(20120-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110
FA-301-SAPAPP 20200416
Read the Satisfactory Academic Progress Policy, and select the reason for appealing your financial aid suspension below:
Significant Illness or Injury: 1. Attach a personal statement explaining the following:
a. The illness or injury; b. Specific dates when it occurred; c. How long the
illness or injury lasted
2. Attach a Doctor or Counselor statement verifying:
a. My illness/injury has been resolved; b. My ability to complete future
coursework successfully; c. I am released to continue my education
3. Attach medical records verifying the illness/injury
COVID-19: I was unable to complete the semester due to the COVID-19.
1. Attach a personal statement explaining how COVID-19 affected your ability to
complete coursework.
Death of family member: 1. Attach a personal statement stating the immediate family member’s (spouse, child,
parent, sibling or grandparent) date of death and relationship to you;
2. Attach a copy of the death certificate or obituary.
Completed requirements: I have completed 6 credit hours at CCC in one semester using my own resources, a pace
of progression of at least 66.66% and a cumulative GPA to a 2.0 or higher. I understand
appeals are evaluated after grades post at the end of the semester.
Review remedial courses: At CCC I attempted and passed remedial courses below 100 level in CHM, ENG, MAT or
RDG. I request that they be excluded from my SAP calculation.
High School Coursework: I was not advised that I was taking a college level course in high school, or was not
advised that there were implications for dropping or failing dual enrollment coursework.
Drop- 100% refund period: I withdrew from all of my courses during the 100% refund period believing it would not
affect my eligibility for future financial aid. This appeal may only be considered once
during my lifetime enrollment at CCC.
Incomplete appeals will be denied and submission of the appeal does not guarantee approval. Allow up to two weeks for
a decision. I understand that approval of the appeal will not waive outstanding charges to the College.
Read and sign below:
II 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 ST Zip Code
Telephone No. (include area code)
CCC Student Email Address
click to sign
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