(2020-2021 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110
The Senior Citizen Tuition Waiver is for Arizona residents who are 65 years of age and older. This waiver reduces tuition
by 25% for up to six credit hours. Non-credit classes, fees, books and class materials must be paid in full and are not paid
for with this waiver. Please complete the CCC admissions application and domicile affidavit and register for classes before
completing this application. This application must be received prior to or during the semester the tuition waiver has been
1. Select the semester you are enrolled for:
Fall 2020 Spring 2021 Summer 2021
2. Number of hours you are enrolled in for semester: ________ (6 credit maximum for waiver. Non-credit classes
are not eligi
ble for funding)
3. Are you 65 years or older? Yes No
Some CCC scholarships, waivers and grants are funde
d in part or in whole with Arizona state monies. These funds
are governed by Arizona State laws. They are not available to a person who is not a citizen of the United States who
is without lawful immigration status. This rule applies to all tuition waivers, fee waivers, grants, scholarship assistance,
financial aid, classification as a resident for tuition purposes, tuition assistance in general, or any other type of
financial assistance that is subsidized in whole or in part with state monies. CCC is required to report to the State of
Arizona the number (but not the names) of students who apply for financial aid funding with state monies and are
denied due to not being lawfully in the U.S. Failure to turn in a domicile Affidavit to Registration and Enrollment
Services may disqualify you for financial assistance that contains state monies.
I certify that the information given is complete and accurate to the best of my knowledge. I understand the submission of false information is
grounds for denial of admission, or immediate suspension if enrolled, and may subject me to criminal charges. 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?
Office of Student Financial Aid Use Only
-Processing Worksheet-
Total Credit Hours:
Total Tuition Cost:
Waiver-Eligible Tuition Cost:
Waiver Amount (25% of Waiver-Eligible Tuition):
Total Due To CCC:
Grant Application :
Approved Denied
Processed By:
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