eApply Add Item Request

If you’re currently completing the eApply application and can’t locate the correct item for selection, please complete the below form.  The request will be processed by an administrator and confirmation sent to you within one business day.

If you have any questions, please reach out to a systems administrator at eapply-admin.

eApply Add Item Form

• Contact Information*

  
  First
  
  

  
  Last
  
  
  
  Email
  
  

• What type of item needs to be added to eApply?*
  • 
    Language
  • 
    Hospital
  • 
    College
  • 
    Insurance Carrier
  • 
    Other (see below)
• What item needs to be added?*
  Please include both name and address for all colleges, hospitals, and insurance carriers. If you’re unsure of the address, a staff member will locate one and verify it with you before the item is added.