail or fax to:
Original payment date:
Refund Amount
Student Signature
Check VSA/MCRefund type:
Voucher #
Rev. 12/06/07
