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 provide documentation of disability and that the Accessibility Services Office will provide reasonable accommodations based on this 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).

Legal First Name

Legal Last Name

Middle Name

Student ID

If you are an employee, please replace the 'C' to an 'E' in your Cochise ID (example: E12345678).

Please use your college issued email address

Phone Number

Campus/Center

Choose all campuses you have classes on.

What accommodation(s) are you requesting?

Please type out the accommodation(s) you're requesting.

Upload supporting document(s)

To be considered for accommodations, please provide medical documentation of your diagnosed disability completed within the last 3 years. If you are submitting an IEP or 504 plan, it must be dated within the last 2 years. Emotional Support Animal (ESA) documentation is reviewed yearly.

Which semester(s) are you requesting accommodations for?

Select all that apply