{"id":508,"date":"2025-10-30T10:09:28","date_gmt":"2025-10-30T16:09:28","guid":{"rendered":"https:\/\/app.galen.edu.bz\/admissions\/?page_id=508"},"modified":"2026-02-12T08:31:12","modified_gmt":"2026-02-12T14:31:12","slug":"undergraduate-application","status":"publish","type":"page","link":"https:\/\/app.galen.edu.bz\/admissions\/undergraduate-application\/","title":{"rendered":"Undergraduate Application"},"content":{"rendered":"<style id=\"wpforms-css-vars-506\">\n\t\t\t\t#wpforms-506 {\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: 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-render-modern\" id=\"wpforms-506\"><form id=\"wpforms-form-506\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"506\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/admissions\/wp-json\/wp\/v2\/pages\/508?wpforms_form_id=506\" data-token=\"1179e9a95da9eb5fac76e36f48f7841f\" data-token-time=\"1793556824\"><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 connector\" data-indicator=\"connector\" data-indicator-color=\"#771214\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"4\" tabindex=\"-1\"><div class=\"wpforms-page-indicator-page active wpforms-page-indicator-page-1\" style=\"min-width:25%;\" data-page=\"1\"><span class=\"wpforms-page-indicator-page-number\" style=\"background-color:#771214\" data-page=\"1\">1<span class=\"wpforms-page-indicator-page-triangle\" style=\"border-top-color:#771214\"><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Requirements<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-2\" style=\"min-width:25%;\" data-page=\"2\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"2\">2<span class=\"wpforms-page-indicator-page-triangle\" ><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Details<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-3\" style=\"min-width:25%;\" data-page=\"3\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"3\">3<span class=\"wpforms-page-indicator-page-triangle\" ><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Demographic<\/span><\/div><div class=\"wpforms-page-indicator-page  wpforms-page-indicator-page-4\" style=\"min-width:25%;\" data-page=\"4\"><span class=\"wpforms-page-indicator-page-number\"  data-page=\"4\">4<span class=\"wpforms-page-indicator-page-triangle\" ><\/span><\/span><span class=\"wpforms-page-indicator-page-title\">Academic<\/span><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-506-field_96-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"96\"><\/div><div id=\"wpforms-506-field_123-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"123\"><div id=\"wpforms-506-field_123\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-506-field_123-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<h3>ADMISSION REQUIREMENTS<\/h3>\n<p>A completed application includes the following:<\/p>\n<ul>\n<li>A cumulative GPA of at least 2.50 on a 0.00 - 4.00 Grade Point Scale<\/li>\n<li>An official transcript from your feeder institution<\/li>\n<li>A completed application form<\/li>\n<li>Names and contact information for three (3) referees<\/li>\n<li>One (1) resume from applicants who hold an Associate Degree, if returning after more than 10 years of stopping out of school<\/li>\n<\/ul>\n<p>Candidates who fall short of these requirements may appeal to the admissions office via admissions@galen.edu.bz for consideration.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-506-field_70-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"70\"><h3 id=\"wpforms-506-field_70\" aria-errormessage=\"wpforms-506-field_70-error\">REFERENCES<\/h3><\/div><div id=\"wpforms-506-field_63-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"63\"><div id=\"wpforms-506-field_63-description\" class=\"wpforms-field-description\">*The contact information for three (3) references must be provided*<\/div><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-506-field_67-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"67\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_67\">Principal Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_67\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][67]\" placeholder=\"Name\" aria-errormessage=\"wpforms-506-field_67-error\" required><\/div><div id=\"wpforms-506-field_165-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"165\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-506-field_165\" aria-hidden=\"false\">Principal Position <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_165\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][165]\" placeholder=\"Position\" aria-errormessage=\"wpforms-506-field_165-error\" required><\/div><div id=\"wpforms-506-field_129-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"129\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-506-field_129\" aria-hidden=\"false\">Principal Contact <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_129\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][129]\" placeholder=\"Contact\" aria-errormessage=\"wpforms-506-field_129-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-506-field_68-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_68\">Teacher Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_68\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][68]\" placeholder=\"Name\" aria-errormessage=\"wpforms-506-field_68-error\" required><\/div><div id=\"wpforms-506-field_166-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"166\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-506-field_166\" aria-hidden=\"false\">Teacher Position <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_166\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][166]\" placeholder=\"Position\" aria-errormessage=\"wpforms-506-field_166-error\" required><\/div><div id=\"wpforms-506-field_130-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"130\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-506-field_130\" aria-hidden=\"false\">Teacher Contact <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_130\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][130]\" placeholder=\"Contact\" aria-errormessage=\"wpforms-506-field_130-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-506-field_69-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_69\">Community Leader Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_69\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][69]\" placeholder=\"Name\" aria-errormessage=\"wpforms-506-field_69-error\" required><\/div><div id=\"wpforms-506-field_167-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"167\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-506-field_167\" aria-hidden=\"false\">Community Leader Position <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_167\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][167]\" placeholder=\"Position\" aria-errormessage=\"wpforms-506-field_167-error\" required><\/div><div id=\"wpforms-506-field_131-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"131\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-506-field_131\" aria-hidden=\"false\">Community Leader Contact <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_131\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][131]\" placeholder=\"Contact\" aria-errormessage=\"wpforms-506-field_131-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_125-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"125\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"506\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/app.galen.edu.bz\/admissions\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-506-field_124-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"124\"><h3 id=\"wpforms-506-field_124\" aria-errormessage=\"wpforms-506-field_124-error\">DETAILS OF APPLICATION<\/h3><\/div><div id=\"wpforms-506-field_73-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"73\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-506-field_74-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"74\"><fieldset><legend class=\"wpforms-field-label\">Semester of intended entry (check one): <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-506-field_74\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_74_1\" name=\"wpforms[fields][74]\" value=\"September\" aria-errormessage=\"wpforms-506-field_74_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_74_1\">September<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_74_2\" name=\"wpforms[fields][74]\" value=\"January\" aria-errormessage=\"wpforms-506-field_74_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_74_2\">January<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-506-field_76-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"76\"><fieldset><legend class=\"wpforms-field-label\">Are you applying to be a full-time or part-time student?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-506-field_76\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_76_1\" name=\"wpforms[fields][76]\" value=\"Full-Time\" aria-errormessage=\"wpforms-506-field_76_1-error\" aria-describedby=\"wpforms-506-field_76-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_76_1\">Full-Time<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_76_2\" name=\"wpforms[fields][76]\" value=\"Part-Time\" aria-errormessage=\"wpforms-506-field_76_2-error\" aria-describedby=\"wpforms-506-field_76-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_76_2\">Part-Time<\/label><\/li><\/ul><div id=\"wpforms-506-field_76-description\" class=\"wpforms-field-description\">Part-Time (9 credits or 3 classes)<\/div><\/fieldset><\/div><div id=\"wpforms-506-field_82-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"82\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_82\">Degree <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-506-field_82\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][82]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Select Choice ---<\/option><option value=\"Associates\"  class=\"choice-1 depth-1\"  >Associates<\/option><option value=\"Certificate\"  class=\"choice-4 depth-1\"  >Certificate<\/option><option value=\"Diploma\"  class=\"choice-5 depth-1\"  >Diploma<\/option><option value=\"Bachelor\"  class=\"choice-6 depth-1\"  >Bachelor<\/option><option value=\"Other\"  class=\"choice-7 depth-1\"  >Other<\/option><\/select><\/div><div id=\"wpforms-506-field_83-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"83\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_83\">Academic Program<\/label><select id=\"wpforms-506-field_83\" class=\"wpforms-field-medium\" name=\"wpforms[fields][83]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Select Associates -<\/option><option value=\"Veterinary Technician\"  class=\"choice-3 depth-1\"  >Veterinary Technician<\/option><option value=\"Associates in Computer Science\"  class=\"choice-4 depth-1\"  >Associates in Computer Science<\/option><\/select><\/div><div id=\"wpforms-506-field_79-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"79\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_79\">Academic Program<\/label><select id=\"wpforms-506-field_79\" class=\"wpforms-field-medium\" name=\"wpforms[fields][79]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Select Bachelors -<\/option><option value=\"Accounting\"  class=\"choice-8 depth-1\"  >Accounting<\/option><option value=\"Accounting (Online)\"  class=\"choice-9 depth-1\"  >Accounting (Online)<\/option><option value=\"Anthropology\"  class=\"choice-4 depth-1\"  >Anthropology<\/option><option value=\"Business Administration\"  class=\"choice-10 depth-1\"  >Business Administration<\/option><option value=\"Business Administration (Online)\"  class=\"choice-11 depth-1\"  >Business Administration (Online)<\/option><option value=\"Computer Science\"  class=\"choice-6 depth-1\"  >Computer Science<\/option><option value=\"Criminal Justice (Online)\"  class=\"choice-3 depth-1\"  >Criminal Justice (Online)<\/option><option value=\"Cyber Security\"  class=\"choice-7 depth-1\"  >Cyber Security<\/option><option value=\"Economics (Online)\"  class=\"choice-12 depth-1\"  >Economics (Online)<\/option><option value=\"Elementary Education\"  class=\"choice-18 depth-1\"  >Elementary Education<\/option><option value=\"Environmental Science\"  class=\"choice-5 depth-1\"  >Environmental Science<\/option><option value=\"Hospitality and Tourism\"  class=\"choice-14 depth-1\"  >Hospitality and Tourism<\/option><option value=\"International Business\"  class=\"choice-17 depth-1\"  >International Business<\/option><option value=\"Marketing (Online)\"  class=\"choice-15 depth-1\"  >Marketing (Online)<\/option><option value=\"Secondary Education\"  class=\"choice-16 depth-1\"  >Secondary Education<\/option><\/select><\/div><div id=\"wpforms-506-field_84-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"84\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_84\">Academic Program<\/label><select id=\"wpforms-506-field_84\" class=\"wpforms-field-medium\" name=\"wpforms[fields][84]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Select Certificate -<\/option><option value=\"Certificate in Accounting\"  class=\"choice-3 depth-1\"  >Certificate in Accounting<\/option><option value=\"Certificate in Educational Leadership\"  class=\"choice-4 depth-1\"  >Certificate in Educational Leadership<\/option><\/select><\/div><div id=\"wpforms-506-field_85-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"85\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_85\">Academic Program<\/label><select id=\"wpforms-506-field_85\" class=\"wpforms-field-medium\" name=\"wpforms[fields][85]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Select Diplomas -<\/option><option value=\"Diploma in Pedagogy\"  class=\"choice-3 depth-1\"  >Diploma in Pedagogy<\/option><option value=\"Diploma in English Education\"  class=\"choice-4 depth-1\"  >Diploma in English Education<\/option><option value=\"Diploma in Math Education\"  class=\"choice-8 depth-1\"  >Diploma in Math Education<\/option><option value=\"Diploma in Physics Education\"  class=\"choice-9 depth-1\"  >Diploma in Physics Education<\/option><option value=\"Diploma in Business Education\"  class=\"choice-10 depth-1\"  >Diploma in Business Education<\/option><option value=\"Diploma in Computer Science Education\"  class=\"choice-11 depth-1\"  >Diploma in Computer Science Education<\/option><option value=\"Diploma in Belizean Studies Education\"  class=\"choice-12 depth-1\"  >Diploma in Belizean Studies Education<\/option><\/select><\/div><div id=\"wpforms-506-field_151-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"151\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_151\">Other<\/label><select id=\"wpforms-506-field_151\" class=\"wpforms-field-medium\" name=\"wpforms[fields][151]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Select Other -<\/option><option value=\"Auditing Student\"  class=\"choice-1 depth-1\"  >Auditing Student<\/option><option value=\"Cont Anthropology\"  class=\"choice-2 depth-1\"  >Cont Anthropology<\/option><option value=\"Visiting Student\"  class=\"choice-3 depth-1\"  >Visiting Student<\/option><option value=\"Transient Student\"  class=\"choice-4 depth-1\"  >Transient Student<\/option><option value=\"Undeclared Major\"  class=\"choice-5 depth-1\"  >Undeclared Major<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-506-field_75-container\" class=\"wpforms-field wpforms-field-text year-select\" data-field-type=\"text\" data-field-id=\"75\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_75\">Year <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_75\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][75]\" value=\"2026\" aria-errormessage=\"wpforms-506-field_75-error\" required><\/div><div id=\"wpforms-506-field_78-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"78\"><fieldset><legend class=\"wpforms-field-label\">Please choose where\/how you will be studying: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-506-field_78\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_78_1\" name=\"wpforms[fields][78]\" value=\"Fully Online\" aria-errormessage=\"wpforms-506-field_78_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_78_1\">Fully Online<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_78_2\" name=\"wpforms[fields][78]\" value=\"Central Farm Campus\" aria-errormessage=\"wpforms-506-field_78_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_78_2\">Central Farm Campus<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_78_3\" name=\"wpforms[fields][78]\" value=\"Hybrid\" aria-errormessage=\"wpforms-506-field_78_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_78_3\">Hybrid<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-506-field_157-container\" class=\"wpforms-field wpforms-field-text wpforms-field-readonly\" data-field-type=\"text\" data-field-id=\"157\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_157\">Code<\/label><input type=\"text\" id=\"wpforms-506-field_157\" class=\"wpforms-field-medium\" name=\"wpforms[fields][157]\" aria-errormessage=\"wpforms-506-field_157-error\" ><\/div><div id=\"wpforms-506-field_81-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-field-readonly\" data-field-type=\"text\" data-field-id=\"81\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_81\">Faculty<\/label><input type=\"text\" id=\"wpforms-506-field_81\" class=\"wpforms-field-medium\" name=\"wpforms[fields][81]\" value=\"Faculty of Arts, Science &amp; Technology (FAST)\" aria-errormessage=\"wpforms-506-field_81-error\" ><\/div><div id=\"wpforms-506-field_86-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-field-readonly\" data-field-type=\"text\" data-field-id=\"86\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_86\">Faculty<\/label><input type=\"text\" id=\"wpforms-506-field_86\" class=\"wpforms-field-medium\" name=\"wpforms[fields][86]\" value=\"Faculty of Business and Entrepreneurship (FBE)\" aria-errormessage=\"wpforms-506-field_86-error\" ><\/div><div id=\"wpforms-506-field_87-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show wpforms-field-readonly\" data-field-type=\"text\" data-field-id=\"87\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_87\">Faculty<\/label><input type=\"text\" id=\"wpforms-506-field_87\" class=\"wpforms-field-medium\" name=\"wpforms[fields][87]\" value=\"Faculty of Education (FE)\" aria-errormessage=\"wpforms-506-field_87-error\" ><\/div><div id=\"wpforms-506-field_88-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=\"88\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_88\">Concentration<\/label><select id=\"wpforms-506-field_88\" class=\"wpforms-field-medium\" name=\"wpforms[fields][88]\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>- Select Concentration -<\/option><option value=\"English Education\"  class=\"choice-1 depth-1\"  >English Education<\/option><option value=\"Math Education\"  class=\"choice-2 depth-1\"  >Math Education<\/option><option value=\"Physics Education\"  class=\"choice-3 depth-1\"  >Physics Education<\/option><option value=\"Business Education\"  class=\"choice-4 depth-1\"  >Business Education<\/option><option value=\"Computer Science Education\"  class=\"choice-5 depth-1\"  >Computer Science Education<\/option><option value=\"Belizean Studies Education\"  class=\"choice-6 depth-1\"  >Belizean Studies Education<\/option><\/select><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_89-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"89\"><fieldset><legend class=\"wpforms-field-label\">Have you previously applied to or attended Galen University?<\/legend><ul id=\"wpforms-506-field_89\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_89_1\" name=\"wpforms[fields][89]\" value=\"Yes\" aria-errormessage=\"wpforms-506-field_89_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_89_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_89_2\" name=\"wpforms[fields][89]\" value=\"No\" aria-errormessage=\"wpforms-506-field_89_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_89_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-506-field_90-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"90\" 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-506-field_92-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"92\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_92\">Year applied:<\/label><input type=\"text\" id=\"wpforms-506-field_92\" class=\"wpforms-field-medium wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"2099\" name=\"wpforms[fields][92]\" aria-errormessage=\"wpforms-506-field_92-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-506-field_93-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"93\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_93\">Last semester\/year enrolled:<\/label><input type=\"text\" id=\"wpforms-506-field_93\" class=\"wpforms-field-medium\" name=\"wpforms[fields][93]\" aria-errormessage=\"wpforms-506-field_93-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-506-field_94-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"94\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_94\">Student ID#:<\/label><input type=\"text\" id=\"wpforms-506-field_94\" class=\"wpforms-field-medium\" name=\"wpforms[fields][94]\" aria-errormessage=\"wpforms-506-field_94-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_95-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"95\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"506\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"506\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/app.galen.edu.bz\/admissions\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\">\t\t<div id=\"wpforms-506-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-506-field_2\" >of to Date<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-506-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-506-field_71-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"71\"><h3 id=\"wpforms-506-field_71\" aria-errormessage=\"wpforms-506-field_71-error\">DEMOGRAPHIC INFORMATION<\/h3><\/div><div id=\"wpforms-506-field_173-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"173\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_173\">Passport Photo <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader wpforms-field-required\"\n\t\tdata-field-id=\"173\"\n\t\tdata-form-id=\"506\"\n\t\tdata-input-name=\"wpforms_506_173\"\n\t\tdata-extensions=\"jpg,jpeg,png\"\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-506-173\" class=\"wpforms-camera-modal-overlay wpforms-camera-format-photo\"  style=\"display: none;\" data-field-id=\"173\"  data-form-id=\"506\">\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-506-173\" 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-506-173\" 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-506-field_173\"\n\t\tname=\"wpforms_506_173\" required\t\tvalue=\"\">\n<div id=\"wpforms-506-field_173-description\" class=\"wpforms-field-description\">Upload your recent passport-sized photograph.<\/div><\/div><div id=\"wpforms-506-field_99-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"99\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-506-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-506-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-506-field_0-error\" required><label for=\"wpforms-506-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-506-field_0-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][0][middle]\" aria-errormessage=\"wpforms-506-field_0-middle-error\" ><label for=\"wpforms-506-field_0-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-506-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-506-field_0-last-error\" required><label for=\"wpforms-506-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-506-field_98-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"98\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_98\">Suffix:<\/label><input type=\"text\" id=\"wpforms-506-field_98\" class=\"wpforms-field-medium\" name=\"wpforms[fields][98]\" aria-errormessage=\"wpforms-506-field_98-error\" aria-describedby=\"wpforms-506-field_98-description\" ><div id=\"wpforms-506-field_98-description\" class=\"wpforms-field-description\">(Jr., Sr., if applicable)<\/div><\/div><div id=\"wpforms-506-field_100-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"100\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_100\">Previous last name(s) if applicable:<\/label><input type=\"text\" id=\"wpforms-506-field_100\" class=\"wpforms-field-medium\" name=\"wpforms[fields][100]\" aria-errormessage=\"wpforms-506-field_100-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_10-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"10\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-506-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-506-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-506-field_1-error\" required><\/div><div id=\"wpforms-506-field_102-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"102\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_102\">Social Security Number:<\/label><input type=\"text\" id=\"wpforms-506-field_102\" class=\"wpforms-field-medium\" name=\"wpforms[fields][102]\" aria-errormessage=\"wpforms-506-field_102-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-506-field_9-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_9\">Home #<\/label><input type=\"tel\" id=\"wpforms-506-field_9\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][9]\" aria-label=\"Home #\" aria-errormessage=\"wpforms-506-field_9-error\" ><\/div><div id=\"wpforms-506-field_108-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_108\">Cell #: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-506-field_108\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][108]\" aria-label=\"Cell #:\" aria-errormessage=\"wpforms-506-field_108-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_11-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"11\"><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-506-field_8-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_8\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-506-field_8\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][8][date]\" aria-errormessage=\"wpforms-506-field_8-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-506-field_136-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"136\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_136\">Place of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_136\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][136]\" aria-errormessage=\"wpforms-506-field_136-error\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_44\">Nationality <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_44\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-506-field_44-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_3-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_3\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-506-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Select One<\/option><option value=\"Male\"  class=\"choice-1 depth-1\"  >Male<\/option><option value=\"Female\"  class=\"choice-2 depth-1\"  >Female<\/option><option value=\"Non-binary\"  class=\"choice-3 depth-1\"  >Non-binary<\/option><option value=\"Prefer not to say\"  class=\"choice-4 depth-1\"  >Prefer not to say<\/option><\/select><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_7-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Mailing Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-506-field_7\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][7][address1]\" placeholder=\"Street Address\" aria-errormessage=\"wpforms-506-field_7-error\" required><label for=\"wpforms-506-field_7\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-506-field_7-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][7][city]\" placeholder=\"City\/Town\/Village\" aria-errormessage=\"wpforms-506-field_7-city-error\" required><label for=\"wpforms-506-field_7-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-506-field_7-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][7][state]\" placeholder=\"District\" aria-errormessage=\"wpforms-506-field_7-state-error\" required><label for=\"wpforms-506-field_7-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-506-field_7-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][7][country]\" value=\"BZ\" aria-errormessage=\"wpforms-506-field_7-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-506-field_7-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-506-field_107-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"107\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Permanent Address<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-506-field_107\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][107][address1]\" placeholder=\"Street Address\" aria-errormessage=\"wpforms-506-field_107-error\" aria-describedby=\"wpforms-506-field_107-description\" ><label for=\"wpforms-506-field_107\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-506-field_107-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][107][city]\" placeholder=\"City\/Town\/Village\" aria-errormessage=\"wpforms-506-field_107-city-error\" aria-describedby=\"wpforms-506-field_107-description\" ><label for=\"wpforms-506-field_107-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-506-field_107-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][107][state]\" placeholder=\"District\" aria-errormessage=\"wpforms-506-field_107-state-error\" aria-describedby=\"wpforms-506-field_107-description\" ><label for=\"wpforms-506-field_107-state\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-506-field_107-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][107][country]\" value=\"BZ\" aria-errormessage=\"wpforms-506-field_107-country-error\" aria-describedby=\"wpforms-506-field_107-description\" ><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-506-field_107-country\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Country<\/label><\/div><\/div><div id=\"wpforms-506-field_107-description\" class=\"wpforms-field-description\">(If different from mailing address, please give your current permanent address for all admission correspondence.)<\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_135-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"135\"><fieldset><legend class=\"wpforms-field-label\">Mailing Address is the same as the Permanent Address. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-506-field_135\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_135_1\" name=\"wpforms[fields][135]\" value=\"Yes\" aria-errormessage=\"wpforms-506-field_135_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_135_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_135_2\" name=\"wpforms[fields][135]\" value=\"No\" aria-errormessage=\"wpforms-506-field_135_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_135_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_114-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"114\"><fieldset><legend class=\"wpforms-field-label\">Do you identify as Indigenous? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-506-field_114\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_114_1\" name=\"wpforms[fields][114]\" value=\"Yes\" aria-errormessage=\"wpforms-506-field_114_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_114_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_114_2\" name=\"wpforms[fields][114]\" value=\"No\" aria-errormessage=\"wpforms-506-field_114_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_114_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_115-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"115\"><fieldset><legend class=\"wpforms-field-label\">Are you currently employed?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-506-field_115\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_115_1\" name=\"wpforms[fields][115]\" value=\"Full-Time\" aria-errormessage=\"wpforms-506-field_115_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_115_1\">Full-Time<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_115_2\" name=\"wpforms[fields][115]\" value=\"Part-time\" aria-errormessage=\"wpforms-506-field_115_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_115_2\">Part-time<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_115_3\" name=\"wpforms[fields][115]\" value=\"Unemployed\" aria-errormessage=\"wpforms-506-field_115_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_115_3\">Unemployed<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_111-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"111\"><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-506-field_110-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_110\">Learning Disabilities<\/label><textarea id=\"wpforms-506-field_110\" class=\"wpforms-field-medium\" name=\"wpforms[fields][110]\" aria-errormessage=\"wpforms-506-field_110-error\" aria-describedby=\"wpforms-506-field_110-description\" ><\/textarea><div id=\"wpforms-506-field_110-description\" class=\"wpforms-field-description\">Do you have any learning disabilities? If yes, kindly share.<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_112-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_112\">Medical Conditions<\/label><textarea id=\"wpforms-506-field_112\" class=\"wpforms-field-medium\" name=\"wpforms[fields][112]\" aria-errormessage=\"wpforms-506-field_112-error\" aria-describedby=\"wpforms-506-field_112-description\" ><\/textarea><div id=\"wpforms-506-field_112-description\" class=\"wpforms-field-description\">Do you have any medical conditions that may create an emergency on campus or on a University trip (e.g. allergies, diseases, etc.)? If yes, kindly share.<\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_116-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"116\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_116\">Emergency Contact Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_116\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][116]\" aria-errormessage=\"wpforms-506-field_116-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_117-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"117\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_117\">Emergency Contact Relation to you:<\/label><input type=\"text\" id=\"wpforms-506-field_117\" class=\"wpforms-field-medium\" name=\"wpforms[fields][117]\" aria-errormessage=\"wpforms-506-field_117-error\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_119-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"119\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_119\">Emergency Contact Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-506-field_119\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][119]\" spellcheck=\"false\" aria-errormessage=\"wpforms-506-field_119-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_120-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"120\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_120\">Emergency Contact Cell#: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-506-field_120\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][120]\" aria-label=\"Emergency Contact Cell#:\" aria-errormessage=\"wpforms-506-field_120-error\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_152-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"152\"><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-506-field_153-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"153\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_153\">Sources<\/label><select id=\"wpforms-506-field_153\" class=\"wpforms-field-medium\" name=\"wpforms[fields][153][]\" multiple=\"multiple\"><option value=\"Expo\/Pop up booth\"  class=\"choice-4 depth-1\"  >Expo\/Pop up booth<\/option><option value=\"Friends\/Family\"  class=\"choice-5 depth-1\"  >Friends\/Family<\/option><option value=\"Galen University student\"  class=\"choice-6 depth-1\"  >Galen University student<\/option><option value=\"Alumni\"  class=\"choice-7 depth-1\"  >Alumni<\/option><option value=\"Website\"  class=\"choice-8 depth-1\"  >Website<\/option><option value=\"Education\/College Fair\"  class=\"choice-9 depth-1\"  >Education\/College Fair<\/option><option value=\"The Galen Hour\"  class=\"choice-10 depth-1\"  >The Galen Hour<\/option><option value=\"Social Media (Facebook\/Instagram)\"  class=\"choice-11 depth-1\"  >Social Media (Facebook\/Instagram)<\/option><option value=\"Radio Ad\"  class=\"choice-12 depth-1\"  >Radio Ad<\/option><option value=\"TV Ad\"  class=\"choice-13 depth-1\"  >TV Ad<\/option><option value=\"Billboard\"  class=\"choice-14 depth-1\"  >Billboard<\/option><option value=\"Eagle Day\"  class=\"choice-15 depth-1\"  >Eagle Day<\/option><\/select><div id=\"wpforms-506-field_153-description\" class=\"wpforms-field-description\">Please indicate the source(s) that led you to apply to Galen University.<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_155-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"155\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_155\">Reasons<\/label><select id=\"wpforms-506-field_155\" class=\"wpforms-field-medium\" name=\"wpforms[fields][155][]\" multiple=\"multiple\"><option value=\"Academic Quality\"  class=\"choice-16 depth-1\"  >Academic Quality<\/option><option value=\"University Reputation\"  class=\"choice-17 depth-1\"  >University Reputation<\/option><option value=\"Qualifications to be attained\"  class=\"choice-18 depth-1\"  >Qualifications to be attained<\/option><option value=\"Career Earning Potential\"  class=\"choice-19 depth-1\"  >Career Earning Potential<\/option><option value=\"Accessible Financial Options\"  class=\"choice-20 depth-1\"  >Accessible Financial Options<\/option><option value=\"Student Centered Support\"  class=\"choice-21 depth-1\"  >Student Centered Support<\/option><option value=\"Convenience of Online Learning Modality\"  class=\"choice-22 depth-1\"  >Convenience of Online Learning Modality<\/option><\/select><div id=\"wpforms-506-field_155-description\" class=\"wpforms-field-description\">Please indicate the reason(s) that led you to apply to Galen University.\n<\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_121-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"121\"><div class=\"wpforms-clear wpforms-pagebreak-split\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"506\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"506\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/app.galen.edu.bz\/admissions\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4 last \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-506-field_138-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"138\"><h3 id=\"wpforms-506-field_138\" aria-errormessage=\"wpforms-506-field_138-error\" aria-describedby=\"wpforms-506-field_138-description\">ACADEMIC INFORMATION<\/h3><div id=\"wpforms-506-field_138-description\" class=\"wpforms-field-description\">Enter information of secondary and tertiary school (if applicable) completed.<\/div><\/div><div id=\"wpforms-506-field_158-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"158\"><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-506-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_18\">Secondary School Completed: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-506-field_18-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_146-container\" class=\"wpforms-field wpforms-field-text year-select\" data-field-type=\"text\" data-field-id=\"146\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_146\">Year Graduated <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_146\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"2099\" data-form-id=\"506\" data-field-id=\"146\" data-text-limit=\"4\" name=\"wpforms[fields][146]\" aria-errormessage=\"wpforms-506-field_146-error\" maxlength=\"4\" required><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_162-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"162\"><fieldset><legend class=\"wpforms-field-label\">Tertiary School Completed? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-506-field_162\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_162_1\" name=\"wpforms[fields][162]\" value=\"Yes\" aria-errormessage=\"wpforms-506-field_162_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_162_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-506-field_162_2\" name=\"wpforms[fields][162]\" value=\"No\" aria-errormessage=\"wpforms-506-field_162_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-506-field_162_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-506-field_159-container\" class=\"wpforms-field wpforms-field-layout wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"layout\" data-field-id=\"159\" 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-506-field_160-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"160\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_160\">Tertiary School Completed (if applicable): <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_160\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][160]\" aria-errormessage=\"wpforms-506-field_160-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_161-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"161\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_161\">Year Graduated <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_161\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input wpforms-limit-characters-enabled\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"2099\" data-form-id=\"506\" data-field-id=\"161\" data-text-limit=\"4\" name=\"wpforms[fields][161]\" aria-errormessage=\"wpforms-506-field_161-error\" maxlength=\"4\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_139-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"139\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_139\">Degree<\/label><input type=\"text\" id=\"wpforms-506-field_139\" class=\"wpforms-field-medium\" name=\"wpforms[fields][139]\" aria-errormessage=\"wpforms-506-field_139-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-506-field_163-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"163\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_163\">Major<\/label><input type=\"text\" id=\"wpforms-506-field_163\" class=\"wpforms-field-medium\" name=\"wpforms[fields][163]\" aria-errormessage=\"wpforms-506-field_163-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-506-field_137-container\" class=\"wpforms-field wpforms-field-repeater wpforms-field-repeater-display-rows\" data-rows-min=\"1\" data-rows-max=\"3\" data-clone-num=\"2\" data-field-type=\"repeater\" data-field-id=\"137\"><\/div><div id=\"wpforms-506-field_174-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"174\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_174\">Proof of Payment <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader wpforms-field-required\"\n\t\tdata-field-id=\"174\"\n\t\tdata-form-id=\"506\"\n\t\tdata-input-name=\"wpforms_506_174\"\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-506-174\" class=\"wpforms-camera-modal-overlay wpforms-camera-format-photo\"  style=\"display: none;\" data-field-id=\"174\"  data-form-id=\"506\">\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-506-174\" 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-506-174\" 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-506-field_174\"\n\t\tname=\"wpforms_506_174\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-506-field_175-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"175\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_175\">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=\"175\"\n\t\tdata-form-id=\"506\"\n\t\tdata-input-name=\"wpforms_506_175\"\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-506-175\" class=\"wpforms-camera-modal-overlay wpforms-camera-format-photo\"  style=\"display: none;\" data-field-id=\"175\"  data-form-id=\"506\">\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-506-175\" 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-506-175\" 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-506-field_175\"\n\t\tname=\"wpforms_506_175\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-506-field_57-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-type=\"file-upload\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_57\">Upload Supporting Documents (Max 10) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader wpforms-field-required\"\n\t\tdata-field-id=\"57\"\n\t\tdata-form-id=\"506\"\n\t\tdata-input-name=\"wpforms_506_57\"\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=\"10\"\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 10 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-506-field_57\"\n\t\tname=\"wpforms_506_57\" required\t\tvalue=\"\">\n<div id=\"wpforms-506-field_57-description\" class=\"wpforms-field-description\"><strong>High School Graduates:<\/strong><ol start=\"4\"><li>Official high school transcript <strong>must be emailed by feeder institution to admissions@galen.edu.bz<\/strong><\/li><li>Copy of high school diploma<\/li><li>Copy of any of the following test scores (if available) - ATLIB, CXC, ACT, SAT<\/li><\/ol><strong>Junior College Graduates &amp; University Transfer Students:<\/strong><ol start=\"4\"><li>Official junior college\/university transcript <strong>must be emailed by feeder institution to admissions@galen.edu.bz<\/strong><\/li><li>Copy of high school diploma and junior college diploma<\/li><\/ol>\n<strong>Diploma Programs:<\/strong><ol start=\"4\"><li>Official university transcript <strong>must be emailed by feeder institution to admissions@galen.edu.bz<\/strong><\/li><li>Copy of bachelor's degree<\/li><\/ol><\/div><\/div><div id=\"wpforms-506-field_140-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"140\"><h3 id=\"wpforms-506-field_140\" aria-errormessage=\"wpforms-506-field_140-error\" aria-describedby=\"wpforms-506-field_140-description\">CERTIFICATION<\/h3><div id=\"wpforms-506-field_140-description\" class=\"wpforms-field-description\">(Enter your name and sign to confirm the submission of your application.)<\/div><\/div><div id=\"wpforms-506-field_141-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"141\"><div id=\"wpforms-506-field_141\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-506-field_141-error\"><p>I, certify that the information in this aplicatin and its supporting documents are current, complete and accurate to the best of my knowledge. I understand that witholding information requested in the application or giving false information can make me ineligible for admission to Galen University.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-506-field_144-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"144\"><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-506-field_142-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"142\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_142\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_142\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][142]\" aria-errormessage=\"wpforms-506-field_142-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-506-field_145-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"145\"><label class=\"wpforms-field-label\" for=\"wpforms-506-field_145\">Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-506-field_145\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][145]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-506-field_145-error\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\" data-input-method=\"draw\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-506-field_145-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear 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