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 - Student Information 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. 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 GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Primary Telephone(###) ###-####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)Note: If you are taking a class(es) and not seeking a degree, select transfer from another college or university as your student type. 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 (List of Acceptable Documents PDF). Documents can be scanned/uploaded below, emailed to firstname.lastname@example.org or mailed or submitted in person to the Admissions Office at: Cochise College, Admissions Office, 901 North Colombo Ave., Sierra Vista, AZ 85635-2317.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 INFORMATIONFailure to answer any question may 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 certificateGradeFreshmanSophomoreJuniorSeniorGraduation Date MM/DD/YYYYExpected Graduation Date MM/DD/YYYYName of High SchoolName 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.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?Administration of Justice AA-AJSAdministration of Justice AAS-AJSAgriculture AAS-AGRAgronomy AAS-AGROAutomotive Technology AAS-ATC--Automotive Technology Certificate 16-30C-ATCAviation Dispatch AGS-AVDPilot Technology (Professional) AGS-PPTPilot Technology (Professional) AAS-PPTUnmanned Aerial Vehicle Flight Operator (Military) AAS-UAVOUnmanned Aircraft Systems and Operations AAS-UASUnmanned Aircraft Systems Technician (Military) AAS-UAVTBiology AS-BIOBuilding 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-HVAC--Utility Industry Certificate 16-30C-UIBusiness Administration ABUS-BUSGBusiness Management AAS-BMT--General Business Certificate 16-30C-GBUS--Entrepreneurship/Small Business Management Certificate 16-30C-ENTCChemistry AS-CHMCisco and Linux Networking AAS-CLNCommunications AA-COMComputer Information Systems ABUS-CISSComputer Information Systems AAS-CISComputer Programming AAS-CPG--Web Developer Certificate 16-30C-WEBDComputer Science AA-CSCComputer Science AS-CSCCulinary Arts AAS-CUL--Chef Garde Manger Apprentice Certificate 16-30C-CGMA--Chef Patissier - Bakers Apprentice Certificate 16-30C-BKRA--Sous Chef Apprentice Certificate 31-44C-SCCACybersecurity AAS-CYBEarly Childhood Care and Education AA-ECEEarly Childhood Care and Education AAS-ECEEconomics AA-ECNEducation (Military) AAS-ED--Technical Education Facilitator (Military) Certificate 16-30C-TEFElectronics Technology AAS-ELTElementary Education AAEE-EEDEngineering AS-EGREngineering AAS-EGREngineering Technology AAS-EGRTEnglish AA-ENGEquine Science and Management AAS-EQSMExercise Science, Health, Physical Education, Recreation and Wellness AA-HPESFine Arts AA-ARTFFire Science Technology AAS-FST--Fire Science Technology Certificate 16-30C-FSTGeneral Requirements AA-GENGGeneral Requirements AS-GENGGeneral Studies AGS-AGSHumanities AA-HUMIntelligence Operations Studies AAS-IOST--IO, Counterintelligence AAS-IOST/CI--IO, General Intelligence Operations AAS-IOST/GIO--IO, Human Intelligence Collector AAS-IOST/HIC--IO, Imagery Analyst AAS-IOST/IMA--IO, Intelligence Analyst AAS-IOST/IA--IO, Linguist AAS-IOST/LIN--IO, Military Intelligence Systems Maintainer AAS-IOST/MISM--IO, Signal Collector Analyst AAS-IOST/SCA--IO, Signals Intelligence Analyst AAS-IOST/SIAJournalism and Media Arts AA-JMALogistics Supply Chain Management AAS-LGSMathematics AS-MATMedia Production Arts AAS-MPAMusic AA-MUSNetwork 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--Medical Assistant Certificate 16-30C-MEDA--Nursing Assistant Certificate 1-15C-CNAParamedicine AGS-AGS/ZPAR--Emergency Medical Technician Certificate 1-15C-EMT--Paramedicine Certificate 45+C-PARPhilosophy AA-PHIPhysics AS-PHYProfessional Administrative Assistant AAS-PAA--Administrative Office Aide Certificate 16-30C-AOA--Receptionist Certificate 16-30C-RCPResidential Construction Technology AAS-RCT--Residential Construction Technology Certificate 31-44C-RCCRespiratory Therapy AGS-AGS/ZRTHSocial Behavioral Sciences AA-SBSTheatre Arts AA-THEWelding 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-WLDNon-degree Seeking 000000-000013 - 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 Disability Services: If you have a disability and require auxiliary aids, services, or other accommodations as a student at Cochise College, please contact the Disability Services Office at (520) 515-5337 or (520) 417-4023. 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.CommentsThis field is for validation purposes and should be left unchanged.