2022-2023 Financial Aid Adjustment/Cancellation Form

Student Name:*

First Name

Initial (optional)

Last Name

Student ID Number:*

I am requesting that CCAC:*

Cancel all aid Reduce my Federal Direct Loan Increase my Federal Direct Loan Reduce my Alternative Loan

From:*

To:*

For the following semesters:*

Fall 2022 Spring 2023 Summer 2023

Reason for Cancellation:*

School Name

Other Reason? *

Yes No

Other:

By signing below, I understand and agree that:

• I must withdraw from classes through the registrar’s office. Canceling my financial aid does not withdraw me from classes.

• I am responsible for any balance owed to CCAC resulting from my decision to cancel my financial aid.

• If I am not transferring to another school, my student loans will enter their six-month grace period, after which I will need to start repaying them. It is my responsibility to contact my lender(s) of any changes.

Student Signature:*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

: