{"id":5058,"date":"2022-09-14T08:45:16","date_gmt":"2022-09-14T13:45:16","guid":{"rendered":"https:\/\/uwm.edu\/safety-health\/?page_id=5058"},"modified":"2022-09-14T08:52:37","modified_gmt":"2022-09-14T13:52:37","slug":"dosimetry-application-form","status":"publish","type":"page","link":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/","title":{"rendered":"Dosimetry Application 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_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_19' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">51ÁÔÆæ Personal Dosimetry Application Form<\/h2>\n                            <p class='gform_description'>Personal Dosimeter form for students\/researchers working with X-ray devices or Radioactive Materials.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/safety-health\/wp-json\/wp\/v2\/pages\/5058' data-formid='19' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_7add6dd53b87a26f57719845dae068d3\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_7add6dd53b87a26f57719845dae068d3\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_19_9\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full 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' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_19_9'>\n                            \n                            <span id='input_19_9_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_9.3' id='input_19_9_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_19_9_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_19_9_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_9.4' id='input_19_9_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_19_9_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_19_9_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_9.6' id='input_19_9_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_19_9_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_19_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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' >Are you over the age of 18?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_35'>\n\t\t\t<div class='gchoice gchoice_19_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Yes'  id='choice_19_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_35_0' id='label_19_35_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_19_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No'  id='choice_19_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_19_35_1' id='label_19_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_10\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon 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_19_10'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_10' id='input_19_10' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_19_10_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_10_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_10' class='gform_hidden' value='https:\/\/uwm.edu\/safety-health\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_19_8\" 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_19_8'>Sex Assigned at Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_19_8' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Female' selected='selected'>Female<\/option><option value='Male' >Male<\/option><\/select><\/div><\/div><div id=\"field_19_11\" class=\"gfield gfield--type-email gfield--input-type-email 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_19_11'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_19_11' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_19_3\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox 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' >I will work with<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_19_3'><div class='gchoice gchoice_19_3_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.1' type='checkbox'  value='X-Ray Devices'  id='choice_19_3_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_3_1' id='label_19_3_1' class='gform-field-label gform-field-label--type-inline'>X-Ray Devices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_19_3_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_3.2' type='checkbox'  value='Radioactive Materials'  id='choice_19_3_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_3_2' id='label_19_3_2' class='gform-field-label gform-field-label--type-inline'>Radioactive Materials<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_13\" 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_19_13'>Primary Investigator:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_19_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was previously badged at:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_19_14'><div class='gchoice gchoice_19_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='UW-Milwaukee'  id='choice_19_14_1'   aria-describedby=\"gfield_description_19_14\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_1' id='label_19_14_1' class='gform-field-label gform-field-label--type-inline'>UW-Milwaukee<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_19_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='Current or Previous Employer'  id='choice_19_14_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_2' id='label_19_14_2' class='gform-field-label gform-field-label--type-inline'>Current or Previous Employer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_19_14_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.3' type='checkbox'  value='None of these; I was never previously badged'  id='choice_19_14_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_14_3' id='label_19_14_3' class='gform-field-label gform-field-label--type-inline'>None of these; I was never previously badged<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_19_14'>Check all that apply<\/div><\/fieldset><div id=\"field_19_29\" class=\"gfield gfield--type-post_custom_field gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_29'>By signing this form, I attest to the following:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_19_29' class='textarea medium'    placeholder='I will exchange my badge on time and return it to the Radiation Safety Officer upon resignation. I certify that the information on this application is correct and complete, to the best of my knowledge. According to DHS 157.22(5), I hereby request and authorize my previous employer(s) to release my dosimetry records. I certify my dosimeter(s) will remain in this sub-account I am applying for and not used in any other location. I certify that I have received training in the radiation source(s) and\/or equipment I will be working with and will implement the ALARA principles to keep my radiation dose as low as reasonably achievable. To my knowledge, I have not exceeded any Federal or state radiation exposure limits prior to my work here at 51ÁÔÆæ. My signature authorizes the Radiation Safety Program to request my radiation exposure from previous employers. Privacy Act Statement: Title 10 Code of Federal Regulations (CFR) Part 19l.13 (NRC), Title 29 CFR Part 1910.96 (OSHA) and Wisconsin Department of Health Services (DHS) Part 157.88 (3) require each employer to obtain all of your radiation exposure records to document previous exposure history. The information is used in the evaluation of risk exposure to ionizing radiation or radioactive materials. It permits meaningful comparison of both current (short-term) and long-term exposure to ionizing radiation or radioactive material. Data on your exposure to ionizing radiation or radioactive materials is always available to you upon request.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_19_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_30'>Employee Signature:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_19_30' type='text' value='' class='large'  aria-describedby=\"gfield_description_19_30\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_19_30'>Name may be typed into the signature field.<\/div><\/div><fieldset id=\"field_19_31\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown 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' >Signature Date:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_19_31' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_19_31_1_container'><label for='input_19_31_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_31[]' id='input_19_31_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_19_31_2_container'><label for='input_19_31_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_31[]' id='input_19_31_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_19_31_3_container'><label for='input_19_31_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_31[]' id='input_19_31_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_19_32\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_32'>Comments - If you have been previously badged, please give employer name and contact phone\/email so previous dosimetry history can be acquired.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_19_32' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_19' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_19' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_19' id='gform_theme_19' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_19' id='gform_style_settings_19' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_19' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='19' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='WXBFQJrTjVdDdpBxyj+vAkac60jkRNCkyBzt3XHhgrJaMQq8jR3uLBTelNA3mSwnzwlxSc5qblFaa7GH5znYiwvhNeCQTs6lNkW8MzUAdbNwRZo=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_19' value='WyJ7XCIzNVwiOltcIjIwNmM3NjRhM2QzMjgxMTExMGI0NzVlZTY4NDYzOTdkXCIsXCI5ZjU1ZDMxYmViOWI5ZDY0ZDMxYmMzZTQ2ODVkMWUwNFwiXX0iLCI5YzcwMzg2ZjZhNjRiNjdkYjhkZDQyMmEyYTc5ZjRhNiJd' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_19' id='gform_target_page_number_19' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_19' id='gform_source_page_number_19' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 19, 'https:\/\/uwm.edu\/safety-health\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_19').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_19');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_19').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_19').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_19').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_19').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_19').val();gformInitSpinner( 19, 'https:\/\/uwm.edu\/safety-health\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [19, current_page]);window['gf_submitting_19'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_19').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [19]);window['gf_submitting_19'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_19').text());}else{jQuery('#gform_19').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"19\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_19\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_19\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_19\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 19, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":7677,"featured_media":0,"parent":1016,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","uwm_wg_additional_authors":[]},"class_list":["post-5058","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.3 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Dosimetry Application Form - FAA USA Safety and Health Programs<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dosimetry Application Form\" \/>\n<meta property=\"og:url\" content=\"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/\" \/>\n<meta property=\"og:site_name\" content=\"FAA USA Safety and Health Programs\" \/>\n<meta property=\"article:modified_time\" content=\"2022-09-14T13:52:37+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/radioisotope-information\\\/dosimetry-application-form\\\/\",\"url\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/radioisotope-information\\\/dosimetry-application-form\\\/\",\"name\":\"Dosimetry Application Form - FAA USA Safety and Health Programs\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/#website\"},\"datePublished\":\"2022-09-14T13:45:16+00:00\",\"dateModified\":\"2022-09-14T13:52:37+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/radioisotope-information\\\/dosimetry-application-form\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/radioisotope-information\\\/dosimetry-application-form\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/radioisotope-information\\\/dosimetry-application-form\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Radioisotope Information\",\"item\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/radioisotope-information\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Dosimetry Application Form\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/#website\",\"url\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/\",\"name\":\"FAA USA Safety and Health Programs\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/uwm.edu\\\/safety-health\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Dosimetry Application Form - FAA USA Safety and Health Programs","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/","og_locale":"en_US","og_type":"article","og_title":"Dosimetry Application Form","og_url":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/","og_site_name":"FAA USA Safety and Health Programs","article_modified_time":"2022-09-14T13:52:37+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/","url":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/","name":"Dosimetry Application Form - FAA USA Safety and Health Programs","isPartOf":{"@id":"https:\/\/uwm.edu\/safety-health\/#website"},"datePublished":"2022-09-14T13:45:16+00:00","dateModified":"2022-09-14T13:52:37+00:00","breadcrumb":{"@id":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/dosimetry-application-form\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/uwm.edu\/safety-health\/"},{"@type":"ListItem","position":2,"name":"Radioisotope Information","item":"https:\/\/uwm.edu\/safety-health\/radioisotope-information\/"},{"@type":"ListItem","position":3,"name":"Dosimetry Application Form"}]},{"@type":"WebSite","@id":"https:\/\/uwm.edu\/safety-health\/#website","url":"https:\/\/uwm.edu\/safety-health\/","name":"FAA USA Safety and Health Programs","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/uwm.edu\/safety-health\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/pages\/5058","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/users\/7677"}],"replies":[{"embeddable":true,"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/comments?post=5058"}],"version-history":[{"count":4,"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/pages\/5058\/revisions"}],"predecessor-version":[{"id":5069,"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/pages\/5058\/revisions\/5069"}],"up":[{"embeddable":true,"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/pages\/1016"}],"wp:attachment":[{"href":"https:\/\/uwm.edu\/safety-health\/wp-json\/wp\/v2\/media?parent=5058"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}