Flagstaff, AZ 86005-2701
PH: 928-226-4219
FAX: 928-226-4110
SENCIT
FA105-SENCIT 20201215
SENIOR CITIZEN TUITION WAIVER APPLICATION
(2021-2022 Academic Year)
The Senior Citizen Tuition Waiver is for Arizona residents who are 65 years of age and older. This waiver reduces tuition
by 25% for up to six credit hours. Non-credit classes, fees, books and class materials must be paid in full and are not paid
for with this waiver. Please complete the CCC admissions application and domicile affidavit and register for classes before
completing this application. This application must be received prior to or during the semester the tuition waiver has been
requested.
1. Select the semester you are enrolled for: Fall 2021 Spring 2022 Summer 2022
2. Number of hours you are enrolled in for semester: ________ (6 credit maximum for waiver. Non-credit classes
are not eligible for funding)
3. Are you 65 years or older? Yes No
Some CCC scholarships, waivers and grants are funded in part or in whole with Arizona state monies. These funds
are governed by Arizona State laws. They are not available to a person who is not a citizen of the United States who
is without lawful immigration status. This rule applies to all tuition waivers, fee waivers, grants, scholarship assistance,
financial aid, classification as a resident for tuition purposes, tuition assistance in general, or any other type of
financial assistance that is subsidized in whole or in part with state monies. CCC is required to report to the State of
Arizona the number (but not the names) of students who apply for financial aid funding with state monies and are
denied due to not being lawfully in the U.S. Failure to turn in a domicile Affidavit to Registration and Enrollment
Services may disqualify you for financial assistance that contains state monies.
I certify that information provided on this form is true and complete to the best of my knowledge. Purposely giving false or
misleading information may result in a delay or denial of my federal financial aid and I may be fined up to $20,000, sent to
prison or both. 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?
Office of Student Financial Aid Use Only
-Processing Worksheet-
Waiver-Eligible Tuition Cost:
Waiver Amount (25% of Waiver-Eligible Tuition):
click to sign
signature
click to edit
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