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-DEMedical Assisting (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)Human Resources – DE (AS)Medical Administrative Specialist – DE (AS)Medical Assistant – DE (AS)Medical Assistant (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)Nursing – DE** (BSN)–Masters Degrees–Business Administration – DE (MBA)Clinical Mental Health Counseling- DEFamily Nurse PractitionerNursing – DE (MSN)Start 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)XCannabis Business Operations-DEXMedical Assisting (Diploma)XWelding Technology (Diploma)XAssociate Degree ProgramsAccounting – DE (AAS)XAddiction Counseling – DE (AS)XBusiness – DE (AS)XCannabis Business Administration – DE (AS)XCannabis Science – DE (AS)XHealth Information Technology – DE (AS)XHealthcare Sciences – DE (AS)XHuman Resources – DE (AS)XMedical Administrative Specialist – 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)XBusiness Administration – DE (BS)XHealthcare Sciences – DE (BS)XHealth Information Management – DE (BS)XMedicinal Plant Sciences – DE (BS)XNursing – DE (BSN) (14M)XNursing – DE (BSN) (26M)XMaster’s Degree ProgramsBusiness Administration – DE (MBA)XClinical Mental Health Counseling – DEXFamily Nurse PractitionerXNursing – DE (MSN)XSubmit