EA FORM PAGE

First Name: *

Last Name *

Middle Initial:

Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Beal Student ID #: *

Date: *

Date of Birth: *

State of Residence: *

Home Phone Number:

Cell Phone Number *

Email: *

Program: *

Start Date:

Estimated Completion Date:

Class Times:

High School/Facility Student graduated from:

Section Campus

Please select the Campus this student will be attending

Bangor

X

Wilton

X

SELECT PROGRAM

This is to populate the Tuition and Fees section for each checkbox. Make sure to only select ONE.

Diploma Programs

Addiction Counseling - DE (Diploma)

X

Medical Assisting (Diploma)

X

Welding Technology (Diploma)

X

Associate Degree Programs

Accounting - DE (AAS)

X

Addiction Counseling - DE (AS)

X

Business - DE (AS)

X

Cannabis Business Administration - DE (AS)

X

Cannabis Science - DE (AS)

X

Health Information Technology - DE (AS)

X

Healthcare Sciences - DE (AS)

X

Human Resources - DE (AS)

X

Medical Administrative Specialist - DE (AS)

X

Medical Assistant - DE (AS)

X

Medical Assistant (AS)

X

Nursing (ADN)

X

Welding Technology - DE (AS)

X

Bachelor's Degree Programs

Addiction Counseling - DE (BS)

X

Biomedical Sciences - DE (BS)

X

Business Administration - DE (BS)

X

Healthcare Sciences - DE (BS)

X

Health Information Management - DE (BS)

X

Medicinal Plant Sciences - DE (BS)

X

Nursing - DE (BSN) (14M)

X

Nursing - DE (BSN) (26M)

X

Master's Degree Programs

Business Administration - DE (MBA)

X

Nursing - DE (MSN)

X