{"id":1295,"date":"2024-04-05T09:51:13","date_gmt":"2024-04-05T14:51:13","guid":{"rendered":"https:\/\/www.missouriwestern.edu\/academy\/?page_id=1295"},"modified":"2024-04-05T09:51:13","modified_gmt":"2024-04-05T14:51:13","slug":"apply-now","status":"publish","type":"page","link":"https:\/\/www.missouriwestern.edu\/academy\/apply-now\/","title":{"rendered":"Apply Now"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-first\" style=\"--awb-bg-size:cover;--awb-margin-bottom:0px;width:48%; margin-right: 4%;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\"><div class=\"fusion-text fusion-text-1\"><h3><\/h3>\n<\/div><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_5' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Law Enforcement Academy Application Form<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5'  action='\/academy\/wp-json\/wp\/v2\/pages\/1295' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_5_67\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_5_67' class='gfield_label gform-field-label' for='input_5_67'><span class='gform-field-label__text'>LinkedIn<\/span><\/label><div class='ginput_container'><input name='input_67' id='input_5_67' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_5_67'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_5_1\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"374d2ee3\" data-field-span=\"12\"><legend id='gfield_label_5_1' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Are you planning to attend the Full-Time Academy for the session beginning in January 2027?<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_1'><div class='gchoice gchoice_5_1_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.1' type='checkbox'  value='Yes'  id='choice_5_1_1'    aria-labelledby=\"label_5_1_1 gfield_label_5_1\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_1_1' id='label_5_1_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_22\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"14b5870c\" data-field-span=\"12\"><h3 class=\"gsection_title\">GENERAL INFORMATION<\/h3><\/div><fieldset id=\"field_5_6\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"2477932d\" data-field-span=\"12\"><legend id='gfield_label_5_6' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_6'>\n                            \n                            <span id='input_5_6_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.3' id='input_5_6_3' value=''   aria-required='true'     aria-labelledby=\"input_5_6_3_label gfield_label_5_6\"\/>\n                                                    <label for='input_5_6_3' id='input_5_6_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_5_6_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.4' id='input_5_6_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_6_4' id='input_5_6_4_label' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_5_6_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.6' id='input_5_6_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_6_6' id='input_5_6_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5f77892c\" data-field-span=\"6\"><label id='gfield_label_5_7' class='gfield_label gform-field-label' for='input_5_7'><span class='gform-field-label__text'>Previous Names Used<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_5_7' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_7\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_7'>If including your maiden name, please include a copy of your Marriage Certificate if your last name is different. If you have had other name changes, please include a copy of your Judgment and Order to Change Name.<\/div><\/div><div id=\"field_5_9\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5f77892c\" data-field-span=\"6\"><label id='gfield_label_5_9' class='gfield_label gform-field-label' for='input_5_9'><span class='gform-field-label__text'>Name Change Documentation<\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='20480000' \/><input name='input_9' id='input_5_9' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_9 gfield_description_5_9\" onchange='javascript:gformValidateFileSize( this, 20480000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_9'>Max. file size: 20 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_9'><\/div> <\/div><div class='gfield_description' id='gfield_description_5_9'>Please upload your Marriage Certificate or Judgement and Order to Change Name here.<\/div><\/div><fieldset id=\"field_5_12\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c6f3d905\" data-field-span=\"12\"><legend id='gfield_label_5_12' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_5_12' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_5_12_1_container'>\n                                        <input type='number' maxlength='2' name='input_12[]' id='input_5_12_1' value=''   aria-required='true'   aria-labelledby=\"input_5_12_1_label gfield_label_5_12\"  placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_5_12_1' id='input_5_12_1_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                    <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_5_12_2_container'>\n                                        <input type='number' maxlength='2' name='input_12[]' id='input_5_12_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <label for='input_5_12_2' id='input_5_12_2_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                    <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_5_12_3_container'>\n                                        <input type='number' maxlength='4' name='input_12[]' id='input_5_12_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                        <label for='input_5_12_3' id='input_5_12_3_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                   <\/div>\n                               <\/div><\/fieldset><div id=\"field_5_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"119e1983\" data-field-span=\"6\"><label id='gfield_label_5_13' class='gfield_label gform-field-label' for='input_5_13'><span class='gform-field-label__text'>Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_5_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_20\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"119e1983\" data-field-span=\"6\"><label id='gfield_label_5_20' class='gfield_label gform-field-label' for='input_5_20'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_20' id='input_5_20' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><fieldset id=\"field_5_14\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"68e6b616\" data-field-span=\"12\"><legend id='gfield_label_5_14' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Mailing Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_14' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_14_1_container' >\n                                        <input type='text' name='input_14.1' id='input_5_14_1' value=''    aria-required='true'    aria-labelledby=\"input_5_14_1_label gfield_label_5_14\"\/>\n                                        <label for='input_5_14_1' id='input_5_14_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_14_2_container' >\n                                        <input type='text' name='input_14.2' id='input_5_14_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_14_2' id='input_5_14_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_14_3_container' >\n                                    <input type='text' name='input_14.3' id='input_5_14_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_14_3' id='input_5_14_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_14_4_container' >\n                                        <select name='input_14.4' id='input_5_14_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_5_14_4' id='input_5_14_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_14_5_container' >\n                                    <input type='text' name='input_14.5' id='input_5_14_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_14_5' id='input_5_14_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_14.6' id='input_5_14_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_5_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"3fceb681\" data-field-span=\"12\"><legend id='gfield_label_5_53' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Have you previously applied for admittance into any other basic law enforcement academy?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_53'><div class='gchoice gchoice_5_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Yes'  id='choice_5_53_1'    aria-labelledby=\"label_5_53_1 gfield_label_5_53\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_1' id='label_5_53_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='No'  id='choice_5_53_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_53_2' id='label_5_53_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8fecfc69\" data-field-span=\"12\"><label id='gfield_label_5_54' class='gfield_label gform-field-label' for='input_5_54'><span class='gform-field-label__text'>If yes, please indicate the name of the training center AND the state in which it was located:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_5_54' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_55\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fb497dfc\" data-field-span=\"12\"><label id='gfield_label_5_55' class='gfield_label gform-field-label' for='input_5_55'><span class='gform-field-label__text'>If you did not attend this training center, or your application to attend was not accepted, please list why:<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_55' id='input_5_55' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ba8ffda9\" data-field-span=\"12\"><h3 class=\"gsection_title\">EMERGENCY CONTACT INFORMATION<\/h3><\/div><fieldset id=\"field_5_16\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6093b620\" data-field-span=\"12\"><legend id='gfield_label_5_16' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_16'>\n                            \n                            <span id='input_5_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_5_16_3' value=''   aria-required='true'     aria-labelledby=\"input_5_16_3_label gfield_label_5_16\"\/>\n                                                    <label for='input_5_16_3' id='input_5_16_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_5_16_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_16_6' id='input_5_16_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_17\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"d2230316\" data-field-span=\"12\"><legend id='gfield_label_5_17' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_5_17_1' value=''    aria-required='true'    aria-labelledby=\"input_5_17_1_label gfield_label_5_17\"\/>\n                                        <label for='input_5_17_1' id='input_5_17_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_5_17_2_container' >\n                                        <input type='text' name='input_17.2' id='input_5_17_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_17_2' id='input_5_17_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_5_17_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_17_3' id='input_5_17_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_17_4_container' >\n                                        <select name='input_17.4' id='input_5_17_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_5_17_4' id='input_5_17_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_5_17_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_17_5' id='input_5_17_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_5_17_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"511372d4\" data-field-span=\"5\"><label id='gfield_label_5_18' class='gfield_label gform-field-label' for='input_5_18'><span class='gform-field-label__text'>Relationship<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_5_18' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_19\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"511372d4\" data-field-span=\"5\"><label id='gfield_label_5_19' class='gfield_label gform-field-label' for='input_5_19'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_19' id='input_5_19' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/div><div data-field-id=\"19\" class=\"spacer gfield\" style=\"grid-column: span 2;\" data-group-id=\"511372d4\"><\/div><div id=\"field_5_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"aab3909b\" data-field-span=\"12\"><h3 class=\"gsection_title\">AGENCY INFORMATION<\/h3><\/div><div id=\"field_5_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"506d5988\" data-field-span=\"12\"><label id='gfield_label_5_23' class='gfield_label gform-field-label' for='input_5_23'><span class='gform-field-label__text'>Agency Name:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_5_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_24\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"0feda763\" data-field-span=\"12\"><legend id='gfield_label_5_24' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Agency Sponsorship<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_24'><div class='gchoice gchoice_5_24_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='Yes'  id='choice_5_24_1'    aria-labelledby=\"label_5_24_1 gfield_label_5_24\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_24_1' id='label_5_24_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_24_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.2' type='checkbox'  value='No'  id='choice_5_24_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_24_2' id='label_5_24_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_25\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"65b85457\" data-field-span=\"12\"><legend id='gfield_label_5_25' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Supervisor Name<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_25'>\n                            \n                            <span id='input_5_25_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_25.3' id='input_5_25_3' value=''   aria-required='false'     aria-labelledby=\"input_5_25_3_label gfield_label_5_25\"\/>\n                                                    <label for='input_5_25_3' id='input_5_25_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_25_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_25.6' id='input_5_25_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_25_6' id='input_5_25_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_26\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5b847b0d\" data-field-span=\"6\"><label id='gfield_label_5_26' class='gfield_label gform-field-label' for='input_5_26'><span class='gform-field-label__text'>Supervisor Email Address<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_26' id='input_5_26' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_5_27\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5b847b0d\" data-field-span=\"6\"><label id='gfield_label_5_27' class='gfield_label gform-field-label' for='input_5_27'><span class='gform-field-label__text'>Supervisor Phone Number<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_27' id='input_5_27' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_5_28\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"e0525c2f\" data-field-span=\"12\"><h3 class=\"gsection_title\">EDUCATION<\/h3><\/div><div id=\"field_5_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c4c5b2b0\" data-field-span=\"6\"><label id='gfield_label_5_29' class='gfield_label gform-field-label' for='input_5_29'><span class='gform-field-label__text'>High School Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_5_29' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div data-field-id=\"29\" class=\"spacer gfield\" style=\"grid-column: span 6;\" data-group-id=\"c4c5b2b0\"><\/div><fieldset id=\"field_5_30\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"667bdc9c\" data-field-span=\"12\"><legend id='gfield_label_5_30' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>High School Address<\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_city has_state ginput_container_address gform-grid-row' id='input_5_30' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_30_3_container' >\n                                    <input type='text' name='input_30.3' id='input_5_30_3' value=''    aria-required='false'    aria-labelledby=\"input_5_30_3_label gfield_label_5_30\"\/>\n                                    <label for='input_5_30_3' id='input_5_30_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_30_4_container' >\n                                        <select name='input_30.4' id='input_5_30_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_5_30_4' id='input_5_30_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><input type='hidden' class='gform_hidden' name='input_30.6' id='input_5_30_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_5_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"93799574\" data-field-span=\"12\"><legend id='gfield_label_5_31' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Did you graduate?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_31'><div class='gchoice gchoice_5_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='Yes'  id='choice_5_31_1'    aria-labelledby=\"label_5_31_1 gfield_label_5_31\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_31_1' id='label_5_31_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_31_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.2' type='checkbox'  value='No'  id='choice_5_31_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_31_2' id='label_5_31_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_32\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"056e6821\" data-field-span=\"12\"><legend id='gfield_label_5_32' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_5_32' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_5_32_1_container'>\n                                        <input type='number' maxlength='2' name='input_32[]' id='input_5_32_1' value=''   aria-required='true'   aria-labelledby=\"input_5_32_1_label gfield_label_5_32\"  placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_5_32_1' id='input_5_32_1_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                    <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_5_32_2_container'>\n                                        <input type='number' maxlength='2' name='input_32[]' id='input_5_32_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <label for='input_5_32_2' id='input_5_32_2_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                    <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_5_32_3_container'>\n                                        <input type='number' maxlength='4' name='input_32[]' id='input_5_32_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                        <label for='input_5_32_3' id='input_5_32_3_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                   <\/div>\n                               <\/div><\/fieldset><fieldset id=\"field_5_33\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"a9c41adc\" data-field-span=\"6\"><legend id='gfield_label_5_33' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Do you have your G.E.D.?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_33'><div class='gchoice gchoice_5_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='Yes'  id='choice_5_33_1'    aria-labelledby=\"label_5_33_1 gfield_label_5_33\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_1' id='label_5_33_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_33_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.2' type='checkbox'  value='No'  id='choice_5_33_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_33_2' id='label_5_33_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_35\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a9c41adc\" data-field-span=\"4\"><label id='gfield_label_5_35' class='gfield_label gform-field-label' for='input_5_35'><span class='gform-field-label__text'>Year you obtained your G.E.D.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_35' id='input_5_35' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div data-field-id=\"35\" class=\"spacer gfield\" style=\"grid-column: span 2;\" data-group-id=\"a9c41adc\"><\/div><fieldset id=\"field_5_36\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4ea59520\" data-field-span=\"12\"><legend id='gfield_label_5_36' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>City and State you obtained your G.E.D. in<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_city has_state ginput_container_address gform-grid-row' id='input_5_36' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_36_3_container' >\n                                    <input type='text' name='input_36.3' id='input_5_36_3' value=''    aria-required='true'    aria-labelledby=\"input_5_36_3_label gfield_label_5_36\"\/>\n                                    <label for='input_5_36_3' id='input_5_36_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_36_4_container' >\n                                        <select name='input_36.4' id='input_5_36_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_5_36_4' id='input_5_36_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><input type='hidden' class='gform_hidden' name='input_36.6' id='input_5_36_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f1d78961\" data-field-span=\"12\"><h3 class=\"gsection_title\">MILITARY \/ DRIVING \/ ARREST RECORDS<\/h3><\/div><fieldset id=\"field_5_38\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"e7c3038e\" data-field-span=\"6\"><legend id='gfield_label_5_38' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Are you a veteran of military service?<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_38'><div class='gchoice gchoice_5_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='Yes'  id='choice_5_38_1'   aria-describedby=\"gfield_description_5_38\" aria-labelledby=\"label_5_38_1 gfield_label_5_38\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_38_1' id='label_5_38_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_38_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.2' type='checkbox'  value='No'  id='choice_5_38_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_38_2' id='label_5_38_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_38'>If yes, please provide a copy of your DD-214.<\/div><\/fieldset><div id=\"field_5_39\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"e7c3038e\" data-field-span=\"6\"><label id='gfield_label_5_39' class='gfield_label gform-field-label' for='input_5_39'><span class='gform-field-label__text'>File<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='20480000' \/><input name='input_39' id='input_5_39' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_39 gfield_description_5_39\" onchange='javascript:gformValidateFileSize( this, 20480000 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_39'>Max. file size: 20 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_39'><\/div> <\/div><div class='gfield_description' id='gfield_description_5_39'>Please upload your DD-214 here.<\/div><\/div><fieldset id=\"field_5_40\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"856934b6\" data-field-span=\"12\"><legend id='gfield_label_5_40' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date of Discharge<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_5_40' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_5_40_1_container'>\n                                        <input type='number' maxlength='2' name='input_40[]' id='input_5_40_1' value=''   aria-required='true'   aria-labelledby=\"input_5_40_1_label gfield_label_5_40\"  placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_5_40_1' id='input_5_40_1_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                    <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_5_40_2_container'>\n                                        <input type='number' maxlength='2' name='input_40[]' id='input_5_40_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <label for='input_5_40_2' id='input_5_40_2_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                    <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_5_40_3_container'>\n                                        <input type='number' maxlength='4' name='input_40[]' id='input_5_40_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                        <label for='input_5_40_3' id='input_5_40_3_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                   <\/div>\n                               <\/div><\/fieldset><div id=\"field_5_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"26bea0a1\" data-field-span=\"6\"><label id='gfield_label_5_41' class='gfield_label gform-field-label' for='input_5_41'><span class='gform-field-label__text'>Type of Discharge<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_5_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div data-field-id=\"41\" class=\"spacer gfield\" style=\"grid-column: span 6;\" data-group-id=\"26bea0a1\"><\/div><fieldset id=\"field_5_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"f813e9c8\" data-field-span=\"12\"><legend id='gfield_label_5_42' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Have you ever been arrested and\/or convicted of a felony, including the receiving of a Suspended Imposition of Sentence, following a plea of guilty to a felony charge?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_42'><div class='gchoice gchoice_5_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='Yes'  id='choice_5_42_1'    aria-labelledby=\"label_5_42_1 gfield_label_5_42\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_42_1' id='label_5_42_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='No'  id='choice_5_42_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_42_2' id='label_5_42_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_57\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"d85bcdf5\" data-field-span=\"12\"><label id='gfield_label_5_57' class='gfield_label gform-field-label' for='input_5_57'><span class='gform-field-label__text'>In what State did this offense occur?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_5_57' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_59\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6742e0c4\" data-field-span=\"12\"><label id='gfield_label_5_59' class='gfield_label gform-field-label' for='input_5_59'><span class='gform-field-label__text'>Please describe the general situation of the offense<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_59' id='input_5_59' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"eafe0dad\" data-field-span=\"12\"><label id='gfield_label_5_60' class='gfield_label gform-field-label' for='input_5_60'><span class='gform-field-label__text'>What was the outcome of this situation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_5_60' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_43\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"9e6ab989\" data-field-span=\"12\"><legend id='gfield_label_5_43' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Have you ever been arrested and\/or convicted of a misdemeanor to include a DWI, BAC, Leaving the Scene?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_43'><div class='gchoice gchoice_5_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='Yes'  id='choice_5_43_1'    aria-labelledby=\"label_5_43_1 gfield_label_5_43\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_43_1' id='label_5_43_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_43_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.2' type='checkbox'  value='No'  id='choice_5_43_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_43_2' id='label_5_43_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"39ae4d7c\" data-field-span=\"12\"><label id='gfield_label_5_61' class='gfield_label gform-field-label' for='input_5_61'><span class='gform-field-label__text'>In what State did this offense occur?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_5_61' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_62\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4dbeb07d\" data-field-span=\"12\"><label id='gfield_label_5_62' class='gfield_label gform-field-label' for='input_5_62'><span class='gform-field-label__text'>Please describe the general situation of the offense<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_62' id='input_5_62' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"d9516169\" data-field-span=\"12\"><label id='gfield_label_5_63' class='gfield_label gform-field-label' for='input_5_63'><span class='gform-field-label__text'>What was the outcome of this situation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_5_63' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_44\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"ec3e120c\" data-field-span=\"12\"><legend id='gfield_label_5_44' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Have you ever been involved in, arrested and\/or convicted of a misdemeanor or felony in this or any other state?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_44'><div class='gchoice gchoice_5_44_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.1' type='checkbox'  value='Yes'  id='choice_5_44_1'    aria-labelledby=\"label_5_44_1 gfield_label_5_44\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_44_1' id='label_5_44_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_44_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.2' type='checkbox'  value='No'  id='choice_5_44_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_44_2' id='label_5_44_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"1302520d\" data-field-span=\"12\"><label id='gfield_label_5_64' class='gfield_label gform-field-label' for='input_5_64'><span class='gform-field-label__text'>In what State did this offense occur?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_5_64' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_65\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c63e61f1\" data-field-span=\"12\"><label id='gfield_label_5_65' class='gfield_label gform-field-label' for='input_5_65'><span class='gform-field-label__text'>Please describe the general situation of the offense<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_5_65' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8b7e0027\" data-field-span=\"12\"><label id='gfield_label_5_66' class='gfield_label gform-field-label' for='input_5_66'><span class='gform-field-label__text'>What was the outcome of this situation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_5_66' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"19b1cc71\" data-field-span=\"12\"><h3 class=\"gsection_title\">FINANCIAL AID<\/h3><\/div><fieldset id=\"field_5_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"002908ff\" data-field-span=\"12\"><legend id='gfield_label_5_46' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Please choose your Financial Aid situation<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_46'><div class='gchoice gchoice_5_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='Agency Sponsorship'  id='choice_5_46_1'    aria-labelledby=\"label_5_46_1 gfield_label_5_46\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_46_1' id='label_5_46_1' class='gform-field-label gform-field-label--type-inline'>Agency Sponsorship<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_46_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.2' type='checkbox'  value='VA\/GI Bill Benefits'  id='choice_5_46_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_46_2' id='label_5_46_2' class='gform-field-label gform-field-label--type-inline'>VA\/GI Bill Benefits<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_46_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.3' type='checkbox'  value='Outside Scholarships'  id='choice_5_46_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_46_3' id='label_5_46_3' class='gform-field-label gform-field-label--type-inline'>Outside Scholarships<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_46_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.4' type='checkbox'  value='Workforce Development'  id='choice_5_46_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_46_4' id='label_5_46_4' class='gform-field-label gform-field-label--type-inline'>Workforce Development<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_46_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.5' type='checkbox'  value='Direct Pay (No assistance)'  id='choice_5_46_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_46_5' id='label_5_46_5' class='gform-field-label gform-field-label--type-inline'>Direct Pay (No assistance)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_46_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.6' type='checkbox'  value='Other (Please describe)'  id='choice_5_46_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_46_6' id='label_5_46_6' class='gform-field-label gform-field-label--type-inline'>Other (Please describe)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8f11a973\" data-field-span=\"12\"><label id='gfield_label_5_47' class='gfield_label gform-field-label' for='input_5_47'><span class='gform-field-label__text'>Please describe your Financial Aid situation<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_5_47' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_47\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_5_47'>You are seeing this field because you have chosen \"Other\". <\/div><\/div><fieldset id=\"field_5_50\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"4b0e2428\" data-field-span=\"12\"><legend id='gfield_label_5_50' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>By checking this box, I certify that the information given herein is true and accurate to the best of my knowledge. I understand that any omission or falsification of the above information will disqualify me from attending the Missouri Western State University Law Enforcement Academy.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_5_50'><div class='gchoice gchoice_5_50_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.1' type='checkbox'  value='I understand the terms, and the information I have given is true and accurate to the best of my knowledge.'  id='choice_5_50_1'    aria-labelledby=\"label_5_50_1 gfield_label_5_50\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_50_1' id='label_5_50_1' class='gform-field-label gform-field-label--type-inline'>I understand the terms, and the information I have given is true and accurate to the best of my knowledge.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_5_51\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"b2943bf2\" data-field-span=\"12\"><legend id='gfield_label_5_51' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Consent to Inquiry &amp; Release of Information<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_51.1' id='input_5_51_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_5_51\" aria-labelledby=\"input_5_51_1_label gfield_label_5_51\" aria-required=\"true\" 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