(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110
FA-510-CAFA CASP CASU 20200416
Terms of Agreement:
1. Student is required to enroll at CCC and the non-parent school prior to submitting this form. A copy of the students’ course
schedule with the start and end dates at the non-parent school must be attached to this form.
2. Student is responsible for making payment arrangements at the non-parent school by their due date.
3. 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
4. Student is responsible for completing enrollment at both schools for the period of this agreement.
5. Student must request an official academic transcript from the non-parent school at the end of the semester.
6. Students are subject to CCC’s Satisfactory Academic Progress policy.
7. 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 for financial aid.
Non-Parent School Name: ______________________________________________________________ Semester: _______________
Course Title at Non-Parent School
(Do not include CCC courses)
Course Number Non-Parent
Course Equivalent at CCC
(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
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Telephone Number
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
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 and Date How do I create a digital signature with Adobe?
Telephone Number
Approved Denied Denial Reason:
CCC FA Staff : Date:
CCC ID# Last Name First Name MI
Mailing Address City ST Zip Code
Telephone No. (include area code) Email Address
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