Bachelor of Applied Sciences Interest Form

To receive more information about this program, please complete this form and a member of the College of eTech will contact you.

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First Name: *

Middle Initial:

Last Name: *

Previous Names (If Applicable):

Date of Birth:*

Address (Line 1):*

Address (Line 2):

City:*

State or Province:*

ZIP or Postal Code:*

Phone Number:*

Email Address:*

What is your highest level of education?*

Have you attended Arkansas Tech University Before?*

How did you learn about our program?