{"id":2413,"date":"2021-04-08T15:35:02","date_gmt":"2021-04-08T20:35:02","guid":{"rendered":"https:\/\/uwm.edu\/bms-labs\/?page_id=2413"},"modified":"2024-04-22T08:53:06","modified_gmt":"2024-04-22T13:53:06","slug":"student-mls-clinical-training-site-preference-form","status":"publish","type":"page","link":"https:\/\/uwm.edu\/bms-labs\/mls-clinical-rotations\/student-mls-clinical-training-site-preference-form\/","title":{"rendered":"MLS Clinical Training Site Preference Form"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-582\" src=\"https:\/\/uwm.edu\/bms-labs\/wp-content\/uploads\/sites\/361\/2013\/10\/BMS-Labs.jpg\" alt=\"BMS Labs\" width=\"252\" height=\"72\" srcset=\"https:\/\/uwm.edu\/bms-labs\/wp-content\/uploads\/sites\/361\/2013\/10\/BMS-Labs.jpg 589w, https:\/\/uwm.edu\/bms-labs\/wp-content\/uploads\/sites\/361\/2013\/10\/BMS-Labs-300x86.jpg 300w\" sizes=\"auto, (max-width: 252px) 100vw, 252px\" \/><\/p>\n<p style=\"text-align: center\"><a href=\"https:\/\/uwm.edu\/bms-labs\/mls-program-resource-center\/year-3-semester-2\/\"><strong>Return to the Junior Year Spring Semester Page<\/strong><\/a><\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<p style=\"text-align: center\">Please complete the following form in order to provide us with your site rankings for clinical placements.\u00a0 Students should be prepared to complete rotations at any site, but we will consider the information that you provide below when making placement decisions.\u00a0 Clinical sites will also provide student preference forms, and these will also be considered in our decision making process.\u00a0 We cannot guarantee that you will rotate at one of your top sites, and we cannot guarantee that you will not be placed at certain sites, but we will do our best to match student and site preferences.\u00a0 All information provided to us in this form will be considered confidential, so please provide any information that may be helpful to us in this process.<\/p>\n<p style=\"text-align: center\"><strong>The final decision for clinical placements will be made by the BMS Program.<\/strong><\/p>\n<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 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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_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_87' style='display:none'><div id='gf_87' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_87'  action='\/bms-labs\/wp-json\/wp\/v2\/pages\/2413#gf_87' data-formid='87' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_7b2f5a7c2b7401cc2a16d453eb04047b\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_7b2f5a7c2b7401cc2a16d453eb04047b\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_87' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>5<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_87_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_87' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_87_1\" class=\"gfield gfield--type-name gfield--input-type-name 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 gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_87_1'>\n                            \n                            <span id='input_87_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_87_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_87_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_87_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_87_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_87_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_87_2\" class=\"gfield gfield--type-email gfield--input-type-email 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_87_2'>51ÁÔÆæ Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_87_2' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_87_35\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_87_35'>If you have no preferences and would be happy to complete rotations at any clinical site, choose &quot;yes&quot; below, and &quot;Next&quot; to submit this form.<\/label><div class='gfield_description' id='gfield_description_87_35'>(leave this question blank and click \"next\" if you would like to rank the clinical sites and provide us more information)<\/div><div class='ginput_container ginput_container_select'><select name='input_35' id='input_87_35' class='medium gfield_select'  aria-describedby=\"gfield_description_87_35\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_87_43' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_87_2' class='gform_page' data-js='page-field-id-43' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_87_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_87_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Site Rankings<\/h2><div class='gsection_description' id='gfield_description_87_23'>Please rank ALL clinical sites in the order of your preference.  If you are undecided between multiple sites (i.e. ACL is your first choice, but second place is tied between West Bend and Menomonee Falls), please let us know in the Placement Questions section on the next page.<\/div><\/li><li id=\"field_87_46\" class=\"gfield gfield--type-select gfield--input-type-select 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_87_46'>1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_87_46' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_16\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_16'>2<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_87_16' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_45'>3<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_87_45' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_15\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_15'>4<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_87_15' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_14\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_14'>5<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_14' id='input_87_14' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_13\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_13'>6<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_87_13' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_12'>7<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_87_12' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_52\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_52'>8<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_52' id='input_87_52' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><li id=\"field_87_53\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_87_53'>9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_53' id='input_87_53' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ACL Laboratories' >ACL Laboratories<\/option><option value='Ascension Health Columbia St. Mary&#039;s (Labcorp)' >Ascension Health Columbia St. Mary&#039;s (Labcorp)<\/option><option value='Children&#039;s Wisconsin' >Children&#039;s Wisconsin<\/option><option value='Fort Memorial Hospital' >Fort Memorial Hospital<\/option><option value='Froedtert Menomonee Falls' >Froedtert Menomonee Falls<\/option><option value='Froedtert West Bend' >Froedtert West Bend<\/option><option value='Froedtert Wisconsin Diagnostic Laboratory' >Froedtert Wisconsin Diagnostic Laboratory<\/option><option value='Holy Family Memorial Manitowoc' >Holy Family Memorial Manitowoc<\/option><option value='Mercyhealth Janesville' >Mercyhealth Janesville<\/option><\/select><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_87_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_87_44' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_87_3' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_87_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_87_28\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Placement Questions<\/h2><div class='gsection_description' id='gfield_description_87_28'>Below are questions that may help us in our decision making.  If you mark \"yes\" to any of the questions below, a paragraph field will appear where you can provide us with more information.  You are free to tell us as much as you would like in order to help us with placement decisions.<\/div><\/li><li id=\"field_87_38\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_87_38'>Are you undecided on how to rank any of the sites?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_87_38'>Example:\n-Your top three sites are all tied, and you'd be happy at any one of them.<\/div><div class='ginput_container ginput_container_select'><select name='input_38' id='input_87_38' class='medium gfield_select'  aria-describedby=\"gfield_description_87_38\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_87_31\" class=\"gfield gfield--type-textarea gfield--input-type-textarea 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_87_31'>Please tell us which sites you are undecided between.  We will consider all of these sites together when determining your clinical placement.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_87_31' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_87_39\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_87_39'>Are you currently working at one of the clinical sites or for one of the hospital systems that are offereing clinical placements?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_87_39'>If you choose \"Yes\", an additional question will appear where you can tell us where.<\/div><div class='ginput_container ginput_container_select'><select name='input_39' id='input_87_39' class='medium gfield_select'  aria-describedby=\"gfield_description_87_39\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_87_48\" class=\"gfield gfield--type-text gfield--input-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_87_48'>Which site\/hospital system do you work for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_87_48' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_87_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_87_19'>How does this influence your rankings?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_87_19'>Some students may prefer to rotate with the hospital system that they currently work for, while others may prefer to rotate at a different location in order to keep work and school separate.  Please tell us below if your current job should be considered when we are deciding on clinical placements.  Please also tell us if your current employment has no influence on your rankings and does not need to be considered.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_87_19' class='textarea medium'  aria-describedby=\"gfield_description_87_19\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_87_40\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_87_40'>Are there any sites that you feel you CAN NOT complete rotations at?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_87_40'>If you choose \"yes\", an additional question will appear.  The site names and justifications will be required for all sites you feel you cannot attend.<\/div><div class='ginput_container ginput_container_select'><select name='input_40' id='input_87_40' class='medium gfield_select'  aria-describedby=\"gfield_description_87_40\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_87_34\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_87_34'>Which clinical site\/s do you feel you CAN NOT attend?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_87_34'>Please include the reasons why you feel you can not attend rotations for each site that you list.  Students should be prepared to complete rotations at any site, but your input will be considered during placement decisions.  Please note - Distance alone will not be factored in to placement decisions (i.e. it is inconvenient for you to drive to a remote location).  If including distance as a rational, please give specifics regarding why the distance is not possible for you.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_34' id='input_87_34' class='textarea medium'  aria-describedby=\"gfield_description_87_34\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_87_47' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_87_47' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_87_4' class='gform_page' data-js='page-field-id-47' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_87_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_87_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Additional Considerations (optional)<\/h2><\/li><li id=\"field_87_37\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_87_37'>If there is anything else you would like us to consider when determining placements, please tell us below!  This may include information such as where you live, access to transportation, or other obligations that may make it easier or harder for you to attend a single site, or sites in a general geographic area.  Please tell us anything you that you would like us to know when considering your placement.<\/label><div class='gfield_description' id='gfield_description_87_37'>If there is anything else you would like us to consider when determining placements, please tell us below!  This may include information such as where you live, access to transportation, or other obligations that may make it easier or harder for you to attend a single site, or sites in a general geographic area.  Please tell us anything you that you would like us to know when considering your placement.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_37' id='input_87_37' class='textarea medium'  aria-describedby=\"gfield_description_87_37\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_87_51' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_87_51' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_87_5' class='gform_page' data-js='page-field-id-51' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_87_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_87_50\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">That&#039;s it!<\/h2><div class='gsection_description' id='gfield_description_87_50'>You may change any answers on this form by clicking \"previous\".  When done, please click \"submit\" at the bottom of this form.  A confirmation email with your answers will be sent to the email that you provided on the first page of this form.  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Please complete the following form in order to provide us with your site rankings for clinical placements.\u00a0 Students should be prepared to complete rotations at any site, but we will consider... 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