Flagstaff, AZ 86005-2701
PH: 928-226-4219
FAX: 928-226-4110
FA-102-Cancellation form 2122 20201215
CANCEL
(2021-2022 Academic Year)
Review and complete by checking one of the following boxes. Return the signed form to the Office of Student Financial
Aid, only if you want to CANCEL your application for Federal Financial Aid at CCC for the 2021-2022 Academic Year.
Check only the box that applies to you.
I will not be attending Coconino Community College during the following semester(s) and by checking the
box(es) and signing below I request that my Federal Financial Aid Application and Scholarships be cancelled.
(Please check all semesters that apply.)
Fall 2021 Spring 2022 Summer 2022
I will be attending Coconino Community College during the following semesters but have not completed my
financial aid file and wish to have it cancelled.
Fall 2021 Spring 2022 Summer 2022
I have completed the Federal Financial Aid Application for the 2021 – 2022 academic year (includes Summer
2022). It has been determined that I am ineligible for federal and/or state funding. Please discontinue the
processing of my file for Federal Financial Aid for the 2021 - 2022 academic year (includes Summer 2022). If
applicable, scholarship awards will not be cancelled.
I hereby provide consent for the use of electronic records and signatures on all financial aid documents. I understand that
if I choose to sign electronically, my electronic signature constitutes a binding contract and may not be denied legal effect,
validity, or enforceability solely because it is in electronic form or because an electronic signature or electronic record was
used in its formation.
Student Signature and Date How do I create a digital signature with Adobe?
Aid cancelled for these semester(s):
click to sign
signature
click to edit
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