CANCEL
CANCELLATION FORM
(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110 finaid@coconino.edu
FA-102-Cancellation form 2021 20200415
Review and c
omplete by checking one of the following boxes. Return the signed form to the Office of Student Financial
Aid, only if you want to CANCEL your application for Federal Financial Aid at CCC for the 2020-2021 Academic Year.
Check only the box that applies to you.
I will not be attending Coconino Community College during the following semester(s) and by checking the
box(es) and signing below I request that my Federal Financial Aid Application and Scholarships be cancelled.
(Please check all semesters that apply.)
Fall 2020 Spring 2021 Summer 2021
I will be attending Coconino Community College during the following semesters but have not completed my
financial aid file and wish to have it cancelled. This will stop any further correspondence.
Fall 2020 Spring 2021 Summer 2021
I have completed the Federal Financial Aid Application for the 2020 2021 academic year (includes Summer
2021). It has been determined that I am ineligible for federal and/or state funding. Please discontinue the
processing of my file for Federal Financial Aid for the 2020 - 2021 academic year (includes Summer 2021). If
applicable, scholarship awards will not be canceled.
Student Signature and Date How do I create a digital signature with Adobe?
OSFA USE ONLY
Aid cancelled for these semester(s):
Fall 2020
Processed by: Date:
Spring 2021
Summer 2021
CCC ID# Last Name First Name MI
Mailing Address City ST Zip Code
Telephone No. (include area code) Email Address
I hereby provide consent for the use of electronic recor
ds 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.
click to sign
signature
click to edit
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