EA FORM PAGE Please enable JavaScript in your browser to complete this form.First Name: *Last Name *Middle Initial:Beal Student ID #: *Date: *Date of Birth: *Address: *City: *State: *Zip: *Country *State of Residence: *Home Phone Number:Cell Phone Number *Email: *Program: *--select one--Non-Degree--Diploma Programs--Addiction Counseling - DE (Diploma)Cannabis Business Operations-DE (Diploma)Practical Nursing (Diploma)Medical Billing and Coding (Diploma)Welding Technology (Diploma)--Associates Degree--Accounting - DE (AAS)Addiction Counseling - DE (AS)Business - DE (AS)Cannabis Business Administration - DE (AS)Cannabis Sciences - DE (AS)Health Information Technology - DE (AS)Healthcare Science - DE (AS)Nursing (ADN)Welding Technology - DE** (AS)--Bachelors Degrees--Addiction Counseling - DE (BS)Biomedical Sciences - DE (BS)Business Administration - DE (BS)Healthcare Science - DE (BS)Health Information Management - DE (BS)Medicinal Plant Sciences - DE (BS)RN-BSN** (BSN)--Masters Degrees--Business Administration - DE (MBA)Clinical Mental Health Counseling- DEHealthcare Administration – DEFamily Nurse PractitionerNursing - DE (MSN)Public Administration - DEPublic Health - DEStart Date:Estimated Completion Date:Program Shift: *--select one--DayEveningOnlineClass Times: *--select one--Mon-Fri (Online, Asynchronous)Mon-Fri (Hybrid)Mon-Fri (On Campus)High School/Facility Student graduated from:Section LocationPlease select the Location this student will be attendingBangor (Main)XWilton (Satellite)XSELECT PROGRAMThis is to populate the Tuition and Fees section for each checkbox. Make sure to only select ONE.Diploma ProgramsAddiction Counseling - DE (Diploma)(14m)XAddiction Counseling - DE (Diploma)(28m)XCannabis Business Operations-DE(10m)XCannabis Business Operations-DE(20m)XPractical Nursing (Diploma)XMedical Billing and Coding (Diploma)XWelding Technology (Diploma)XAssociate Degree ProgramsAccounting - DE (AAS)XAddiction Counseling - DE (AS)(20m)XAddiction Counseling - DE (AS)(40m)XBusiness - DE (AS)XCannabis Business Administration - DE (AS)(20m)XCannabis Business Administration - DE (AS)(40m)XCannabis Science - DE (AS)(18m)XCannabis Science - DE (AS)(36m)XHealth Information Technology - DE (AS)(18m)XHealth Information Technology - DE (AS)(36m)XHealthcare Sciences - DE (AS)XMedical Assistant - DE (AS)XMedical Assistant (AS)XNursing (ADN)XWelding Technology - DE (AS)XBachelor's Degree ProgramsAddiction Counseling - DE (BS)XBiomedical Sciences - DE (BS)(34m)XBiomedical Sciences - DE (BS)(68m)XBusiness Administration - DE (BS)XHealthcare Sciences - DE (BS)XHealth Information Management - DE (BS)(38m)XHealth Information Management - DE (BS)(76m)XMedicinal Plant Sciences - DE (BS)XRN-BSN - DE (BSN)(14M)XRN-BSN - DE (BSN)(26M)XMaster's Degree ProgramsBusiness Administration - DE (MBA)XClinical Mental Health Counseling - DE(22m)XClinical Mental Health Counseling - DE(44m)XHealthcare Administration – DE(12m)XHealthcare Administration – DE(24m)XFamily Nurse Practitioner (20m)XFamily Nurse Practitioner (40m)XNursing - DE (MSN)XPublic Administration - DE (12m)XPublic Administration - DE (24m)XPublic Health - DE (12m)XPublic Health - DE (24m)XSubmit
