{"id":1734,"date":"2026-05-06T08:09:35","date_gmt":"2026-05-06T14:09:35","guid":{"rendered":"https:\/\/app.galen.edu.bz\/admissions\/?page_id=1734"},"modified":"2026-05-06T08:10:13","modified_gmt":"2026-05-06T14:10:13","slug":"eagle-merit-scholarships","status":"publish","type":"page","link":"https:\/\/app.galen.edu.bz\/admissions\/eagle-merit-scholarships\/","title":{"rendered":"Eagle Merit Scholarships"},"content":{"rendered":"<style id=\"wpforms-css-vars-1581\">\n\t\t\t\t#wpforms-1581 {\n\t\t\t\t--wpforms-field-border-color: #e3d0ad;\n--wpforms-field-border-color-spare: #e3d0ad;\n--wpforms-field-text-color: #771214;\n--wpforms-label-color: #771214;\n--wpforms-label-sublabel-color: #771214;\n--wpforms-button-background-color: #771214;\n--wpforms-container-border-color: #D9C3A9;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 50px;\n--wpforms-field-size-input-spacing: 20px;\n--wpforms-field-size-font-size: 18px;\n--wpforms-field-size-line-height: 21px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 18px;\n--wpforms-field-size-sublabel-spacing: 10px;\n--wpforms-field-size-icon-size: 1.25;\n--wpforms-label-size-font-size: 14px;\n--wpforms-label-size-line-height: 17px;\n--wpforms-label-size-sublabel-font-size: 13px;\n--wpforms-label-size-sublabel-line-height: 16px;\n--wpforms-button-size-font-size: 14px;\n--wpforms-button-size-height: 37px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 5px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-quiz wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-1581\"><form id=\"wpforms-form-1581\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1581\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/admissions\/wp-json\/wp\/v2\/pages\/1734?wpforms_form_id=1581\" data-token=\"8f13edeabe549e518979bf5fe242d7ca\" data-token-time=\"1779747870\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator circles\" data-indicator=\"circles\" data-indicator-color=\"#771214\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"5\" tabindex=\"-1\" data-allow-page-navigation=\"1\"><div class=\"wpforms-page-indicator-page active wpforms-page-indicator-page-1\" data-page=\"1\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 1\"><span class=\"wpforms-page-indicator-page-number\" style=\"background-color:#771214\" data-page=\"1\">1<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-2\" data-page=\"2\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 2\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"2\">2<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-3\" data-page=\"3\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 3\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"3\">3<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-4\" data-page=\"4\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 4\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"4\">4<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-5\" data-page=\"5\" role=\"button\" tabindex=\"0\" aria-label=\"Go to page 5\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"5\">5<\/span><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-1581-field_88-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"88\"><\/div><div id=\"wpforms-1581-field_1-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_1\">Type of Scholarship <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1581-field_1\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][1]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>-- Select Type of Scholarship --<\/option><option value=\"Eagle Merit Scholarship\"  class=\"choice-1 depth-1\"  >Eagle Merit Scholarship<\/option><option value=\"Eagle Athletic Scholarship\"  class=\"choice-2 depth-1\"  >Eagle Athletic Scholarship<\/option><\/select><\/div><div id=\"wpforms-1581-field_2-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"2\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_2\">Sub Category<\/label><select id=\"wpforms-1581-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\"><option value=\"Male basketball\"  class=\"choice-1 depth-1\"  >Male basketball<\/option><option value=\"Male canoeing\"  class=\"choice-2 depth-1\"  >Male canoeing<\/option><option value=\"Male cycling\"  class=\"choice-3 depth-1\"  >Male cycling<\/option><option value=\"Male volleyball\"  class=\"choice-4 depth-1\"  >Male volleyball<\/option><option value=\"Female basketball\"  class=\"choice-5 depth-1\"  >Female basketball<\/option><option value=\"Female canoeing\"  class=\"choice-6 depth-1\"  >Female canoeing<\/option><option value=\"Female cycling\"  class=\"choice-7 depth-1\"  >Female cycling<\/option><option value=\"Female volleyball\"  class=\"choice-8 depth-1\"  >Female volleyball<\/option><\/select><\/div><div id=\"wpforms-1581-field_307-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"content\" data-field-id=\"307\"><div id=\"wpforms-1581-field_307\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1581-field_307-error\"><p>Galen University's scholarships are awarded for FULL-TIME study at Galen University to Belizeans who demonstrate the best combination of citizenship and academic potential.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1581-field_3-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"3\"><h3 id=\"wpforms-1581-field_3\" aria-errormessage=\"wpforms-1581-field_3-error\">DEMOGRAPHIC INFORMATION<\/h3><\/div><div id=\"wpforms-1581-field_70-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"70\"><div id=\"wpforms-1581-field_70\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-1581-field_70-error\"><p><strong>Legal Name<\/strong> (Please enter your name as it appears on your passport and\/or other official documents.)<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1581-field_65-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"65\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_65\">How do you Identify?<\/label><select id=\"wpforms-1581-field_65\" class=\"wpforms-field-small\" name=\"wpforms[fields][65]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Select Choice <\/option><option value=\"Male\"  class=\"choice-5 depth-1\"  >Male<\/option><option value=\"Female\"  class=\"choice-6 depth-1\"  >Female<\/option><option value=\"Non-Binary\"  class=\"choice-7 depth-1\"  >Non-Binary<\/option><option value=\"Prefer not to say\"  class=\"choice-8 depth-1\"  >Prefer not to say<\/option><\/select><\/div><div id=\"wpforms-1581-field_325-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"325\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1581-field_325\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][325][first]\" placeholder=\"First \" aria-errormessage=\"wpforms-1581-field_325-error\" aria-describedby=\"wpforms-1581-field_325-description\" required><label for=\"wpforms-1581-field_325\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-1581-field_325-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][325][middle]\" placeholder=\"Middle\" aria-errormessage=\"wpforms-1581-field_325-middle-error\" aria-describedby=\"wpforms-1581-field_325-description\" ><label for=\"wpforms-1581-field_325-middle\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1581-field_325-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][325][last]\" placeholder=\"Last\" aria-errormessage=\"wpforms-1581-field_325-last-error\" aria-describedby=\"wpforms-1581-field_325-description\" required><label for=\"wpforms-1581-field_325-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><div id=\"wpforms-1581-field_325-description\" class=\"wpforms-field-description\">Legal Name (Please enter your name as it appears on your passport and\/or other official documents.)<\/div><\/fieldset><\/div><div id=\"wpforms-1581-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_5\">Suffix:<\/label><input type=\"text\" id=\"wpforms-1581-field_5\" class=\"wpforms-field-small\" name=\"wpforms[fields][5]\" placeholder=\"(Jr., Sr., if applicable)\" aria-errormessage=\"wpforms-1581-field_5-error\" ><\/div><div id=\"wpforms-1581-field_334-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"334\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_334\">Upload a Passport-sized Photo:<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"334\"\n\t\tdata-form-id=\"1581\"\n\t\tdata-input-name=\"wpforms_1581_334\"\n\t\tdata-extensions=\"png,gif,jpg\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>, or\t\t\t\t<span class=\"wpforms-camera\">Capture With Your Camera<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t<\/div>\n<\/div>\n\n<div id=\"wpforms-camera-modal-1581-334\" class=\"wpforms-camera-modal-overlay wpforms-camera-format-photo\"  style=\"display: none;\" data-field-id=\"334\"  data-form-id=\"1581\">\n\t<div class=\"wpforms-camera-modal\">\n\t\t<div class=\"wpforms-camera-modal-header\">\n\t\t\t<div class=\"wpforms-camera-modal-title\">Camera Preview<\/div>\n\t\t\t<div class=\"wpforms-camera-modal-close\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"11\" fill=\"none\">\n\t\t\t\t\t<path d=\"M10.688 2.219 7.405 5.5l3.282 3.313a.964.964 0 0 1 0 1.406.964.964 0 0 1-1.407 0L6 6.938l-3.313 3.28a.964.964 0 0 1-1.406 0 .964.964 0 0 1 0-1.405L4.563 5.5 1.28 2.219a.964.964 0 0 1 0-1.406.964.964 0 0 1 1.407 0L6 4.092 9.281.814a.964.964 0 0 1 1.406 0 .964.964 0 0 1 0 1.406Z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t<\/div>\n\t\t<\/div>\n\n\t\t<div class=\"wpforms-camera-modal-content\">\n\t\t\t<div class=\"wpforms-camera-preview\">\n\t\t\t\t<video id=\"wpforms-camera-video-1581-334\" autoplay playsinline muted disablepictureinpicture><\/video>\n\t\t\t<\/div>\n\t\t\t<div class=\"wpforms-camera-error\"><\/div>\n\t\t<\/div>\n\n\t\t\t\t\t<div class=\"wpforms-camera-modal-footer\">\n\t\t\t\t<div class=\"wpforms-camera-modal-actions\">\n\t\t\t\t\t<button class=\"wpforms-camera-capture\" title=\"Capture Photo\" disabled>\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"22\" fill=\"none\">\n\t\t\t\t\t\t\t\t<path fill=\"#fff\" d=\"M6.984 2.047C7.313 1.109 8.156.5 9.141.5h5.718c.985 0 1.829.61 2.157 1.547l.468 1.453H21c1.64 0 3 1.36 3 3v12c0 1.64-1.36 3-3 3H3c-1.64 0-3-1.36-3-3v-12c0-1.64 1.36-3 3-3h3.516l.468-1.453ZM12 8a4.501 4.501 0 0 0 0 9 4.501 4.501 0 0 0 0-9Z\"\/>\n\t\t\t\t\t\t\t<\/svg>\n\t\t\t\t\t<\/button>\n\t\t\t\t\t<button class=\"wpforms-camera-stop\" style=\"display:none;\">O<\/button>\n\t\t\t\t\t<div class=\"wpforms-camera-countdown\" style=\"display: none;\">\n\t\t\t\t\t\t<svg>\n\t\t\t\t\t\t\t<circle class=\"bg\" r=\"22\"><\/circle>\n\t\t\t\t\t\t\t<circle class=\"progress\" r=\"22\"><\/circle>\n\t\t\t\t\t\t<\/svg>\n\t\t\t\t\t\t<span>3<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"wpforms-camera-flip\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpforms-camera-modal-buttons\" style=\"display: none;\">\n\t\t\t\t\t<button class=\"wpforms-camera-cancel\" title=\"Retake Photo\"><\/button>\n\t\t\t\t\t<button class=\"wpforms-camera-accept\">Use Photo<\/button>\n\t\t\t\t\t<button class=\"wpforms-camera-accept-crop\" style=\"display: none;\">Apply Crop<\/button>\n\t\t\t\t\t<button class=\"wpforms-camera-crop\" title=\"Crop Photo\"><\/button>\n\t\t\t\t\t<button class=\"wpforms-camera-crop-cancel\" title=\"Cancel Crop\" style=\"display: none;\"><\/button>\n\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\n\t\t<canvas id=\"wpforms-camera-canvas-1581-334\" style=\"display:none;\"><\/canvas>\n\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1581-field_334\"\n\t\tname=\"wpforms_1581_334\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-1581-field_66-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"66\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1581-field_10-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-small\"><div ><input type=\"text\" id=\"wpforms-1581-field_10\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][10][address1]\" placeholder=\"Street Address\" aria-errormessage=\"wpforms-1581-field_10-error\" required><label for=\"wpforms-1581-field_10\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-small\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1581-field_10-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][10][city]\" placeholder=\"Village\/Town\/City\" aria-errormessage=\"wpforms-1581-field_10-city-error\" required><label for=\"wpforms-1581-field_10-city\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1581-field_10-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][10][state]\" placeholder=\"District\" aria-errormessage=\"wpforms-1581-field_10-state-error\" required><label for=\"wpforms-1581-field_10-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-small\"><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1581-field_10-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][10][country]\" value=\"BZ\" aria-errormessage=\"wpforms-1581-field_10-country-error\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\"  selected='selected'>Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1581-field_10-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1581-field_104-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"104\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_104\">Permanent Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1581-field_104\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][104]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1581-field_104-error\" required><\/div><div id=\"wpforms-1581-field_102-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"102\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_102\" aria-hidden=\"false\">Mobile#: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1581-field_102\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][102]\" placeholder=\"Mobile #\" aria-label=\"Mobile#:\" aria-errormessage=\"wpforms-1581-field_102-error\" required><\/div><div id=\"wpforms-1581-field_103-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"103\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_103\" aria-hidden=\"false\">Home#:<\/label><input type=\"tel\" id=\"wpforms-1581-field_103\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][103]\" placeholder=\"Home #\" aria-label=\"Home#:\" aria-errormessage=\"wpforms-1581-field_103-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_90-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"90\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"1581\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-1581-field_39-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"39\"><h3 id=\"wpforms-1581-field_39\" aria-errormessage=\"wpforms-1581-field_39-error\">RECOMMENDATIONS<\/h3><\/div><div id=\"wpforms-1581-field_19-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"19\"><div id=\"wpforms-1581-field_19\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1581-field_19-error\"><p>Three detailed letters of reference are needed. Please submit these along with the application form.<\/p>\n<ul>\n<li style=\"text-align:left\">Referees should prepare a character reference letter describing their affiliation to the applicant and their knowledge of the applicant\u2019s capabilities.<\/li>\n<li>These testimonials should highlight the applicant\u2019s attitude, initiative, personal ethics, and involvement in co-curricular activities that will increase his or her chances of being an engaged student at Galen University.<\/li>\n<li>Referees are also invited to comment on any volunteering, service or leadership undertaken by the student or demonstrate financial need if applicable.<\/li>\n<li>Kindly provide the required contact information for referees below.<\/li>\n<li>Referees cannot be relatives of the applicant.<\/li>\n<\/ul>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1581-field_336-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"336\"><div id=\"wpforms-1581-field_336-description\" class=\"wpforms-field-description\"><p style=\"text-align:left;\"><strong>If you are applying for the Athletic Scholarship at least 1 (one) of your referees must be a past or current coach.<\/strong><\/p><\/div><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"21\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_21\" aria-hidden=\"false\">Name [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" placeholder=\"Name\" aria-errormessage=\"wpforms-1581-field_21-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"22\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_22\" aria-hidden=\"false\">Occupation [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" placeholder=\"Occupation\" aria-errormessage=\"wpforms-1581-field_22-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_105-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"105\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_105\" aria-hidden=\"false\">Mobile # [1]<\/label><input type=\"tel\" id=\"wpforms-1581-field_105\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][105]\" aria-label=\"Mobile # [1]\" aria-errormessage=\"wpforms-1581-field_105-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_107-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"107\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_107\" aria-hidden=\"false\">Email [1]<\/label><input type=\"email\" id=\"wpforms-1581-field_107\" class=\"wpforms-field-medium\" name=\"wpforms[fields][107]\" placeholder=\"Email\" spellcheck=\"false\" aria-errormessage=\"wpforms-1581-field_107-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_347-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"347\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Reference 1)<\/legend><ul id=\"wpforms-1581-field_347\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_347_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_347_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][347][]\" value=\"Add Reference\" aria-errormessage=\"wpforms-1581-field_347_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Reference<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_337-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"337\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_338-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"338\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_338\" aria-hidden=\"false\">Name [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_338\" class=\"wpforms-field-medium\" name=\"wpforms[fields][338]\" placeholder=\"Name\" aria-errormessage=\"wpforms-1581-field_338-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_339-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"339\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_339\" aria-hidden=\"false\">Occupation [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_339\" class=\"wpforms-field-medium\" name=\"wpforms[fields][339]\" placeholder=\"Occupation\" aria-errormessage=\"wpforms-1581-field_339-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_340-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"340\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_340\" aria-hidden=\"false\">Mobile # [2]<\/label><input type=\"tel\" id=\"wpforms-1581-field_340\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][340]\" aria-label=\"Mobile # [2]\" aria-errormessage=\"wpforms-1581-field_340-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_341-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"341\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_341\" aria-hidden=\"false\">Email [2]<\/label><input type=\"email\" id=\"wpforms-1581-field_341\" class=\"wpforms-field-medium\" name=\"wpforms[fields][341]\" placeholder=\"Email\" spellcheck=\"false\" aria-errormessage=\"wpforms-1581-field_341-error\" ><\/div><\/div><\/div><\/div><\/div>\t\t<div id=\"wpforms-1581-field_4-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"4\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1581-field_4\" >Recommendation list 4<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1581-field_4\" class=\"wpforms-field-medium\" name=\"wpforms[fields][4]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1581-field_348-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"348\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Reference 2)<\/legend><ul id=\"wpforms-1581-field_348\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_348_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_348_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][348][]\" value=\"Add Reference\" aria-errormessage=\"wpforms-1581-field_348_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Reference<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_342-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"342\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_343-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"343\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_343\" aria-hidden=\"false\">Name [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_343\" class=\"wpforms-field-medium\" name=\"wpforms[fields][343]\" placeholder=\"Name\" aria-errormessage=\"wpforms-1581-field_343-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_344-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"344\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_344\" aria-hidden=\"false\">Occupation [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_344\" class=\"wpforms-field-medium\" name=\"wpforms[fields][344]\" placeholder=\"Occupation\" aria-errormessage=\"wpforms-1581-field_344-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_345-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"345\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_345\" aria-hidden=\"false\">Mobile # [3]<\/label><input type=\"tel\" id=\"wpforms-1581-field_345\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][345]\" aria-label=\"Mobile # [3]\" aria-errormessage=\"wpforms-1581-field_345-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\"><div id=\"wpforms-1581-field_346-container\" class=\"wpforms-field wpforms-field-email wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"email\" data-field-id=\"346\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_346\" aria-hidden=\"false\">Email [3]<\/label><input type=\"email\" id=\"wpforms-1581-field_346\" class=\"wpforms-field-medium\" name=\"wpforms[fields][346]\" placeholder=\"Email\" spellcheck=\"false\" aria-errormessage=\"wpforms-1581-field_346-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_335-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"335\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_335\">Upload Official Recommendation Letters Here:<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"335\"\n\t\tdata-form-id=\"1581\"\n\t\tdata-input-name=\"wpforms_1581_335\"\n\t\tdata-extensions=\"pdf\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"3\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 3 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1581-field_335\"\n\t\tname=\"wpforms_1581_335\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-1581-field_37-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"content\" data-field-id=\"37\" style=\"display:none;\"><div id=\"wpforms-1581-field_37\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-1581-field_37-error\"><div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1581-field_40-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"40\"><h3 id=\"wpforms-1581-field_40\" aria-errormessage=\"wpforms-1581-field_40-error\">PROOF OF NEED<\/h3><\/div><div id=\"wpforms-1581-field_310-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"310\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_310\">Upload TD4<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"310\"\n\t\tdata-form-id=\"1581\"\n\t\tdata-input-name=\"wpforms_1581_310\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"1\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1581-field_310\"\n\t\tname=\"wpforms_1581_310\" \t\tvalue=\"\">\n<div id=\"wpforms-1581-field_310-description\" class=\"wpforms-field-description\"><p>Please submit a copy of the most recent TD4 of whoever will fund your Galen education.<\/p>\n\n<p style=\"margin-top:10px;font-style:italic;border-left:3px solid #ccc;padding-left:10px;\">\n    <strong>Note:<\/strong> If you are unable to provide a TD4 statement, please state why in the following section.\n<\/p><\/div><\/div><div id=\"wpforms-1581-field_38-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_38\">Explain Your Financial Needs<\/label><textarea id=\"wpforms-1581-field_38\" class=\"wpforms-field-large wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"38\" data-text-limit=\"400\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-1581-field_38-error\" aria-describedby=\"wpforms-1581-field_38-description\" ><\/textarea><div id=\"wpforms-1581-field_38-description\" class=\"wpforms-field-description\">Submit a  paragraph explaining your financial need and include all other dependents that this person supports. <\/div><\/div><div id=\"wpforms-1581-field_87-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"87\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"1581\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"1581\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-1581-field_41-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"41\"><h3 id=\"wpforms-1581-field_41\" aria-errormessage=\"wpforms-1581-field_41-error\">INTENDED ACADEMIC PROGRAM OF STUDY<\/h3><\/div><div id=\"wpforms-1581-field_42-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-hide wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_42\">Please select your intended Academic program of study at Galen University from the list below:  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1581-field_42\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][42]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Select Choice <\/option><option value=\"Accounting\"  class=\"choice-2 depth-1\"  >Accounting<\/option><option value=\"Business Administration\"  class=\"choice-4 depth-1\"  >Business Administration<\/option><option value=\"Economics\"  class=\"choice-5 depth-1\"  >Economics<\/option><option value=\"International Business\"  class=\"choice-6 depth-1\"  >International Business<\/option><option value=\"Hospitality and Tourism Management\"  class=\"choice-7 depth-1\"  >Hospitality and Tourism Management<\/option><option value=\"Marketing\"  class=\"choice-8 depth-1\"  >Marketing<\/option><option value=\"Entrepreneurship\"  class=\"choice-9 depth-1\"  >Entrepreneurship<\/option><option value=\"Certificate in Accounting\"  class=\"choice-10 depth-1\"  >Certificate in Accounting<\/option><option value=\"Anthropology\"  class=\"choice-11 depth-1\"  >Anthropology<\/option><option value=\"Computer Science\"  class=\"choice-12 depth-1\"  >Computer Science<\/option><option value=\"Criminal Justice\"  class=\"choice-13 depth-1\"  >Criminal Justice<\/option><option value=\"Environmental Science\"  class=\"choice-14 depth-1\"  >Environmental Science<\/option><option value=\"Veterinary Technician\"  class=\"choice-15 depth-1\"  >Veterinary Technician<\/option><option value=\"Associates in Computer Science\"  class=\"choice-16 depth-1\"  >Associates in Computer Science<\/option><option value=\"Elementary Education\"  class=\"choice-17 depth-1\"  >Elementary Education<\/option><option value=\"Secondary Education\"  class=\"choice-20 depth-1\"  >Secondary Education<\/option><option value=\"Diploma in Pedagogy\"  class=\"choice-19 depth-1\"  >Diploma in Pedagogy<\/option><option value=\"Certificate in Educational Leadership\"  class=\"choice-1 depth-1\"  >Certificate in Educational Leadership<\/option><\/select><\/div><div id=\"wpforms-1581-field_43-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"43\"><h3 id=\"wpforms-1581-field_43\" aria-errormessage=\"wpforms-1581-field_43-error\">EDUCATIONAL DATA<\/h3><\/div><div id=\"wpforms-1581-field_351-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"351\"><div id=\"wpforms-1581-field_351-description\" class=\"wpforms-field-description\"><strong>Please list in chronological order (starting from most recent) all schools (Secondary, College, University) <\/strong><strong>you have attended or are currently attending. <span style=\"text-decoration:underline;\">Certified\/attested copies of official results must accompany <\/span><\/strong><strong><span style=\"text-decoration:underline;\">this application.<\/span><\/strong><\/div><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_316-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"316\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_316\" aria-hidden=\"false\">Institution Attended [1] <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1581-field_316\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][316]\" placeholder=\"Institution Attended\" aria-errormessage=\"wpforms-1581-field_316-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_317-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"317\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_317\" aria-hidden=\"false\">City &amp; Country [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_317\" class=\"wpforms-field-medium\" name=\"wpforms[fields][317]\" placeholder=\"City &amp; Country\" aria-errormessage=\"wpforms-1581-field_317-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_321-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"321\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_321\" aria-hidden=\"false\">Completion Date [1]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_321\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][321][date]\" placeholder=\"Completion Date\" aria-errormessage=\"wpforms-1581-field_321-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_319-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"319\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_319\" aria-hidden=\"false\">Major [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_319\" class=\"wpforms-field-medium\" name=\"wpforms[fields][319]\" placeholder=\"Major\" aria-errormessage=\"wpforms-1581-field_319-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_320-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"320\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_320\" aria-hidden=\"false\">Degree Earned [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_320\" class=\"wpforms-field-medium\" name=\"wpforms[fields][320]\" placeholder=\"Degree Earned\" aria-errormessage=\"wpforms-1581-field_320-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_318-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"318\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_318\" aria-hidden=\"false\">GPA [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_318\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9.99\" name=\"wpforms[fields][318]\" placeholder=\"GPA\" aria-errormessage=\"wpforms-1581-field_318-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_350-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"350\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Academic Qualification 1)<\/legend><ul id=\"wpforms-1581-field_350\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_350_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_350_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][350][]\" value=\"Add Academic Qualification\" aria-errormessage=\"wpforms-1581-field_350_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Academic Qualification<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_356-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"356\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_357-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"357\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_357\" aria-hidden=\"false\">Institution Attended [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_357\" class=\"wpforms-field-medium\" name=\"wpforms[fields][357]\" placeholder=\"Institution Attended\" aria-errormessage=\"wpforms-1581-field_357-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_359-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"359\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_359\" aria-hidden=\"false\">City &amp; Country [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_359\" class=\"wpforms-field-medium\" name=\"wpforms[fields][359]\" placeholder=\"City &amp; Country\" aria-errormessage=\"wpforms-1581-field_359-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_361-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"361\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_361\" aria-hidden=\"false\">Completion Date [2]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_361\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][361][date]\" placeholder=\"Completion Date\" aria-errormessage=\"wpforms-1581-field_361-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_358-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"358\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_358\" aria-hidden=\"false\">Major [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_358\" class=\"wpforms-field-medium\" name=\"wpforms[fields][358]\" placeholder=\"Major\" aria-errormessage=\"wpforms-1581-field_358-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_360-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"360\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_360\" aria-hidden=\"false\">Degree Earned [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_360\" class=\"wpforms-field-medium\" name=\"wpforms[fields][360]\" placeholder=\"Degree Earned\" aria-errormessage=\"wpforms-1581-field_360-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_362-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"362\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_362\" aria-hidden=\"false\">GPA [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_362\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9.99\" name=\"wpforms[fields][362]\" placeholder=\"GPA\" aria-errormessage=\"wpforms-1581-field_362-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_363-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"363\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Academic Qualification 2)<\/legend><ul id=\"wpforms-1581-field_363\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_363_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_363_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][363][]\" value=\"Add Academic Qualification\" aria-errormessage=\"wpforms-1581-field_363_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Academic Qualification<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_364-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"364\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_365-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"365\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_365\" aria-hidden=\"false\">Institution Attended [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_365\" class=\"wpforms-field-medium\" name=\"wpforms[fields][365]\" placeholder=\"Institution Attended\" aria-errormessage=\"wpforms-1581-field_365-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_367-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"367\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_367\" aria-hidden=\"false\">City &amp; Country [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_367\" class=\"wpforms-field-medium\" name=\"wpforms[fields][367]\" placeholder=\"City &amp; Country\" aria-errormessage=\"wpforms-1581-field_367-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_369-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"369\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_369\" aria-hidden=\"false\">Completion Date [3]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_369\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][369][date]\" placeholder=\"Completion Date\" aria-errormessage=\"wpforms-1581-field_369-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_366-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"366\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_366\" aria-hidden=\"false\">Major [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_366\" class=\"wpforms-field-medium\" name=\"wpforms[fields][366]\" placeholder=\"Major\" aria-errormessage=\"wpforms-1581-field_366-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_368-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"368\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_368\" aria-hidden=\"false\">Degree Earned [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_368\" class=\"wpforms-field-medium\" name=\"wpforms[fields][368]\" placeholder=\"Degree Earned\" aria-errormessage=\"wpforms-1581-field_368-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_370-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"370\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_370\" aria-hidden=\"false\">GPA [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_370\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9.99\" name=\"wpforms[fields][370]\" placeholder=\"GPA\" aria-errormessage=\"wpforms-1581-field_370-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_371-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"371\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Academic Qualification 3)<\/legend><ul id=\"wpforms-1581-field_371\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_371_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_371_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][371][]\" value=\"Add Academic Qualification\" aria-errormessage=\"wpforms-1581-field_371_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Academic Qualification<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_372-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"372\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_373-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"373\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_373\" aria-hidden=\"false\">Institution Attended [4]<\/label><input type=\"text\" id=\"wpforms-1581-field_373\" class=\"wpforms-field-medium\" name=\"wpforms[fields][373]\" placeholder=\"Institution Attended\" aria-errormessage=\"wpforms-1581-field_373-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_375-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"375\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_375\" aria-hidden=\"false\">City &amp; Country [4]<\/label><input type=\"text\" id=\"wpforms-1581-field_375\" class=\"wpforms-field-medium\" name=\"wpforms[fields][375]\" placeholder=\"City &amp; Country\" aria-errormessage=\"wpforms-1581-field_375-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_377-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"377\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_377\" aria-hidden=\"false\">Completion Date [4]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_377\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][377][date]\" placeholder=\"Completion Date\" aria-errormessage=\"wpforms-1581-field_377-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_374-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"374\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_374\" aria-hidden=\"false\">Major [4]<\/label><input type=\"text\" id=\"wpforms-1581-field_374\" class=\"wpforms-field-medium\" name=\"wpforms[fields][374]\" placeholder=\"Major\" aria-errormessage=\"wpforms-1581-field_374-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_376-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"376\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_376\" aria-hidden=\"false\">Degree Earned [4]<\/label><input type=\"text\" id=\"wpforms-1581-field_376\" class=\"wpforms-field-medium\" name=\"wpforms[fields][376]\" placeholder=\"Degree Earned\" aria-errormessage=\"wpforms-1581-field_376-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_378-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"378\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_378\" aria-hidden=\"false\">GPA [4]<\/label><input type=\"text\" id=\"wpforms-1581-field_378\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9.99\" name=\"wpforms[fields][378]\" placeholder=\"GPA\" aria-errormessage=\"wpforms-1581-field_378-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_379-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"379\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Academic Qualification 4)<\/legend><ul id=\"wpforms-1581-field_379\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_379_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_379_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][379][]\" value=\"Add Academic Qualification\" aria-errormessage=\"wpforms-1581-field_379_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Academic Qualification<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_380-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"380\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_381-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"381\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_381\" aria-hidden=\"false\">Institution Attended [5]<\/label><input type=\"text\" id=\"wpforms-1581-field_381\" class=\"wpforms-field-medium\" name=\"wpforms[fields][381]\" placeholder=\"Institution Attended\" aria-errormessage=\"wpforms-1581-field_381-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_383-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"383\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_383\" aria-hidden=\"false\">City &amp; Country [5]<\/label><input type=\"text\" id=\"wpforms-1581-field_383\" class=\"wpforms-field-medium\" name=\"wpforms[fields][383]\" placeholder=\"City &amp; Country\" aria-errormessage=\"wpforms-1581-field_383-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_385-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"385\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_385\" aria-hidden=\"false\">Completion Date [5]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_385\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][385][date]\" placeholder=\"Completion Date\" aria-errormessage=\"wpforms-1581-field_385-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_382-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"382\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_382\" aria-hidden=\"false\">Major [5]<\/label><input type=\"text\" id=\"wpforms-1581-field_382\" class=\"wpforms-field-medium\" name=\"wpforms[fields][382]\" placeholder=\"Major\" aria-errormessage=\"wpforms-1581-field_382-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_384-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"384\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_384\" aria-hidden=\"false\">Degree Earned [5]<\/label><input type=\"text\" id=\"wpforms-1581-field_384\" class=\"wpforms-field-medium\" name=\"wpforms[fields][384]\" placeholder=\"Degree Earned\" aria-errormessage=\"wpforms-1581-field_384-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_386-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"386\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_386\" aria-hidden=\"false\">GPA [5]<\/label><input type=\"text\" id=\"wpforms-1581-field_386\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9.99\" name=\"wpforms[fields][386]\" placeholder=\"GPA\" aria-errormessage=\"wpforms-1581-field_386-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_331-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"331\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_331\">Upload Proof of Academic Qualifications Here: <\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"331\"\n\t\tdata-form-id=\"1581\"\n\t\tdata-input-name=\"wpforms_1581_331\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 5 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1581-field_331\"\n\t\tname=\"wpforms_1581_331\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-1581-field_72-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"72\"><h3 id=\"wpforms-1581-field_72\" aria-errormessage=\"wpforms-1581-field_72-error\">OTHER QUALIFICATIONS<\/h3><\/div><div id=\"wpforms-1581-field_388-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"388\"><div id=\"wpforms-1581-field_388-description\" class=\"wpforms-field-description\"><strong>Please list any other qualifications (CXC, ATLIB, ACT, SAT, or the equivalent) obtained by examination. <\/strong>\n<strong>Certified\/attested copies of official results must accompany this application.<\/strong>\n\n<\/div><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_250-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"250\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_250\" aria-hidden=\"false\">Board of Examining Body [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_250\" class=\"wpforms-field-medium\" name=\"wpforms[fields][250]\" placeholder=\"Board of Examining Body (e.g., CXC)\" aria-errormessage=\"wpforms-1581-field_250-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_249-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"249\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_249\" aria-hidden=\"false\">Subject [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_249\" class=\"wpforms-field-medium\" name=\"wpforms[fields][249]\" placeholder=\"Subject (e.g., English A)\" aria-errormessage=\"wpforms-1581-field_249-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_251-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"251\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_251\" aria-hidden=\"false\">Grade\/Result [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_251\" class=\"wpforms-field-medium\" name=\"wpforms[fields][251]\" placeholder=\"Grade\/Result\" aria-errormessage=\"wpforms-1581-field_251-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_322-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"322\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_322\" aria-hidden=\"false\">Examination Date [1]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_322\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][322][date]\" placeholder=\"[m\/d\/Y]\" aria-errormessage=\"wpforms-1581-field_322-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_387-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"387\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Other Qualification 1)<\/legend><ul id=\"wpforms-1581-field_387\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_387_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_387_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][387][]\" value=\"Add Other Qualification\" aria-errormessage=\"wpforms-1581-field_387_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Other Qualification<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_396-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"396\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_398-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"398\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_398\" aria-hidden=\"false\">Board of Examining Body [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_398\" class=\"wpforms-field-medium\" name=\"wpforms[fields][398]\" placeholder=\"Board of Examining Body (e.g., CXC)\" aria-errormessage=\"wpforms-1581-field_398-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_397-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"397\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_397\" aria-hidden=\"false\">Subject [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_397\" class=\"wpforms-field-medium\" name=\"wpforms[fields][397]\" placeholder=\"Subject (e.g., English A)\" aria-errormessage=\"wpforms-1581-field_397-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_399-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"399\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_399\">Grade\/Result [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_399\" class=\"wpforms-field-medium\" name=\"wpforms[fields][399]\" aria-errormessage=\"wpforms-1581-field_399-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_400-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"400\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_400\" aria-hidden=\"false\">Examination Date [2]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_400\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][400][date]\" aria-errormessage=\"wpforms-1581-field_400-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_395-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"395\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Other Qualification 2)<\/legend><ul id=\"wpforms-1581-field_395\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_395_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_395_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][395][]\" value=\"Add Other Qualification\" aria-errormessage=\"wpforms-1581-field_395_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Other Qualification<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_401-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"401\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_403-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"403\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_403\" aria-hidden=\"false\">Board of Examining Body [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_403\" class=\"wpforms-field-medium\" name=\"wpforms[fields][403]\" placeholder=\"Board of Examining Body (e.g., CXC)\" aria-errormessage=\"wpforms-1581-field_403-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_402-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"402\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_402\" aria-hidden=\"false\">Subject [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_402\" class=\"wpforms-field-medium\" name=\"wpforms[fields][402]\" placeholder=\"Subject (e.g., English A)\" aria-errormessage=\"wpforms-1581-field_402-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_404-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"404\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_404\">Grade\/Result [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_404\" class=\"wpforms-field-medium\" name=\"wpforms[fields][404]\" placeholder=\"Grade\/Result\" aria-errormessage=\"wpforms-1581-field_404-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1581-field_405-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"405\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_405\" aria-hidden=\"false\">Examination Date [3]<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1581-field_405\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][405][date]\" aria-errormessage=\"wpforms-1581-field_405-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_332-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"332\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_332\">Upload Proof of External Examination Grade(s) Here: <\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"332\"\n\t\tdata-form-id=\"1581\"\n\t\tdata-input-name=\"wpforms_1581_332\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"3\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 3 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1581-field_332\"\n\t\tname=\"wpforms_1581_332\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-1581-field_73-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"73\"><h3 id=\"wpforms-1581-field_73\" aria-errormessage=\"wpforms-1581-field_73-error\" aria-describedby=\"wpforms-1581-field_73-description\">ACHIEVEMENTS<\/h3><div id=\"wpforms-1581-field_73-description\" class=\"wpforms-field-description\"><strong>Please list any other achievements (certificates, awards, recognition) in chronological order. <\/strong><\/div><\/div><div id=\"wpforms-1581-field_419-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"419\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1581-field_199-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"199\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_199\" aria-hidden=\"false\">Achievement [1]<\/label><input type=\"text\" id=\"wpforms-1581-field_199\" class=\"wpforms-field-medium\" name=\"wpforms[fields][199]\" aria-errormessage=\"wpforms-1581-field_199-error\" aria-describedby=\"wpforms-1581-field_199-description\" ><div id=\"wpforms-1581-field_199-description\" class=\"wpforms-field-description\">Certificates, awards, recognition (e.g. certificate programs, sports award etc.)<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_198-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"198\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_198\" aria-hidden=\"false\">Year<\/label><input type=\"text\" id=\"wpforms-1581-field_198\" class=\"wpforms-field-medium wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" data-form-id=\"1581\" data-field-id=\"198\" data-text-limit=\"4\" name=\"wpforms[fields][198]\" placeholder=\"Year\" aria-errormessage=\"wpforms-1581-field_198-error\" maxlength=\"4\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_435-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"435\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Achievement 1)<\/legend><ul id=\"wpforms-1581-field_435\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_435_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_435_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][435][]\" value=\"Add Achievement\" aria-errormessage=\"wpforms-1581-field_435_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Achievement<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_421-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"421\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1581-field_422-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"422\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_422\" aria-hidden=\"false\">Achievement [2]<\/label><input type=\"text\" id=\"wpforms-1581-field_422\" class=\"wpforms-field-medium\" name=\"wpforms[fields][422]\" aria-errormessage=\"wpforms-1581-field_422-error\" aria-describedby=\"wpforms-1581-field_422-description\" ><div id=\"wpforms-1581-field_422-description\" class=\"wpforms-field-description\">Certificates, awards, recognition (e.g. certificate programs, sports award etc.)<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_423-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"423\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_423\" aria-hidden=\"false\">Year<\/label><input type=\"text\" id=\"wpforms-1581-field_423\" class=\"wpforms-field-medium wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" data-form-id=\"1581\" data-field-id=\"423\" data-text-limit=\"4\" name=\"wpforms[fields][423]\" placeholder=\"Year\" aria-errormessage=\"wpforms-1581-field_423-error\" maxlength=\"4\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_436-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"436\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Achievement 2)<\/legend><ul id=\"wpforms-1581-field_436\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_436_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_436_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][436][]\" value=\"Add Achievement\" aria-errormessage=\"wpforms-1581-field_436_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Achievement<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_424-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"424\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1581-field_425-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"425\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_425\" aria-hidden=\"false\">Achievement [3]<\/label><input type=\"text\" id=\"wpforms-1581-field_425\" class=\"wpforms-field-medium\" name=\"wpforms[fields][425]\" aria-errormessage=\"wpforms-1581-field_425-error\" aria-describedby=\"wpforms-1581-field_425-description\" ><div id=\"wpforms-1581-field_425-description\" class=\"wpforms-field-description\">Certificates, awards, recognition (e.g. certificate programs, sports award etc.)<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_426-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"426\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_426\" aria-hidden=\"false\">Year<\/label><input type=\"text\" id=\"wpforms-1581-field_426\" class=\"wpforms-field-medium wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" data-form-id=\"1581\" data-field-id=\"426\" data-text-limit=\"4\" name=\"wpforms[fields][426]\" placeholder=\"Year\" aria-errormessage=\"wpforms-1581-field_426-error\" maxlength=\"4\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_434-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"434\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Achievement 3)<\/legend><ul id=\"wpforms-1581-field_434\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_434_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_434_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][434][]\" value=\"Add Achievement\" aria-errormessage=\"wpforms-1581-field_434_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Achievement<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_427-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"427\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1581-field_428-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"428\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_428\" aria-hidden=\"false\">Achievement 4<\/label><input type=\"text\" id=\"wpforms-1581-field_428\" class=\"wpforms-field-medium\" name=\"wpforms[fields][428]\" aria-errormessage=\"wpforms-1581-field_428-error\" aria-describedby=\"wpforms-1581-field_428-description\" ><div id=\"wpforms-1581-field_428-description\" class=\"wpforms-field-description\">Certificates, awards, recognition (e.g. certificate programs, sports award etc.)<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_429-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"429\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_429\" aria-hidden=\"false\">Year<\/label><input type=\"text\" id=\"wpforms-1581-field_429\" class=\"wpforms-field-medium wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" data-form-id=\"1581\" data-field-id=\"429\" data-text-limit=\"4\" name=\"wpforms[fields][429]\" placeholder=\"Year\" aria-errormessage=\"wpforms-1581-field_429-error\" maxlength=\"4\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_433-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"433\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkbox (Achievements 4)<\/legend><ul id=\"wpforms-1581-field_433\" class=\"wpforms-icon-choices wpforms-icon-choices-classic wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #771214;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_433_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M256 512A256 256 0 1 0 256 0a256 256 0 1 0 0 512zM232 344V280H168c-13.3 0-24-10.7-24-24s10.7-24 24-24h64V168c0-13.3 10.7-24 24-24s24 10.7 24 24v64h64c13.3 0 24 10.7 24 24s-10.7 24-24 24H280v64c0 13.3-10.7 24-24 24s-24-10.7-24-24z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-1581-field_433_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][433][]\" value=\"Add Achievement\" aria-errormessage=\"wpforms-1581-field_433_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Add Achievement<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_430-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"430\" style=\"display:none;\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1581-field_431-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"431\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_431\" aria-hidden=\"false\">Achievement [5]<\/label><input type=\"text\" id=\"wpforms-1581-field_431\" class=\"wpforms-field-medium\" name=\"wpforms[fields][431]\" aria-errormessage=\"wpforms-1581-field_431-error\" aria-describedby=\"wpforms-1581-field_431-description\" ><div id=\"wpforms-1581-field_431-description\" class=\"wpforms-field-description\">Certificates, awards, recognition (e.g. certificate programs, sports award etc.)<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1581-field_432-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"432\" style=\"display:none;\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_432\" aria-hidden=\"false\">Year<\/label><input type=\"text\" id=\"wpforms-1581-field_432\" class=\"wpforms-field-medium wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" data-form-id=\"1581\" data-field-id=\"432\" data-text-limit=\"4\" name=\"wpforms[fields][432]\" placeholder=\"Year\" aria-errormessage=\"wpforms-1581-field_432-error\" maxlength=\"4\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1581-field_333-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"333\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_333\">Upload Proof of Certificates, Awards, Recognition Here:  <\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"333\"\n\t\tdata-form-id=\"1581\"\n\t\tdata-input-name=\"wpforms_1581_333\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 5 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1581-field_333\"\n\t\tname=\"wpforms_1581_333\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-1581-field_91-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"91\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"1581\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"1581\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-1581-field_92-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"92\"><h3 id=\"wpforms-1581-field_92\" aria-errormessage=\"wpforms-1581-field_92-error\" aria-describedby=\"wpforms-1581-field_92-description\">DISPLAY YOUR INNER EAGLE<\/h3><div id=\"wpforms-1581-field_92-description\" class=\"wpforms-field-description\"><div style=\"line-height:1.8;margin-bottom:20px;\">\n    <div style=\"margin-bottom:10px;\"><strong>Answer each question in 150 words or less<\/strong> and <strong>CAST<\/strong> yourself in a relevant light.<\/div>\n    \n    <div style=\"margin-bottom:10px;\"><strong>Connect<\/strong> in classroom performance to out of class experiences - civic and community involvement.<\/div>\n    \n    <div style=\"margin-bottom:10px;\"><strong>Be Authentic<\/strong>, this is your application - set yourself apart.<\/div>\n    \n    <div style=\"margin-bottom:10px;\"><strong>Be Specific<\/strong> - highlight relevant experiences.<\/div>\n    \n    <div><strong>Take the time<\/strong> to review your application against the requirements and instructions.<\/div>\n<\/div><\/div><\/div><div id=\"wpforms-1581-field_108-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_108\">1.\u00a0If you had the authority to change Galen in a positive way, what specific change(s) would you make?<\/label><textarea id=\"wpforms-1581-field_108\" class=\"wpforms-field-small wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"108\" data-text-limit=\"250\" name=\"wpforms[fields][108]\" aria-errormessage=\"wpforms-1581-field_108-error\" ><\/textarea><\/div><div id=\"wpforms-1581-field_109-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"109\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_109\">2.\u00a0 Describe how you demonstrated leadership ability both in and out of school.<\/label><textarea id=\"wpforms-1581-field_109\" class=\"wpforms-field-small wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"109\" data-text-limit=\"250\" name=\"wpforms[fields][109]\" aria-errormessage=\"wpforms-1581-field_109-error\" ><\/textarea><\/div><div id=\"wpforms-1581-field_110-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_110\">3.\u00a0 Describe a special attribute or accomplishment that sets you apart from others.<\/label><textarea id=\"wpforms-1581-field_110\" class=\"wpforms-field-small wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"110\" data-text-limit=\"250\" name=\"wpforms[fields][110]\" aria-errormessage=\"wpforms-1581-field_110-error\" ><\/textarea><\/div><div id=\"wpforms-1581-field_113-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"113\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_113\">4.\u00a0 Why are you a good candidate to receive this scholarship?<\/label><textarea id=\"wpforms-1581-field_113\" class=\"wpforms-field-small wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"113\" data-text-limit=\"250\" name=\"wpforms[fields][113]\" aria-errormessage=\"wpforms-1581-field_113-error\" ><\/textarea><\/div><div id=\"wpforms-1581-field_112-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_112\">\u00a05.\u00a0 \u00a0Who in your life has been your biggest influence and why?<\/label><textarea id=\"wpforms-1581-field_112\" class=\"wpforms-field-small wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"112\" data-text-limit=\"250\" name=\"wpforms[fields][112]\" aria-errormessage=\"wpforms-1581-field_112-error\" ><\/textarea><\/div><div id=\"wpforms-1581-field_111-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"111\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_111\">6.\u00a0 How has your education contributed to who you are?<\/label><textarea id=\"wpforms-1581-field_111\" class=\"wpforms-field-small wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"111\" data-text-limit=\"250\" name=\"wpforms[fields][111]\" aria-errormessage=\"wpforms-1581-field_111-error\" ><\/textarea><\/div><div id=\"wpforms-1581-field_115-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"115\"><h3 id=\"wpforms-1581-field_115\" aria-errormessage=\"wpforms-1581-field_115-error\">PROFESSIONAL SKILLS<\/h3><\/div><div id=\"wpforms-1581-field_116-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-type=\"checkbox\" data-field-id=\"116\"><fieldset><legend class=\"wpforms-field-label\">Check each of the skills that you possess (based on experience).  Proof (Image, Certificate, Resume, CV, Portfolio  etc.) is required. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1581-field_116\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_1\" name=\"wpforms[fields][116][]\" value=\"Carpentry\" aria-errormessage=\"wpforms-1581-field_116_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_1\">Carpentry<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_2\" name=\"wpforms[fields][116][]\" value=\"Coaching\" aria-errormessage=\"wpforms-1581-field_116_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_2\">Coaching<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_6\" name=\"wpforms[fields][116][]\" value=\"Drawing\" aria-errormessage=\"wpforms-1581-field_116_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_6\">Drawing<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_7\" name=\"wpforms[fields][116][]\" value=\"Event Planning\" aria-errormessage=\"wpforms-1581-field_116_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_7\">Event Planning<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_17\" name=\"wpforms[fields][116][]\" value=\"Expressive Arts\" aria-errormessage=\"wpforms-1581-field_116_17-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_17\">Expressive Arts<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_16\" name=\"wpforms[fields][116][]\" value=\"Graphic Design\" aria-errormessage=\"wpforms-1581-field_116_16-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_16\">Graphic Design<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_15\" name=\"wpforms[fields][116][]\" value=\"Journalism\" aria-errormessage=\"wpforms-1581-field_116_15-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_15\">Journalism<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_14\" name=\"wpforms[fields][116][]\" value=\"Landscaping\" aria-errormessage=\"wpforms-1581-field_116_14-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_14\">Landscaping<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_13\" name=\"wpforms[fields][116][]\" value=\"Leadership\" aria-errormessage=\"wpforms-1581-field_116_13-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_13\">Leadership<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_12\" name=\"wpforms[fields][116][]\" value=\"Management of social media platforms\" aria-errormessage=\"wpforms-1581-field_116_12-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_12\">Management of social media platforms<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_11\" name=\"wpforms[fields][116][]\" value=\"Marketing\" aria-errormessage=\"wpforms-1581-field_116_11-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_11\">Marketing<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_10\" name=\"wpforms[fields][116][]\" value=\"Video Editing\" aria-errormessage=\"wpforms-1581-field_116_10-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_10\">Video Editing<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_9\" name=\"wpforms[fields][116][]\" value=\"Website Management\" aria-errormessage=\"wpforms-1581-field_116_9-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_9\">Website Management<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_8\" name=\"wpforms[fields][116][]\" value=\"Painting\" aria-errormessage=\"wpforms-1581-field_116_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_8\">Painting<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_5\" name=\"wpforms[fields][116][]\" value=\"Clerical\/Offfice\" aria-errormessage=\"wpforms-1581-field_116_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_5\">Clerical\/Offfice<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_3\" name=\"wpforms[fields][116][]\" value=\"Photography\" aria-errormessage=\"wpforms-1581-field_116_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_3\">Photography<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_4\" name=\"wpforms[fields][116][]\" value=\"Tutoring\" aria-errormessage=\"wpforms-1581-field_116_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_4\">Tutoring<\/label><\/li><li class=\"choice-18 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_18\" name=\"wpforms[fields][116][]\" value=\"Accounting\" aria-errormessage=\"wpforms-1581-field_116_18-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_18\">Accounting<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_19\" name=\"wpforms[fields][116][]\" value=\"Computer Science\" aria-errormessage=\"wpforms-1581-field_116_19-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_19\">Computer Science<\/label><\/li><li class=\"choice-24 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_24\" name=\"wpforms[fields][116][]\" value=\"Economics\" aria-errormessage=\"wpforms-1581-field_116_24-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_24\">Economics<\/label><\/li><li class=\"choice-23 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_23\" name=\"wpforms[fields][116][]\" value=\"English\" aria-errormessage=\"wpforms-1581-field_116_23-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_23\">English<\/label><\/li><li class=\"choice-22 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_116_22\" name=\"wpforms[fields][116][]\" value=\"Math\" aria-errormessage=\"wpforms-1581-field_116_22-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_116_22\">Math<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_304-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"304\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_304\">Other (please specify):<\/label><input type=\"text\" id=\"wpforms-1581-field_304\" class=\"wpforms-field-medium\" name=\"wpforms[fields][304]\" aria-errormessage=\"wpforms-1581-field_304-error\" ><\/div><div id=\"wpforms-1581-field_330-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"330\"><label class=\"wpforms-field-label\" for=\"wpforms-1581-field_330\">Attach your  CV, Resume, and\/or Professional Portfolio Here:<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"330\"\n\t\tdata-form-id=\"1581\"\n\t\tdata-input-name=\"wpforms_1581_330\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"2\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 2 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-1581-field_330\"\n\t\tname=\"wpforms_1581_330\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-1581-field_326-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"326\"><h3 id=\"wpforms-1581-field_326\" aria-errormessage=\"wpforms-1581-field_326-error\" aria-describedby=\"wpforms-1581-field_326-description\">STATEMENT OF PURPOSE<\/h3><div id=\"wpforms-1581-field_326-description\" class=\"wpforms-field-description\"><div style=\"margin-top:10px;line-height:1.5;\">\n    <p>Please provide a <strong>clear statement of purpose<\/strong> to demonstrate how this scholarship award will further your personal and professional goals.<\/p>\n    \n    <p style=\"margin-bottom:5px;\"><strong>Include:<\/strong><\/p>\n    <ul style=\"padding-left:20px;margin-top:5px;\">\n        <li>Intended field of study<\/li>\n        <li>Future personal and professional goals<\/li>\n        <li>How the scholarship award will support your journey<\/li>\n    <\/ul>\n\n    <p style=\"margin-top:15px;font-style:italic;\"><strong>Suggested length:<\/strong> 500 words.<\/p>\n<\/div><\/div><\/div><div id=\"wpforms-1581-field_438-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"438\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-1581-field_438\" aria-hidden=\"false\">Statement of Purpose Response Field<\/label><textarea id=\"wpforms-1581-field_438\" class=\"wpforms-field-medium wpforms-limit-words-enabled\" data-form-id=\"1581\" data-field-id=\"438\" data-text-limit=\"500\" name=\"wpforms[fields][438]\" aria-errormessage=\"wpforms-1581-field_438-error\" ><\/textarea><\/div><div id=\"wpforms-1581-field_122-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"122\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"1581\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"1581\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5 last \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-1581-field_117-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"117\"><h3 id=\"wpforms-1581-field_117\" aria-errormessage=\"wpforms-1581-field_117-error\">Check List<\/h3><\/div><div id=\"wpforms-1581-field_118-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"118\"><div id=\"wpforms-1581-field_118\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1581-field_118-error\"><p>Thank you for applying into Galen University's Scholarship Program!<\/p>\n<p>Please ensure that all supporting documentation is included and all sections of this application are completed before making your submission.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1581-field_119-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-type=\"checkbox\" data-field-id=\"119\"><fieldset><legend class=\"wpforms-field-label\">Checklist<\/legend><ul id=\"wpforms-1581-field_119\"><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_119_11\" name=\"wpforms[fields][119][]\" value=\"Completed Application Form\" aria-errormessage=\"wpforms-1581-field_119_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_119_11\">Completed Application Form<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_119_13\" name=\"wpforms[fields][119][]\" value=\"Attached Supporting Documents\" aria-errormessage=\"wpforms-1581-field_119_13-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_119_13\">Attached Supporting Documents<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_119_15\" name=\"wpforms[fields][119][]\" value=\"Attached Copies of Certificates\/Awards\" aria-errormessage=\"wpforms-1581-field_119_15-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_119_15\">Attached Copies of Certificates\/Awards<\/label><\/li><li class=\"choice-17 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_119_17\" name=\"wpforms[fields][119][]\" value=\"Submitted Proof of Need\" aria-errormessage=\"wpforms-1581-field_119_17-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_119_17\">Submitted Proof of Need<\/label><\/li><li class=\"choice-19 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_119_19\" name=\"wpforms[fields][119][]\" value=\"Finished Personal Statement\" aria-errormessage=\"wpforms-1581-field_119_19-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_119_19\">Finished Personal Statement<\/label><\/li><li class=\"choice-21 depth-1\"><input type=\"checkbox\" id=\"wpforms-1581-field_119_21\" name=\"wpforms[fields][119][]\" value=\"Provided Proof of Skills\" aria-errormessage=\"wpforms-1581-field_119_21-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1581-field_119_21\">Provided Proof of Skills<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1581-field_123-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"123\"><h3 id=\"wpforms-1581-field_123\" aria-errormessage=\"wpforms-1581-field_123-error\" aria-describedby=\"wpforms-1581-field_123-description\">Declaration<\/h3><div id=\"wpforms-1581-field_123-description\" class=\"wpforms-field-description\">(Please print your name, sign and date in the spaces below to confirm the submission of your scholarship application.) <\/div><\/div><div id=\"wpforms-1581-field_124-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"124\"><div id=\"wpforms-1581-field_124\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1581-field_124-error\"><div style=\"line-height:1.6;margin-bottom:20px\">\n<p>I certify that the information and support materials provided are current, complete and accurate to the best of my knowledge.<\/p>\n<ul style=\"list-style-type:disc;padding-left:25px;margin-top:15px\">\n<li style=\"margin-bottom:10px\">I understand that withholding information requested in this scholarship application or giving false information will make me illegible for at scholarship consideration Galen University.<\/li>\n<li style=\"margin-bottom:10px\">I understand that <strong>I must work 120 hours per semester<\/strong> and make myself available to render assistance to Galen University when needed if I qualify for the Eagle Merit Scholarship.<\/li>\n<li>If I qualify for the Athletic Scholarship, I understand that I am expected to attend all practices and games, make myself available to render assistance to Galen University when needed, and I must participate in a minimum of two events per semester.<\/li>\n<\/ul>\n<\/div>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1581-field_300-container\" class=\"wpforms-field 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