(2020-2021 Academic Year V1, V5)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110 firstname.lastname@example.org
I am classified as an Independent Student by the
FAFSA. I have filled out Column 1 below and Included
my spouse’s information if I am married.
I am classified as a Dependent Student by the
FAFSA. I have filled out both Column 1 and Column 2
below. Parental information and Student Information is
What was your cash balance in your
savings and checking accounts the
day you completed the FAFSA?
What was the net worth of investments
including real estate the day you
completed the FAFSA? *Do not
include your current home in which
you live. (Net worth means current
value minus debt.)
What was the net worth of your
businesses, and/or investment farms
the day you completed the FAFSA?
*Do not include a family farm or
business with 100 or fewer full-time
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 an digital signature with Adobe?
Parent signature and Date
(For Dependent students
only, must be signed and mailed to CCC.)
CCC ID# Last Name First Name MI
Mailing Address City ST Zip Code
Telephone No. (include area code) Email Address
click to sign
click to edit