Flagstaff, AZ 86005-2701
PH: 928-226-4219
FAX: 928-226-4110
CASP
FA-510-CAFA CASP CASU 20201215
INDIVIDUAL CONSORTIUM AGREEMENT
(2021-2022 Academic Year)
Terms of Agreement: (Initial each item to indicate you have read the Agreement)
1. ___Student is required to enroll at CCC and the non-parent school prior to submitting this form.
2. ___A copy of the students’ course schedule with the start and end dates at the non-parent school must be attached to this form.
1. ___Student is responsible for making payment arrangements at the non-parent school by their due date.
2. ___Student will receive financial aid through CCC. Disbursement of financial aid will be based on CCC’s disbursement schedule,
which may not concur with the non-parent school. Financial aid records will be maintained at CCC
3. ___Student is responsible for completing enrollment at both schools for the period of this agreement.
4. ___Student must request an official academic transcript from the non-parent school at the end of the semester.
5. ___Students are subject to CCC’s Satisfactory Academic Progress policy.
6. ___This agreement is valid only for the courses listed below that pertain to your program/major. Any course changes at the non-
parent school will require a new agreement.
STEP 1: Student must complete this section with a CCC Academic Advisor. Call 928-226-4323 for an appt.
By signing this form, I acknowledge that I will abide by the terms listed above. Failure to do so voids this agreement which may disqualify
me from receiving financial aid. 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.
Non-Parent School Name: ______________________________________________________________ Semester: _______________
Course Title at Non-Parent School
(Do not include CCC courses)
Course Number Non-Parent
(how will it transfer to CCC)
Credit Hours
Student Signature and Date How do I create a digital signature with Adobe?
STEP 2: CCC Academic Advisor must complete this section. Student is responsible for submitting it to the
Financial Aid Office at the non-parent school for completion of Step 3.
As this students CCC Academic Advisor, I verify that the courses listed in STEP 1 are acceptable for transfer and are required for the
student's program/major at CCC. I have advised the student that no audit courses will be counted.
Total # of Credits approved from non-parent school (from STEP 1 above):
CCC Academic Advisor Signature Telephone Number Date
STEP 3: Financial Aid Office of non-parent school must complete this section and return to CCC Financial
Aid using the CCC Secure Upload form at www.coconino.edu/upload.
I agree to verify hours of enrollment and tuition/fees. I will notify the CCC Office of Student Financial Aid of any resources awarded to the
student at the non-parent institution and any course adjustments or withdrawals.
Total tuition and fees at non-parent Institution: $
Non-Parent Institution Financial Aid Office Signature & Title Telephone Number Date
STEP 4: CCC FINANCIAL AID OFFICE APPROVAL OR DENIAL
Approved Denied Denial Reason:
Incomplete
CCC FA Staff :
Date:
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