{"id":1441,"date":"2016-12-01T16:05:27","date_gmt":"2016-12-01T21:05:27","guid":{"rendered":"https:\/\/www.highpoint.edu\/pharmacy\/?page_id=1441"},"modified":"2016-12-01T16:06:34","modified_gmt":"2016-12-01T21:06:34","slug":"scform","status":"publish","type":"page","link":"https:\/\/www.highpoint.edu\/pharmacy\/scform\/","title":{"rendered":"Standardized Client Interest Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_8' >\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_8'  action='\/pharmacy\/wp-json\/wp\/v2\/pages\/1441' data-formid='8' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_8_21\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_21'>URL<\/label><div class='ginput_container'><input name='input_21' id='input_8_21' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_8_21'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_8_2\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_2'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_8_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_3'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_8_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_4\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_4'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_8_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is your sex?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_9'>\n\t\t\t<div class='gchoice gchoice_8_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Male'  id='choice_8_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_9_0' id='label_8_9_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Female'  id='choice_8_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_9_1' id='label_8_9_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Prefer not to answer'  id='choice_8_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_9_2' id='label_8_9_2' class='gform-field-label gform-field-label--type-inline'>Prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_5\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_5'>What is your e-mail address?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_8_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_6\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_6'>What is your home phone number?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_8_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_15\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_15'>What is your cell phone number?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_8_15' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you currently work for High Point University?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_7'>\n\t\t\t<div class='gchoice gchoice_8_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Yes'  id='choice_8_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_7_0' id='label_8_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No'  id='choice_8_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_7_1' id='label_8_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_8\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_8'>If yes, what is your job title and in what department?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_8_8' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_10\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_10'>Voluntary Information (not required) - Ethnicity<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_8_10' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_11\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_11'>Voluntary Information (not required) - Height<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_8_11' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_20\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_20'>Voluntary Information (not required) - Weight<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_8_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have previous experience as a Standardized Client?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_13'>\n\t\t\t<div class='gchoice gchoice_8_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Yes'  id='choice_8_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_13_0' id='label_8_13_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='No'  id='choice_8_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_8_13_1' id='label_8_13_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_12\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_12'>If you have previous experience as a Standardized Client where did you work?<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_8_12' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_14\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_14'>Would you like us to contact you about participating as a Standardized Client in the HPU School of Pharmacy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_8_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_8_17\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_8_17'>Which electronic devices do you use? (such as laptop, iPad, desktop, smartphone, DVR, GPS, etc.) - List all that apply.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_8_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_8_19\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Students begin their labs at 9am or 1pm. Each lab can last up to 3 hours. What times can you participate, beginning 30 minutes before the lab period begins? Please mark each time block you can participate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_19'><div class='gchoice gchoice_8_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Monday 8:30 - 12:00'  id='choice_8_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_1' id='label_8_19_1' class='gform-field-label gform-field-label--type-inline'>Monday 8:30 - 12:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.2' type='checkbox'  value='Monday 12:30 - 4:00'  id='choice_8_19_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_2' id='label_8_19_2' class='gform-field-label gform-field-label--type-inline'>Monday 12:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.3' type='checkbox'  value='Monday 8:30 - 4:00'  id='choice_8_19_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_3' id='label_8_19_3' class='gform-field-label gform-field-label--type-inline'>Monday 8:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.4' type='checkbox'  value='Tuesday 8:30 - 12:00'  id='choice_8_19_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_4' id='label_8_19_4' class='gform-field-label gform-field-label--type-inline'>Tuesday 8:30 - 12:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.5' type='checkbox'  value='Tuesday 12:30 - 4:00'  id='choice_8_19_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_5' id='label_8_19_5' class='gform-field-label gform-field-label--type-inline'>Tuesday 12:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.6' type='checkbox'  value='Tuesday 8:30 - 4:00'  id='choice_8_19_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_6' id='label_8_19_6' class='gform-field-label gform-field-label--type-inline'>Tuesday 8:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.7' type='checkbox'  value='Wednesday 8:30 - 12:00'  id='choice_8_19_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_7' id='label_8_19_7' class='gform-field-label gform-field-label--type-inline'>Wednesday 8:30 - 12:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.8' type='checkbox'  value='Wednesday 12:30 - 4:00'  id='choice_8_19_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_8' id='label_8_19_8' class='gform-field-label gform-field-label--type-inline'>Wednesday 12:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.9' type='checkbox'  value='Wednesday 8:30 - 4:00'  id='choice_8_19_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_9' id='label_8_19_9' class='gform-field-label gform-field-label--type-inline'>Wednesday 8:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.11' type='checkbox'  value='Thursday 8:30 - 12:00'  id='choice_8_19_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_11' id='label_8_19_11' class='gform-field-label gform-field-label--type-inline'>Thursday 8:30 - 12:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.12' type='checkbox'  value='Thursday 12:30 - 4:00'  id='choice_8_19_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_12' id='label_8_19_12' class='gform-field-label gform-field-label--type-inline'>Thursday 12:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.13' type='checkbox'  value='Thursday 8:30 - 4:00'  id='choice_8_19_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_13' id='label_8_19_13' class='gform-field-label gform-field-label--type-inline'>Thursday 8:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.14' type='checkbox'  value='Friday 8:30 - 12:00'  id='choice_8_19_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_14' id='label_8_19_14' class='gform-field-label gform-field-label--type-inline'>Friday 8:30 - 12:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.15' type='checkbox'  value='Friday 12:30 - 4:00'  id='choice_8_19_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_15' id='label_8_19_15' class='gform-field-label gform-field-label--type-inline'>Friday 12:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_8_19_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.16' type='checkbox'  value='Friday 8:30 - 4:00'  id='choice_8_19_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_8_19_16' id='label_8_19_16' class='gform-field-label gform-field-label--type-inline'>Friday 8:30 - 4:00<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_8_\" class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_8_'><\/label><div id='input_8_0' class='ginput_container ginput_recaptcha' 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