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EA FORM PAGE

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: *

Start Date:

Estimated Completion Date:

Program Shift: *

Class Times: *

High School/Facility Student graduated from:

Section Location

Please select the Location this student will be attending

Bangor (Main)

X

Wilton (Satellite)

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

Cannabis Business Operations-DE

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

Clinical Mental Health Counseling – DE

X

Family Nurse Practitioner

X

Nursing – DE (MSN)

X

Beal University

Main School

99 Farm Road
Bangor, ME 04401
USA

Satellite Location

75 Allen Street
Wilton, ME 04294
USA

Website: https://beal.edu
Phone: 207-307-3900
Fax: 207-947-0208

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