Cochise: Application for Admission to Cochise College

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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 admissions@cochise.edu. Complete all sections of the application form. When you are done, submit the form by clicking the Submit button. You will receive email confirmation of your application within 5 business days. Required entries are indicated with • Bold Headings •.

1 Student Name / Identification
Complete Legal Name: • Last •		A value is required.
• First •		A value is required.
Middle
Previous or Other Names
Cochise College ID #
• Social Security # •		A value is required. - A value is required. - A value is required.
Note: You will be assigned a Cochise College ID Number. Disclosure of your social security number is mandatory 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
• Street •		A value is required.
• City •		A value is required.
• State •		A value is required.
• ZIP •		A value is required.
• Country •		A value is required.
Telephone		( ) -
Email Address
In Case of Emergency: Name
Phone		( ) -

3 Enrollment Information
Semester you plan to enter Cochise College		Year:
		Fall I / August Fall II / October Spring I / January Spring II / March Summer I / June Summer II / July
Student Type		High School / Middle School Student First-time College Student Transfer from Another College or University Re-Admit (Previously Attended Cochise College)

4 Biographical Information
Gender		Male Female
Date of Birth		/ / (Month/Day/Year)
Predominant Ethnic Origin (for Statistical Purposes)		White Black Hispanic/Latino Asian-American Native Hawaiian and other Pacific Islander American Indian / Alaskan Native Other / Multiracial

5 Citizenship Status
Citizenship		United States Other If Other, Specify Country: Note: documentation required
Type of Visa (If Not US Citizen)		Student (F-1) Border Commuter Permanent Resident Resident Alien Adjusting Status Other If Other, Specify:

6 Residency Information
Note: Failure to answer any question may result in classification as a non-resident for tuition purposes. Contact the Admissions Office at (520) 515-5336/5412 if you have any questions about residency requirements.
When did your current residency in Arizona begin?
What are your sources of income?		Self-Supporting (self/spouse) Parent or guardian If parent or guardian, their address:
In which state did you file taxes last year?
In which state did you file taxes two years ago?
Did your employer require that you, your spouse, or parent be transferred to Arizona?		Yes (Documentation Required) No If yes, name of employer
Are you registered to vote?		Yes No If Yes, in which state?
Do you have a driver's license or identification card?		Yes No If Yes, in which state?
Are you a member of an American Indian tribe whose reservation lies wholly, or in part, in Arizona?		Yes (Documentation Required) No
Notes: 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 the first member of your birth family (father, mother, brother, sister) to attend college?		Yes No

8 Military / Veteran Status
		Non-Military Active Duty * Reservist * Veteran -- ETS Date: Military Dependent * National Guard * *Arizona Unit Address / Installation (Verification Required)

9 Cochise College Education Objective
		PI - Personal Interest TR - Transfer to a Four-year School WK - Improve Work Skills CR - Prepare for a New Career CP - Complete a Certificate Program AD - Complete an Associate's Degree

10 How Did You Hear About Cochise College?
		High School Visit Career Fair Cochise College Web Site Family / Friend Cochise County Resident Mailing Brochure Newspaper Radio Ad Military Education Center TV Ad Catalog Other

11 Additional Information

This information is captured to determine if you may be eligible for services provided by the Carl Perkins Grant and for grant reporting purposes. Please check all that apply.

	Single-parent household -- I am a parent who has custody and responsibility for the support and care of one or more dependent children under the age of 18 in the same residence. OR
	I am a single pregnant woman.

Limited English proficiency -- I am a student who is limited in speaking, writing, or understanding the English language, and whose native language is not English or who lives in a family or community where English is not the main language.

	Displaced homemaker -- I am an individual who has primarily been caring for a home and family and has reduced marketable skills; and is no longer supported by the income of another family member. OR
	I am a parent who has been receiving cash assistance for his/her children and him/herself and after two years is still unemployed or underemployed and is having trouble getting or upgrading employment.

12 Previous School Information
Check your status on the right and fill in the appropriate date, if applicable:		High School Graduate : Month Year Currently Attending High School : Grade Expected Graduation: Month Year Home-Schooled : Grade Expected Graduation: Month Year GED Diploma : Month Year No High School diploma or GED certificate
School Information
Name of Middle School (if currently attending)
Name of High School
City / State
College Information		To have transfer work evaluated, official transcripts must be requested from each institution and sent directly to Cochise College.

13 Information Release
Do you give permission for the college to release directory information relative to your enrollment (as per the Family Education Rights and Privacy Act of 1974)?
		Yes No

14 Verification
I 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 on the right and then clicking the Submit button I verify the above to be true.
Name:
Date:
Disability Services: If you have a disability and require auxiliary aids, services, or other accommodations as a student at Cochise College, please contact the ADA coordinator at (520) 515-5337 or (520) 417-4023. Notice of Non-discrimination: Cochise College is committed to a policy of non-discrimination on the basis of race, sex, religion, color, national origin, creed, disability, marital or parental status in admission, educational programs or activities and employment, as specified by federal and state laws and regulations. Inquiries may be addressed to: Human Resources, Cochise College, 4190 West Hwy 80, Douglas, AZ 85607-6190, (520) 417-4727, or to Director, Office of Civil Rights, HHS, Washington, D.C. 20201. Tuition Waivers Golden Apache Tuition Waiver. Golden Apache fee waiver available for students 60 years of age or older. See Admissions Office ofr criteria. New Mexico Tuition Waiver. New Mexico Tuition Waiver(NMTW) availble for New Mexico residents on a limited basis. See Admissions Office for criteria. Western Undergraduate Exchange Tuition Waiver. Western Undergraduate Exchange (WUE) Program Tuition waiver available for students who live in one of the following states: Alaska, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming. WWW.FAFSA.ED.GOV Apply for financial aid early! You must complete and submit a Free Application for Federal Student Aid (FAFSA) to apply for federal studnet aid for college. The quickest way to apply is online using FAFSA on the web at http://www.fafsa.ed.gov. The Financial Aid Office uses information from the FAFSA to determine if you areeligible to recieve federal student aid from grants, loans, and work-study programs. So be sure to fill out a FAFSA even if you think you won't qualify. The Cochise College school code is 001072. Also, find scholarship information at the college website: http://www.cochise.edu.

15 Degrees and Certificates

Please select a degree or certificate from one of the lists below. Note: you may choose only one degree or certificate.

AA Degree - For University Transfer
AAEE Degree - For University Transfer
AS Degree - For University Transfer
ABUS Degree - For University Transfer
AGS Degree - For University Transfer
AAS Degree - Two-year Training for Employment
Certificate Programs - Short-term Training for Employment
Other

Last Updated On: 10/19/07