ATB21
ABILITY TO BENEFIT FORM
(2020-2021 Academic Year – V4,V5)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110 finaid@coconino.edu
FA-702-ATB21 202004016
On the Free Application for Federal Student Aid (FAFSA) you were asked if you have a High School Diploma,
a GED, or have completed Home-Schooling. Provide one of the following documents that indicate the
student’s high school completion status when the student will begin college in 2020–2021:
Please check ONE of the following:
I have received my High School Diploma and
have attached a copy of it or a copy of my High
School transcript showing graduation date.
High School Name: _________________________
Location (City / State): _______________________
Date earned (Month /Year): ___________________
I have received my GED or State-authorized
examination such as the High School
Equivalency Test (HiSET) or the Test
Assessing Secondary Completion (TASC). I
have attached this documentation.
Location (Ci
ty / State):_______________________
Date earned (Month /Year):___________________
I have completed a secondary home schooling
program which is recognized by my state and
have attached documentation from the State.
State of Approval:___________________________
Date completed (Month / Year):________________
I have completed at least a two-year
Associate’s degree program that is acceptable
for full credit toward a bachelor’s degree. An
official academic transcript from my previous
college has been submitted to Registration and
Enrollment Services at CCC.
School Name: _____________________________
Location (City / State): _______________________
Date earned (Month /Year): ___________________
I do not have any of the approved credentials. I understand that I am not eligible for financial aid
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?
CCC ID# Last Name First Name MI
Mailing Address City State Zip Code
Telephone No. (include area code) Email Address
click to sign
signature
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