Cochise College Admissions Application This application must be completed for admission or re-entry to Cochise College. If you have questions about the application and its contents, please contact the Admissions Office (Sierra Vista Campus) at (800) 593-9567 or (520) 515-5336/5412. You may also email questions to email@example.com. Complete all sections of the application form. You will receive an email confirmation of your application within 5 business days. Required entries are indicated with *. Step 1 of 4 25% 1 - STUDENT NAME / IDENTIFICATION Information you provide is required and confidential and is used to comply with federal reporting requirements and has no effect on your enrollment status.Complete Legal Name:* First Middle Last Previous Name (Maiden Name, etc.) First Last Cochise College ID# (if returning student)Note: You will be assigned a Cochise College ID Number. Social Security #*Disclosure of your social security number is requested and will aid in matching your current and future records with any past records, ensuring that you will receive full credit for all academic work. Your social security number is necessary for reporting education tax credit information to the federal government, for using federal financial aid, and for verification of student status under Arizona Proposition 300.2 - CONTACT INFORMATION P.O. Box or Mailing Address*Please enter two-letter US State abbreviation (i.e. - AZ, MI, TX). For international addresses, please provide full description for the State/Providence/Region. P.O. Box or Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Cell Phone - Used for Emergency Notification System*(###) ###-####Primary Telephone, if different from cell phone number.(###) ###-####Email Address* Enter Email Confirm Email In Case of Emergency - NameEmergency Phone(###) ###-#### 3 - ENROLLMENT INFORMATIONYear you plan to enter Cochise College:Semester you plan to enter Cochise College:Fall I / AugustFall II / OctoberSpring I / JanuarySpring II / MarchSummer I / JuneStudent TypeHigh School / Middle School StudentFirst-time College Student (after High School)Transfer from Another College or University (after High School)Re-Admit (previously attended Cochise College)Adult Ed (attending the Adult Ed GED/ESL)4 - BIOGRAPHICAL INFORMATIONGenderMaleFemaleDate of Birth* MM/DD/YYYY Ethnicity/Race Information **Please answer both questions (requested for statistical purposes)Are you Hispanic or Latino/Spanish origin?Hispanic or Latino / Spanish OriginNot Hispanic or Latino / Spanish OriginWhat is your race? (choose one or more) White Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native 5 - CITIZENSHIP STATUSStudents need to declare their citizenship or lawful immigration status and present designated documents for Prop 300. (List of Acceptable Documents PDF - link opens new window). CitizenshipUnited StatesOtherIf other, specify countryType of VisaInternational Student (F-1)Border CommuterPermanent ResidentResident Alien"Dreamer", Deferred Action Child Arrival (DACA)Other Type of VisaIf other, specify visa type6 - RESIDENCY INFORMATIONTo be eligible for in-state tuition, students must: - Provide Prop 300 indicating legal status in the United States AND - Have lived in Arizona for more than a year or - Have a parent who has lived in Arizona for a year or more (if a dependent) or - Is transferred to Arizona by employer or is stationed as military, border patrol, etc. or - An honorably discharged veteran with a DD Form 214 residing in Arizona Documents can be scanned and emailed to firstname.lastname@example.org or submitted in person at the closest campus or center near you, or to the Admissions Office at: Cochise College, Admissions, 901 North Colombo Ave., Sierra Vista, AZ 85635-2317. Failure to answer any question or submit documentation will result in classification as a non-resident for tuition purposes. Contact the Admissions & Registration Office at 1-800-593-9567 if you have any questions about residency requirements.When did your current residency in Arizona begin? MM/DD/YYYYWhat are your sources of income?Self-Supporting (self/spouse)Parent or guardianIf spouse, are they an Arizona resident?YesNoIf parent or guardian, their addressIn which state will you file taxes this year?AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDid you file taxes in Arizona last year?YesNoAre you a member or family member of Homeland Security stationed in Arizona?YesNoAre you a full-time employee of an Arizona school district as a teacher or teacher's aide?YesNoDid your employer require that you, your spouse, or parent be transferred to Arizona within the last year?Yes (Document Required)NoIf yes, name of employerAre you a Veteran?YesNoAre you registered to vote in Arizona?YesNoDo you have an Arizona driver's license or identification card?YesNoAre you a member of an American Indian tribe whose reservation lies wholly, or in part, in Arizona?Yes (Document Required)NoNote: Change in residency status from out-of-state must be initiated by you. Cochise College will not automatically adjust your status. 7 - FAMILY EDUCATION Are you a first-generation college student? (Neither parent attended college)YesNo8 - MILITARY / VETERAN STATUS Military/Veteran StatusNon-MilitaryActive DutyReservistVeteranVeteran DependentMilitary DependentNational GuardArizona Unit Address / Installation(Verification Required)Active Duty Separation Date MM/DD/YYYY9 - COCHISE COLLEGE EDUCATION GOAL Cochise College Education GoalPI - Personal InterestTR - Transfer to a Four-year SchoolWK - Improve Work SkillsCR - Prepare for a New CareerCP - Complete a Certificate ProgramAD - Complete an Associate's DegreeCT - Complete associate's degree and transferES - Enrolled in other college/univ., supplementing coursework10 - HOW DID YOU HEAR ABOUT COCHISE How did you hear about Cochise College?High School VisitCareer FairCochise WebsiteInternet AdFamily / FriendMailingNewspaperRadio AdMilitary Education CenterCollege RecruiterMobile App AdOtherIf other, specify 11 - PREVIOUS SCHOOL INFORMATION Previous School InformationHigh School GraduateCurrently Attending High SchoolHome-SchooledGED DiplomaNo High School diploma or GED certificateAdult Ed StudentGradeFreshmanSophomoreJuniorSeniorGraduation DateMM/YYYYExpected Graduation DateMM/YYYYName of High SchoolOnline High School?YesNoName of Middle School (if currently attending)City / State (Province) City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Student Accountability Information System (SAIS) NumberYour SAIS Number is the student ID number assigned to you by your Arizona school district or charter school in the year 2000 or later.Transfer to Cochise Page (link opens new window) To have transfer work evaluated, official transcripts must be requested from each institution and sent directly to Cochise College. 12 - DEGREES AND CERTIFICATES Which degree or certificate are you pursuing?Non-degree Seeking 000000-0000Administration of Justice AA-AJS; 31-44C-AGCAAnimal Science AAS-AGRA--Animal Science Certificate 16-30C-ASCAutomotive Technology AAS-ATC--Automotive Technology Certificate 16-30C-ATCAviation Dispatch AGS-AVDAZ Gen Ed Curriculum Art Certificate 31-44C-AGCAAZ Gen Ed Curriculum Business Certificate 31-44C-AGCBAZ Gen Ed Curriculum Science Certificate 31-44C-AGCSPilot Technology (Professional) AGS-PPTPilot Technology (Professional) AAS-PPTUnmanned Aerial Vehicle Flight Operator (Military) AAS-UAVOUnmanned Aircraft Systems Operations (High School Students ONLY) 16-30C-UASOUnmanned Aircraft Systems Technician (Military) AAS-UAVTBiology AS-BIO; 31-44C-AGCSBuilding Construction Technology AAS-BCT--Carpentry Technology Certificate 16-30C-CTC--Computer-Aided Drafting Certificate 16-30C-CAD--General Computer-Aided Drafting Certificate 16-30C-GCAD--HVAC Certificate 16-30C-HVACBusiness Administration ABUS-BUSG; 31-44C-AGCBBusiness Management AAS-BMT--Entrepreneurship/Small Business Management Certificate 16-30C-ENTCChemistry AS-CHM; 31-44C-AGCSCisco and Linux Networking AAS-CLNComputer Information Systems ABUS-CISS; 31-44C-AGCBComputer Information Systems AAS-CIS--Virtual Reality Technologist Certificate 16-30C-VRTCComputer Programming AAS-CPGComputer Science AA-CSC; 31-44C-AGCAComputer Science AS-CSC; 31-44C-AGCSCrop Science AAS-AGRC--Crop Science Certificate 16-30C-CRSC--Horticulture Science Certificate 16-30C-HCSCCulinary Arts AAS-CUL--Chef Patissier - Bakers Apprentice Certificate 16-30C-BKRA--Sous Chef Apprentice Certificate 31-44C-SCCACybersecurity AAS-CYBEarly Childhood Care and Education AA-ECE; 31-44C-AGCAEarly Childhood Care and Education AAS-ECE--Early Childhood Care and Education Certificate 16-30C-ECECEconomics AA-ECN; 31-44C-AGCAEducation (Military) AAS-ED--Technical Education Facilitator (Military) Certificate 16-30C-TEFElectronics Technology AAS-ELTElementary Education AAEE-EED; 31-44C-AGCAEngineering AS-EGR; 31-44C-AGCSExercise Science, Health, Physical Education, Recreation and Wellness AA-HPES; 31-44C-AGCAFine Arts AA-ARTF; 31-44C-AGCAGeneral Requirements AA-GENG; 31-44C-AGCAGeneral Requirements AS-GENG; 31-44C-AGCSGeneral Studies AGS-AGSIntelligence Operations Studies AAS-IOSTLaw Enforcement AGS-AGS/ZLEO--Law Enforcement Certificate AGS-AGS/ZLEOLiberal Studies AA-LBS; 31-44C-AGCAMathematics AS-MAT; 31-44C-AGCSMedia Production Arts AAS-MPAMusic AA-MUS; 31-44C-AGCANetwork Technology AAS-NWT--Cisco Networking Certificate 16-30C-CNT--Computer Maintenance and Repair Certificate 16-30C-COMR--Linux System Administrator Certificate 16-30C-LSANursing AGS-AGS/ZPRN--Home Health Aide Certificate 1-15C-HHAC--Medical Assistant Certificate 16-30C-MEDA--Nursing Assistant Certificate 1-15C-CNAParamedicine AGS-AGS/ZPAR--Emergency Medical Technician Certificate 1-15C-EMT--Fire Science Technology Certificate 16-30C-FST--Paramedicine Certificate AGS-AGS/ZPARPhysics AS-PHY; 31-44C-AGCSResidential Construction Technology AAS-RCT--Residential Construction Technology Certificate 31-44C-RCCRespiratory Therapy AGS-AGS/ZRTHSocial Behavioral Sciences AA-SBS; 31-44C-AGCATheatre Arts AA-THE; 31-44C-AGCAWelding Technology AAS-WLD--Aerospace Thermal Fusion Certificate 16-30C-AETF--Aerospace Welding Technology Certificate 16-30C-AEWT--General Welding Technology Certificate 16-30C-GWLD--Welding Technology Certificate 16-30C-WLD13 - INFORMATION RELEASEDo you give permission for the college to release directory information (Name, Major, Attendance Dates, Enrollment Status, Degrees Received, and most recent attended institution) as per the Family Education Rights and Privacy Act of 1974?YesNo14 - VERIFICATIONI certify that the information given is complete to the best of my knowledge. I understand that submission of false information is grounds for denial of admission or immediate suspension if enrolled. If accepted as a student at Cochise College, I agree to abide by the rules and regulations of the college regarding conduct and other obligations. By entering my name and date below and then clicking the Submit button I verify the above to be true.Signature (Enter Full Name)*Date* MM/DD/YYYY ReCAPTCHADisability Services: Cochise College values inclusive learning environments and strives to make all aspects of the College accessible to our students. If you have a disability and believe you need an accommodation to improve access to learning and campus services, you may begin the Welcome Process and review the Disability Student Guide at the disabilities services page Notice of Non-discrimination: Cochise College does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability. For additional information or to register a complaint, please contact the Dean of Student Services at 520-515-3647 or 520-417-4050 or go to Student Complaint Form website (link opens new window).NameThis field is for validation purposes and should be left unchanged.