Eastman Institute for Oral Health / Educational Programs / How to Apply / Pay Your Application Fee Online Pay Your Non-Refundable Fee Online - Application Fee, Enrollment Deposit and Replacement Certificate/Diploma Fee, Transcript Order Fee Application Information Applicant Name Payment Type -- select item --- Application Fee ($195.00) New Trainee Enrollment Deposit ($1800.00) Replacement Certificate/Diploma ($35.00) EIOH Transcript Fee ($3.50) Program Applying To: Address Information Street Address City State / Province / Region Zip / Postal Code Country United States Afghanistan Aland Islands Albania Algeria American Samoa (US) Andorra Angola Anguilla (UK) Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda (UK) Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands (UK) Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands (UK) Central African Republic Chad Chile China Christmas Island (AU) Cocos (Keeling) Islands (AU) Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands (NZ) Costa Rica Côte D'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (UK) Faroe Islands (DK) Fiji Finland France French Guiana (FR) French Polynesia (FR) French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar (UK) Greece Greenland (DK) Grenada Guadeloupe (FR) Guam (US) Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City) Honduras Hong Kong (CN) Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic (North) Korea, Republic of (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau (CN) Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (FR) Mauritania Mauritius Mayotte (FR) Mexico Micronesia, Federated States of Moldova Republic of Monaco Mongolia Montenegro Montserrat (UK) Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia (FR) New Zealand Nicaragua Niger Nigeria Niue Norfolk Island (AU) Northern Mariana Islands (US) Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands (UK) Poland Portugal Puerto Rico (US) Qatar Reunion (FR) Romania Russia Rwanda Saint Barthelemy Saint Helena (UK) Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint Pierre & Miquelon (FR) Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich Islands (UK) South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands (UK) Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (US) Wallis and Futuna (FR) Western Sahara Yemen Zambia Zimbabwe