Cochise College New Accommodation Request

* indicates a required field

Accessibility Specific Information

I hereby apply for services for individuals with disabilities at Cochise College. I understand that it will be necessary for me to document the nature and extent of my disability. The Disability Services Office will provide reasonable accommodations based on the appropriate documentation so that I may fully participate in the educational process. I also understand that all information I provide to Cochise College will remain confidential and will only be used to determine reasonable accommodation(s). 

*
*
*
*
Please use your college issued email address
*
Choose all campuses you have classes on.
[select]
*

To be considered for accommodations, provide medical documentation of your diagnosed disability or an IEP (Individual Education Plan within the last 2 years).