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(2021-2022 Academic Year) (Coconino Community College)

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2800 S Lone Tree Rd
Flagstaff, AZ 86005-2701
PH: 928-226-4219
FAX: 928-226-4110
finaid@coconino.edu
SCHDSG
FA703-SCHDSG 20201215
SCHOLARSHIP DESIGNATION FORM
(2021-2022 Academic Year)
Thank you for supporting students at Coconino Community College. All disbursement of funds (institutional or
donor based) by the College are non-refundable to the donor once they have been given to students. CCC will
verify that the student has met the enrollment requirements prior to disbursement. If other donor requirements
are not met by a student, donors can withhold future disbursements to that student until conditions are met.
Contact us with any questions you may have at 928.226.4219 or at finaid@coconino.edu
. Thank you again.
Name of Scholarship (or donor)
Amount
$
Name of Student (Last, First, MI)
CCC Student ID or Comet ID
Date of Birth
Please tell us how to disburse the scholarship to the student:
Split Between both Fall and Spring terms Summer I Term Only (May – July)
Fall Term Only Summer II Term Only (July – August)
Spring Term Only
Will the student receive an additional scholarship check for this academic year?
Yes – Amount of check: $_____________ No
Tell us what conditions the student must meet to release the check:
Student must maintain a specific cumulative GPA (ex: 3.0 or 3.5, etc) :
ONLY Release check if student is enrolled full-time at CCC (Full-time at CCC is 12 credit hours)
Ok to release check if student is enrolled less than full-time at CCC.
o Number of credit hours student must be enrolled in:
three-quarter time is 9-11 credit hours;
half-time is 6-8 credit hours;
less than half time is 5 or fewer credit hours
Scholarship Donor Contact Information:
Contact Person
Contact Person Signature
Contact Person Email Address
Phone Number
Address (Street)
City, State, Zip Code
Write checks out to Coconino Community College. Please mail both check AND this form together to:
Office of Student Financial Aid
2800 S. Lone Tree Road
Flagstaff, AZ 86005-2701
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(2021-2022 Academic Year) (Coconino Community College)

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Completed 2 February 2021

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