{"id":2027,"date":"2026-07-30T15:46:00","date_gmt":"2026-07-30T21:46:00","guid":{"rendered":"https:\/\/app.galen.edu.bz\/admissions\/?page_id=2027"},"modified":"2026-07-30T15:46:01","modified_gmt":"2026-07-30T21:46:01","slug":"career-development-programs-application","status":"publish","type":"page","link":"https:\/\/app.galen.edu.bz\/admissions\/career-development-programs-application\/","title":{"rendered":"Career Development Programs Application"},"content":{"rendered":"<style id=\"wpforms-css-vars-1886-block-daed6728-a02f-4d34-af69-368a10f1c098\">\n\t\t\t\t#wpforms-1886.wpforms-block-daed6728-a02f-4d34-af69-368a10f1c098 {\n\t\t\t\t--wpforms-label-color: #771214;\n--wpforms-label-sublabel-color: #771214;\n--wpforms-field-border-color: #e3d0ad;\n--wpforms-field-border-color-spare: #e3d0ad;\n--wpforms-field-text-color: #771214;\n--wpforms-container-border-color: #D9C3A9;\n--wpforms-button-background-color: #771214;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 31px;\n--wpforms-field-size-input-spacing: 10px;\n--wpforms-field-size-font-size: 14px;\n--wpforms-field-size-line-height: 17px;\n--wpforms-field-size-padding-h: 9px;\n--wpforms-field-size-checkbox-size: 14px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 0.75;\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-block wpforms-block-daed6728-a02f-4d34-af69-368a10f1c098 wpforms-render-modern\" id=\"wpforms-1886\"><form id=\"wpforms-form-1886\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1886\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/admissions\/wp-json\/wp\/v2\/pages\/2027?wpforms_form_id=1886\" data-token=\"056353fe1a5f01b4f9f31468ab0df936\" data-token-time=\"1787546571\"><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-field-container\"><div id=\"wpforms-1886-field_2-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"2\"><div id=\"wpforms-1886-field_2\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-1886-field_2-error\"><p>Galen University provides market driven, transformative, experiential education for personal and social development. The University upholds the highest standards of human rights and does not discriminate against individuals on the basis of race, color, sexual orientation, gender, religion, ability, age, nationality or ethnicity in the administration of its admission and academic policies and all university programs and activities.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1886-field_6-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"6\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tDETAILS OF APPLICATION \n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1886-field_3-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-modern\" data-field-type=\"select\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_3\">Program <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1886-field_3\" class=\"wpforms-field-large wpforms-field-required choicesjs-select\" data-size-class=\"wpforms-field-row wpforms-field-large\" data-search-enabled=\"\" name=\"wpforms[fields][3]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"CAEP - Climate Adaptive Education Program\"  class=\"choice-2 depth-1\"  >CAEP &#8211; Climate Adaptive Education Program<\/option><option value=\"MMD - Migration Management Diploma\"  class=\"choice-3 depth-1\"  >MMD &#8211; Migration Management Diploma<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_39-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"39\"><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-1886-field_5-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Semester within which the program is taken <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1886-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_5_1\" name=\"wpforms[fields][5]\" value=\"Fall\" aria-errormessage=\"wpforms-1886-field_5_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_5_1\">Fall<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_5_2\" name=\"wpforms[fields][5]\" value=\"Spring\" aria-errormessage=\"wpforms-1886-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_5_2\">Spring<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_5_3\" name=\"wpforms[fields][5]\" value=\"Summer\" aria-errormessage=\"wpforms-1886-field_5_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_5_3\">Summer<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1886-field_7-container\" class=\"wpforms-field wpforms-field-text year-select\" data-field-type=\"text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_7\">Year <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_7\" class=\"wpforms-field-small wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" name=\"wpforms[fields][7]\" value=\"2026\" aria-errormessage=\"wpforms-1886-field_7-error\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_8-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"8\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tACADEMIC INFORMATION \n\t\t\t<\/h3><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-1886-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_9\">Secondary School completed:  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-1886-field_9-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1886-field_10-container\" class=\"wpforms-field wpforms-field-text year-select\" data-field-type=\"text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_10\">Year Graduated:  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_10\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-1886-field_10-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1886-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_11\">Tertiary School (if completed) Name: <\/label><input type=\"text\" id=\"wpforms-1886-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1886-field_11-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1886-field_13-container\" class=\"wpforms-field wpforms-field-text year-select\" data-field-type=\"text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_13\">Year Graduated:<\/label><input type=\"text\" id=\"wpforms-1886-field_13\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"9999\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-1886-field_13-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_12-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-type=\"checkbox\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Level of Tertiary <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1886-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1886-field_12_1\" name=\"wpforms[fields][12][]\" value=\"Associate\" aria-errormessage=\"wpforms-1886-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_12_1\">Associate<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1886-field_12_2\" name=\"wpforms[fields][12][]\" value=\"Bachelors\" aria-errormessage=\"wpforms-1886-field_12_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_12_2\">Bachelors<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1886-field_12_3\" name=\"wpforms[fields][12][]\" value=\"Post Graduate\" aria-errormessage=\"wpforms-1886-field_12_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_12_3\">Post Graduate<\/label><\/li><\/ul><\/fieldset><\/div>\t\t<div id=\"wpforms-1886-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1886-field_1\" >Emergency the INFORMATION<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1886-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1886-field_14-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"14\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tDEMOGRAPHIC INFORMATION \n\t\t\t<\/h3><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-100\"><div class=\"wpforms-layout-column wpforms-layout-column-100\" ><div id=\"wpforms-1886-field_15-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Legal 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-1886-field_15\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][15][first]\" aria-errormessage=\"wpforms-1886-field_15-error\" aria-describedby=\"wpforms-1886-field_15-description\" required><label for=\"wpforms-1886-field_15\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-1886-field_15-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][15][middle]\" aria-errormessage=\"wpforms-1886-field_15-middle-error\" aria-describedby=\"wpforms-1886-field_15-description\" ><label for=\"wpforms-1886-field_15-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1886-field_15-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][15][last]\" aria-errormessage=\"wpforms-1886-field_15-last-error\" aria-describedby=\"wpforms-1886-field_15-description\" required><label for=\"wpforms-1886-field_15-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-1886-field_15-description\" class=\"wpforms-field-description\">(Please enter your name as it appears on your social security card.)<\/div><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_38-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"38\"><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-1886-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_17\">Suffix:<\/label><input type=\"text\" id=\"wpforms-1886-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-1886-field_17-error\" aria-describedby=\"wpforms-1886-field_17-description\" ><div id=\"wpforms-1886-field_17-description\" class=\"wpforms-field-description\">(Jr., Sr., if applicable) <\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_18\">Previous last name(s) if applicable:<\/label><input type=\"text\" id=\"wpforms-1886-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1886-field_18-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_43-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_43\">Birthdate: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1886-field_43\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][43][date]\" aria-errormessage=\"wpforms-1886-field_43-error\" required><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 class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_19\">Social Security Number: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_19\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"999999999\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-1886-field_19-error\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_20-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">How do you Identify?<\/legend><ul id=\"wpforms-1886-field_20\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_20_1\" name=\"wpforms[fields][20]\" value=\"Male\" aria-errormessage=\"wpforms-1886-field_20_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_20_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_20_2\" name=\"wpforms[fields][20]\" value=\"Female\" aria-errormessage=\"wpforms-1886-field_20_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_20_2\">Female<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_20_3\" name=\"wpforms[fields][20]\" value=\"Non-binary\" aria-errormessage=\"wpforms-1886-field_20_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_20_3\">Non-binary<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_20_4\" name=\"wpforms[fields][20]\" value=\"Prefer not to say\" aria-errormessage=\"wpforms-1886-field_20_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_20_4\">Prefer not to say<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1886-field_21-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Permanent Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1886-field_21\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][21][address1]\" placeholder=\"Street Address\" aria-errormessage=\"wpforms-1886-field_21-error\" required><label for=\"wpforms-1886-field_21\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1886-field_21-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][21][city]\" placeholder=\"City\/Town\/Village\" aria-errormessage=\"wpforms-1886-field_21-city-error\" required><label for=\"wpforms-1886-field_21-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-1886-field_21-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][21][state]\" placeholder=\"District\" aria-errormessage=\"wpforms-1886-field_21-state-error\" required><label for=\"wpforms-1886-field_21-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1886-field_24-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"24\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1886-field_22-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_22\">Permanent Email: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1886-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1886-field_22-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1886-field_23-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_23\">Cell #: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1886-field_23\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][23]\" aria-label=\"Cell #:\" aria-errormessage=\"wpforms-1886-field_23-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_25-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"25\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tCURRENT PLACE OF EMPLOYMENT\n\t\t\t<\/h3><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-1886-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_26\">Organization\/Ministry:  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-1886-field_26-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_27-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_27\">Work#: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1886-field_27\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][27]\" aria-label=\"Work#:\" aria-errormessage=\"wpforms-1886-field_27-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-inline-labels\" data-field-type=\"text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_28\">Department:  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-1886-field_28-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_29\">Position:  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" aria-errormessage=\"wpforms-1886-field_29-error\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_31-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"31\"><fieldset><legend class=\"wpforms-field-label\">Do you have any learning disabilities? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1886-field_31\" class=\"wpforms-field-required\"><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1886-field_31_3\" name=\"wpforms[fields][31]\" value=\"No\" aria-errormessage=\"wpforms-1886-field_31_3-error\" aria-describedby=\"wpforms-1886-field_31-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_31_3\">No<\/label><\/li><li class=\"choice-4 depth-1 wpforms-other-choice\"><input type=\"radio\" id=\"wpforms-1886-field_31_4\" data-other-choice=\"true\" name=\"wpforms[fields][31]\" value=\"Yes\" aria-errormessage=\"wpforms-1886-field_31_4-error\" aria-describedby=\"wpforms-1886-field_31-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_31_4\">Yes<\/label><\/li><\/ul><input type=\"text\" id=\"wpforms-1886-field_31_other\" class=\"wpforms-other-input wpforms-field-required wpforms-field-large wpforms-hidden\" name=\"wpforms[fields][31][other]\" disabled=\"disabled\" required><div id=\"wpforms-1886-field_31-description\" class=\"wpforms-field-description\">If yes, kindly share.<\/div><\/fieldset><\/div><div id=\"wpforms-1886-field_32-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"32\"><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-1886-field_33-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_33\">Emergency Contact Name: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_33\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][33]\" aria-errormessage=\"wpforms-1886-field_33-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_34\">Relation: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1886-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-1886-field_34-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_35-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_35\">Emergency Contact Email: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1886-field_35\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][35]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1886-field_35-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_41-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_41\">Emergency Contact Cell #: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1886-field_41\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][41]\" aria-label=\"Emergency Contact Cell #:\" aria-errormessage=\"wpforms-1886-field_41-error\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1886-field_37-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-1886-field_37\">Copy of social security card <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader wpforms-field-required\"\n\t\tdata-field-id=\"37\"\n\t\tdata-form-id=\"1886\"\n\t\tdata-input-name=\"wpforms_1886_37\"\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>, 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-1886-37\" class=\"wpforms-camera-modal-overlay wpforms-camera-format-photo\"  style=\"display: none;\" data-field-id=\"37\"  data-form-id=\"1886\">\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-1886-37\" 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-1886-37\" 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-1886-field_37\"\n\t\tname=\"wpforms_1886_37\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-1886-field_46-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"46\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tApplication package checklist\n\t\t\t<\/h3><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-1886-field_42-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Application package checklist <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1886-field_42\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1886-field_42_1\" name=\"wpforms[fields][42][]\" value=\"Completed application form\" aria-errormessage=\"wpforms-1886-field_42_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1886-field_42_1\">Completed application form<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1886-field_45-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Application package checklist (copy) <span class=\"wpforms-required-label\" 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src=\"https:\/\/app.galen.edu.bz\/admissions\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container 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