Flagstaff, AZ 86005-2701
PH: 928-226-4219
FAX: 928-226-4110
BVOOFA/SP/SU
FA-560-BVOOFA BVOOSP BVOOSU 20201215
(2021-2022 Academic Year)
Students who are awarded financial aid and a CCC Bookstore voucher, but prefer to purchase their books and schools supplies
elsewhere must complete the table below and provide a printout of the book cost or school supply information from the vendor. Funds
for the amount of books and/or supplies sold by the vendor will be issued to you no later than the end of the first week of classes either
by direct deposit or a check mailed to the address in
MyCCC. If this Book Voucher Opt Out is approved, your Book Voucher at the CCC
Bookstore will be reduced by the approved amount.
I wish to opt out of the Book Voucher for the following semester: □ Fall 2021 □ Spring 2022 □ Summer 2022
Name of Book or School Supply
Name of Vendor
(Amazon, Chegg, etc.)
Vendor Price
$
$
$
$
$
$
$
$
$
$
$
$
Shipping + Handling
(if applicable)
$
Shipping + Handling
(if applicable)
$
$
$
If approved, I would like the funds disbursed to me in the following manner (choose one):
Direct Deposit (My financial aid is already set up for direct deposit)
Pick up a check from Student Accounts at the CCC Lone Tree Campus
Send a check to me at the address listed in MyCCC
I understand that by opting out of the CCC Bookstore Voucher I will receive funds to be used for books and supplies in the amount
listed on this form and will have my Bookstore Voucher reduced accordingly at the CCC Bookstore. I authorize CCC to pay this
Bookstore Voucher Opt Out using my financial aid. 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
Approved Denied Amount $ Processed By: Date___________
click to sign
signature
click to edit
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