(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110
FA703-SCHDSG 20200416
Thank you for supporting students at Coconino Community College. All disbursement of funds (institutional or donor
based) by the College are non-refundable to the donor once they have been given to students. CCC will verify that the
student has met the enrollment requirements prior to disbursement. If other donor requirements are not met by a
student, donors can withhold future disbursements to that student until conditions are met. Contact us with any
questions you may have at 928.226.4219 or at Thank you again.
Name of Scholarship
Name of Student (Last, First, MI)
CCC Student ID or Comet ID
Date of Birth
/ /
The enclosed check should be applied to:
Fall Term Only (August December)
Spring Term Only (January May)
Split Between both Fall and Spring terms
(August May)
Summer I Term Only (May July)
Summer II Term Only (July August)
This student will receive an additional check for this academic year for the term in the
amount of $ .
Tell us what conditions the student must meet to release the check:
Student must maintain a specific cumulative GPA:
ONLY Release check if student is enrolled full-time at CCC (Full-time at CCC is 12 credit hours)
Ok to release check if student is enrolled less than full-time at CCC.
o Number of credit hours student must be enrolled in:
three-quarter time is 9-11 credit hours;
half-time is 6-8 credit hours;
less than half time is 5 or fewer credit hours
Scholarship Donor Contact Information:
Contact Person
Contact Person Signature
Email Address
Phone Number
Address (Street)
City, State, Zip Code
Write checks out to Coconino Community College. Please mail both check AND this form together to:
Office of Student Financial Aid
2800 S. Lone Tree Road
Flagstaff, AZ 86005-2701