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Early Start Program _________________________________ Date _________________________________ Name of School / School Board _________________________________ Address _________________________________ Address RE: _____________________________ (Student Name and NSU ID Number) Dear Nicholls State University: ____________________________________, hereby agrees to pay $_________________ for the (School name or school board name) (amount of payment) above named student enrolled at Nicholls State University for the _________________ semester. (semester paying for, ex. Fall 2012) We understand the amount will be billed to us after the beginning of the semester and payment is due upon receipt of the invoice. Thank you. ________________________________ Authorized Signature ________________________________ Date Instructions: 1. This form can be reproduced as necessary. 2. Insert current date and contractor address. This address will be used to bill the contractor. 3. All information must be completed (student name, ID, amount of payment and applicable term) and the form must be signed by a designated representative of the school / school board for the form to be accepted by NSU Fee Collection Center. 4. Completed forms must be submitted to the Fee Collection Center no later than the fee payment deadline for each semester. The deadline for each term can be found on our website at www.nicholls.edu/fees. 5. A form for each student will need to be completed and submitted for each semester in which the student enrolls. 6. Forms containing strikeouts or other changes will not be accepted. 7. The contractor will be billed after the beginning of the semester and payment is due upon receipt of the invoice.
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