BVOOFA/SP/SU
BOOK VOUCHER OPT OUT
(2019-2020 Academic Year)
2800 S Lone Tree Rd Flagstaff, AZ 86005-2701 PH: 928-226-4219 FAX: 928-226-4110 finaid@coconino.edu
FA-560-BVOOFA BVOOSP BVOOSU 20181018
Students who are awarded, but wish to opt out of the CCC Bookstore voucher must complete the table below and provide a printout of
the book cost or school supply information from the vendor. Funds for the amount of books and/or supplies sold by the vendor will be
issued to you no later than the end of the first week of classes either by direct deposit or a check mailed to the address on Web4/Self
Service. If this Book Voucher Opt Out is approved, your Book Voucher at the CCC Bookstore will be canceled.
I wish to opt out of the Book Voucher for the following semester: Fall 2019 Spring 2020 Summer 2020
Name of Book or School Supply
CCC Bookstore
Price
List name of Vendor
(Amazon.com, UT&T, etc.)
Vendor Price
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Shipping + Handling
(if applicable)
$
Total Amount
$
$
If approved, I would like the funds disbursed to me in the following manner (choose one):
Direct Deposit (I have my financial aid set up for direct deposit)
Pick up a check at the CCC Lone Tree Campus
Send a check to me at the address listed in Web4/Self Service
I understand that by opting out of the CCC Bookstore Voucher I will receive funds to be used for books and supplies in the amount
listed on this form and official estimate on printout and will have my Bookstore Voucher canceled at the CCC Bookstore. I authorize
CCC to pay this Bookstore Voucher Opt Out using my financial aid.
Student Signature Date
CCC ID# Last Name First Name MI
Mailing Address City ST Zip Code
Telephone No. (include area code) Email Address
Office of Student Financial Aid Use Only
Approved Denied Amount $ Processed By:
Comments:_____________________________________________________________________________________________ Date___________