{"id":1547,"date":"2023-12-21T16:20:56","date_gmt":"2023-12-21T22:20:56","guid":{"rendered":"https:\/\/uwm.edu\/wellness\/?page_id=1547"},"modified":"2026-03-26T12:04:40","modified_gmt":"2026-03-26T17:04:40","slug":"wellness-program-request","status":"publish","type":"page","link":"https:\/\/uwm.edu\/wellness\/wellness-programs\/wellness-program-request\/","title":{"rendered":"Wellness Program Request"},"content":{"rendered":"\n<p>Looking for a health and well-being program for your student organization, class or other group? We have a variety of programs to choose from and can also work with you to tailor-make a program to meet your needs. Our programs can be done in a variety of formats and encourage self-awareness, empathy, skills building and an exchange of ideas. For more information, <a href=\"https:\/\/uwm.edu\/wellness\/wellness-programs\">visit our menu of wellness programs here.<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading hidden\" id=\"h-wellness-program-request-web-form\">Wellness Program Request Web Form<\/h2>\n\n\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 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_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Wellness Program Request Form<\/h2>\n                            <p class='gform_description'>Fill out this form to request a Wellness Program<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/wellness\/wp-json\/wp\/v2\/pages\/1547#gf_2' data-formid='2' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_e2b319fd2e41264554e8d155ce5222e0\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_e2b319fd2e41264554e8d155ce5222e0\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_48\" 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_2_48'>Phone<\/label><div class='ginput_container'><input name='input_48' id='input_2_48' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_48'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_2_4\" 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\"  ><h3 class=\"gsection_title\">Program\/Event Information<\/h3><\/div><fieldset id=\"field_2_28\" 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' >I&#039;d like to request a program about:<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_2_28'>\n\t\t\t<div class='gchoice gchoice_2_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Emotional Health\/Stress Management'  id='choice_2_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_0' id='label_2_28_0' class='gform-field-label gform-field-label--type-inline'>Emotional Health\/Stress Management<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Sleep'  id='choice_2_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_1' id='label_2_28_1' class='gform-field-label gform-field-label--type-inline'>Sleep<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Nutrition'  id='choice_2_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_2' id='label_2_28_2' class='gform-field-label gform-field-label--type-inline'>Nutrition<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Alcohol &amp; Other Drugs'  id='choice_2_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_3' id='label_2_28_3' class='gform-field-label gform-field-label--type-inline'>Alcohol &amp; Other Drugs<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Healthy Relationships'  id='choice_2_28_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_4' id='label_2_28_4' class='gform-field-label gform-field-label--type-inline'>Healthy Relationships<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Sexual Health'  id='choice_2_28_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_5' id='label_2_28_5' class='gform-field-label gform-field-label--type-inline'>Sexual Health<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Body Acceptance'  id='choice_2_28_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_6' id='label_2_28_6' class='gform-field-label gform-field-label--type-inline'>Body Acceptance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Helping Others in Distress'  id='choice_2_28_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_7' id='label_2_28_7' class='gform-field-label gform-field-label--type-inline'>Helping Others in Distress<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Overall Wellness'  id='choice_2_28_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_8' id='label_2_28_8' class='gform-field-label gform-field-label--type-inline'>Overall Wellness<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Victim Advocacy'  id='choice_2_28_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_9' id='label_2_28_9' class='gform-field-label gform-field-label--type-inline'>Victim Advocacy<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Overview of SHAW Services'  id='choice_2_28_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_10' id='label_2_28_10' class='gform-field-label gform-field-label--type-inline'>Overview of SHAW Services<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_28_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='gf_other_choice'  id='choice_2_28_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_28_11' id='label_2_28_11' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_2_28_other' class='gchoice_other_control' name='input_28_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_6\" 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' >Emotional Health\/Stress Management Programs<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_2_6'>\n\t\t\t<div class='gchoice gchoice_2_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Calm and Crafty'  id='choice_2_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_0' id='label_2_6_0' class='gform-field-label gform-field-label--type-inline'>Calm and Crafty<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='De-stress, not Distress'  id='choice_2_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_1' id='label_2_6_1' class='gform-field-label gform-field-label--type-inline'>De-stress, not Distress<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Emotional Well-being Digital Resource Overview'  id='choice_2_6_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_2' id='label_2_6_2' class='gform-field-label gform-field-label--type-inline'>Emotional Well-being Digital Resource Overview<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Intro to Mindfulness'  id='choice_2_6_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_3' id='label_2_6_3' class='gform-field-label gform-field-label--type-inline'>Intro to Mindfulness<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Managing Anxiety'  id='choice_2_6_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_4' id='label_2_6_4' class='gform-field-label gform-field-label--type-inline'>Managing Anxiety<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Mindful Walk'  id='choice_2_6_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_5' id='label_2_6_5' class='gform-field-label gform-field-label--type-inline'>Mindful Walk<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Unhooking from Imposter Syndrome'  id='choice_2_6_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_6' id='label_2_6_6' class='gform-field-label gform-field-label--type-inline'>Unhooking from Imposter Syndrome<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='You Can Help!: Prevent Suicide (student training)'  id='choice_2_6_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_7' id='label_2_6_7' class='gform-field-label gform-field-label--type-inline'>You Can Help!: Prevent Suicide (student training)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_34\" 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' >Sleep Programs<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_2_34'>\n\t\t\t<div class='gchoice gchoice_2_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Sleep On It'  id='choice_2_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_34_0' id='label_2_34_0' class='gform-field-label gform-field-label--type-inline'>Sleep On It<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_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' >Nutrition Programs<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_2_35'>\n\t\t\t<div class='gchoice gchoice_2_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Eating on a Time Crunch'  id='choice_2_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_35_0' id='label_2_35_0' class='gform-field-label gform-field-label--type-inline'>Eating on a Time Crunch<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_36\" 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' >Alcohol &amp; Other Drugs Programs<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_2_36'>\n\t\t\t<div class='gchoice gchoice_2_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Drinking or Drug Culture Close-Up'  id='choice_2_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_36_0' id='label_2_36_0' class='gform-field-label gform-field-label--type-inline'>Drinking or Drug Culture Close-Up<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Rethinking Your Drinking'  id='choice_2_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_36_1' id='label_2_36_1' class='gform-field-label gform-field-label--type-inline'>Rethinking Your Drinking<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_36_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='You Can Help!: Stop Overdose'  id='choice_2_36_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_36_2' id='label_2_36_2' class='gform-field-label gform-field-label--type-inline'>You Can Help!: Stop Overdose<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_37\" 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' >Healthy Relationship Programs<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_2_37'>\n\t\t\t<div class='gchoice gchoice_2_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Boundaries: Building the Foundation'  id='choice_2_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_0' id='label_2_37_0' class='gform-field-label gform-field-label--type-inline'>Boundaries: Building the Foundation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Boundaries: Revising the Blueprint'  id='choice_2_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_1' id='label_2_37_1' class='gform-field-label gform-field-label--type-inline'>Boundaries: Revising the Blueprint<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Consent: Sweet as Candy'  id='choice_2_37_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_2' id='label_2_37_2' class='gform-field-label gform-field-label--type-inline'>Consent: Sweet as Candy<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Enthusiastic Consent'  id='choice_2_37_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_3' id='label_2_37_3' class='gform-field-label gform-field-label--type-inline'>Enthusiastic Consent<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Relationship Goals: Exploring Healthy Relationships'  id='choice_2_37_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_4' id='label_2_37_4' class='gform-field-label gform-field-label--type-inline'>Relationship Goals: Exploring Healthy Relationships<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Snack &amp; Chat'  id='choice_2_37_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_5' id='label_2_37_5' class='gform-field-label gform-field-label--type-inline'>Snack &amp; Chat<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Swipe Safely'  id='choice_2_37_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_6' id='label_2_37_6' class='gform-field-label gform-field-label--type-inline'>Swipe Safely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_37_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='You Can Help!: Prevent Sexual and Relationship Violence'  id='choice_2_37_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_37_7' id='label_2_37_7' class='gform-field-label gform-field-label--type-inline'>You Can Help!: Prevent Sexual and Relationship Violence<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_38\" 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' >Sexual Health Programs<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_2_38'>\n\t\t\t<div class='gchoice gchoice_2_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Condom Olympics'  id='choice_2_38_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_38_0' id='label_2_38_0' class='gform-field-label gform-field-label--type-inline'>Condom Olympics<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_39\" 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' >Body Acceptance Programs<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_2_39'>\n\t\t\t<div class='gchoice gchoice_2_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='Journaling for Body Acceptance'  id='choice_2_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_39_0' id='label_2_39_0' class='gform-field-label gform-field-label--type-inline'>Journaling for Body Acceptance<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_40\" 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' >Helping Others in Distress Programs<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_2_40'>\n\t\t\t<div class='gchoice gchoice_2_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='How to Help a Friend'  id='choice_2_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_40_0' id='label_2_40_0' class='gform-field-label gform-field-label--type-inline'>How to Help a Friend<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='You Can Help!: Stop Overdose'  id='choice_2_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_40_1' id='label_2_40_1' class='gform-field-label gform-field-label--type-inline'>You Can Help!: Stop Overdose<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_40_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='You Can Help!: Prevent Sexual and Relationship Violence'  id='choice_2_40_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_40_2' id='label_2_40_2' class='gform-field-label gform-field-label--type-inline'>You Can Help!: Prevent Sexual and Relationship Violence<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_40_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='You Can Help!: Prevent Suicide (student training)'  id='choice_2_40_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_40_3' id='label_2_40_3' class='gform-field-label gform-field-label--type-inline'>You Can Help!: Prevent Suicide (student training)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_41\" 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' >Overall Wellness Programs<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_2_41'>\n\t\t\t<div class='gchoice gchoice_2_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Balancing Personal Wellness'  id='choice_2_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_41_0' id='label_2_41_0' class='gform-field-label gform-field-label--type-inline'>Balancing Personal Wellness<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='SMART Goals and Vision Boards'  id='choice_2_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_41_1' id='label_2_41_1' class='gform-field-label gform-field-label--type-inline'>SMART Goals and Vision Boards<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_41_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Health BINGO'  id='choice_2_41_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_41_2' id='label_2_41_2' class='gform-field-label gform-field-label--type-inline'>Health BINGO<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_42\" 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' >Victim Advocacy Programs<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_2_42'>\n\t\t\t<div class='gchoice gchoice_2_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Trauma Informed Care'  id='choice_2_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_42_0' id='label_2_42_0' class='gform-field-label gform-field-label--type-inline'>Trauma Informed Care<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Victim Advocacy Services Overview'  id='choice_2_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_42_1' id='label_2_42_1' class='gform-field-label gform-field-label--type-inline'>Victim Advocacy Services Overview<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_43\" 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' >Overview of SHAW Services Programs<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_2_43'>\n\t\t\t<div class='gchoice gchoice_2_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Overview of all Student Health and Wellness Center Services'  id='choice_2_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_0' id='label_2_43_0' class='gform-field-label gform-field-label--type-inline'>Overview of all Student Health and Wellness Center Services<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Overview of SHAW Medical Services Only'  id='choice_2_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_1' id='label_2_43_1' class='gform-field-label gform-field-label--type-inline'>Overview of SHAW Medical Services Only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Overview of SHAW Counseling Services Only'  id='choice_2_43_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_2' id='label_2_43_2' class='gform-field-label gform-field-label--type-inline'>Overview of SHAW Counseling Services Only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Overview of SHAW Health Promotion Services Only'  id='choice_2_43_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_3' id='label_2_43_3' class='gform-field-label gform-field-label--type-inline'>Overview of SHAW Health Promotion Services Only<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_43_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Overview of SHAW Victim Advocacy Services Only'  id='choice_2_43_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_43_4' id='label_2_43_4' class='gform-field-label gform-field-label--type-inline'>Overview of SHAW Victim Advocacy Services Only<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_7\" class=\"gfield gfield--type-text gfield--input-type-text 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_2_7'>What do you hope to accomplish with this program\/activity? What are your intended goals for the program?<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_7' id='input_2_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_8' 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_2_2' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_9\" 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\"  ><h3 class=\"gsection_title\">Program Details<\/h3><\/div><fieldset id=\"field_2_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full 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' >Who is the primary audience of the program? [check all that apply]<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_10'><div class='gchoice gchoice_2_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Students'  id='choice_2_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_10_1' id='label_2_10_1' class='gform-field-label gform-field-label--type-inline'>Students<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Staff'  id='choice_2_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_10_2' id='label_2_10_2' class='gform-field-label gform-field-label--type-inline'>Staff<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Faculty'  id='choice_2_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_10_3' id='label_2_10_3' class='gform-field-label gform-field-label--type-inline'>Faculty<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Public'  id='choice_2_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_10_4' id='label_2_10_4' class='gform-field-label gform-field-label--type-inline'>Public<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_33\" class=\"gfield gfield--type-text gfield--input-type-text 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_2_33'>Please share anything you think would be helpful for us to know about the target audience.<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_2_33' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_11\" class=\"gfield gfield--type-text gfield--input-type-text 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_2_11'>How much time is scheduled for the program?<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_2_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_13\" class=\"gfield gfield--type-number gfield--input-type-number 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_2_13'>Expected number of attendees<\/label><div class='ginput_container ginput_container_number'><input name='input_13' id='input_2_13' type='number' step='any' min='1'  value='' class='large'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_2_13\" \/><div class='gfield_description instruction ' id='gfield_instruction_2_13'>Please enter a number greater than or equal to <strong>1<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_2_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Location<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_14'>\n\t\t\t<div class='gchoice gchoice_2_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Virtual'  id='choice_2_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_0' id='label_2_14_0' class='gform-field-label gform-field-label--type-inline'>Virtual<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='In person\/On-campus'  id='choice_2_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_1' id='label_2_14_1' class='gform-field-label gform-field-label--type-inline'>In person\/On-campus<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='In person\/Off-campus'  id='choice_2_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_14_2' id='label_2_14_2' class='gform-field-label gform-field-label--type-inline'>In person\/Off-campus<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_18'>Preferred dates and times: Please include at least 3 available dates and times.<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='large'  aria-describedby=\"gfield_description_2_18\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_2_18'>Please provide at least two weeks notice. We will do our best to accommodate but cannot guarantee to fulfill requests with less than two weeks notice. <\/div><\/div><fieldset id=\"field_2_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >If needed, will audio\/video be available?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_20'>\n\t\t\t<div class='gchoice gchoice_2_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Yes'  id='choice_2_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_0' id='label_2_20_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_2_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No'  id='choice_2_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_20_1' id='label_2_20_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_21' 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_2_21' 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_2_3' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_22\" 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\"  ><h3 class=\"gsection_title\">Program Contact<\/h3><\/div><fieldset id=\"field_2_23\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full 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<\/legend><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_2_23'>\n                            \n                            <span id='input_2_23_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.3' id='input_2_23_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_23_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_23_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.6' id='input_2_23_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_23_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_24\" class=\"gfield gfield--type-email gfield--input-type-email 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_2_24'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_24' id='input_2_24' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_2_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full 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 primary role at 51ÁÔÆæ?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_31'>\n\t\t\t<div class='gchoice gchoice_2_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Student'  id='choice_2_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_31_0' id='label_2_31_0' class='gform-field-label gform-field-label--type-inline'>Student<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Staff member'  id='choice_2_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_31_1' id='label_2_31_1' class='gform-field-label gform-field-label--type-inline'>Staff member<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Faculty\/Instructor'  id='choice_2_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_31_2' id='label_2_31_2' class='gform-field-label gform-field-label--type-inline'>Faculty\/Instructor<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_47\" 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' >Will you be the primary point of contact for the day of the event?<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_2_47'>\n\t\t\t<div class='gchoice gchoice_2_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='Yes'  id='choice_2_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_0' id='label_2_47_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_2_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='No'  id='choice_2_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_47_1' id='label_2_47_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_32\" class=\"gfield gfield--type-text gfield--input-type-text 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_2_32'>Please list the point of contact for the day of the event (name and email address)<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_2_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_46\" class=\"gfield gfield--type-text gfield--input-type-text 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_2_46'>Please list your org name, team, department, unit, school, or college if applicable<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_45\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full 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' >How did you hear about our wellness program menu? Select all that apply<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_45'><div class='gchoice gchoice_2_45_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.1' type='checkbox'  value='Newsletter \/ Campus Annoucement'  id='choice_2_45_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_1' id='label_2_45_1' class='gform-field-label gform-field-label--type-inline'>Newsletter \/ Campus Annoucement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_45_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.2' type='checkbox'  value='Social Media'  id='choice_2_45_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_2' id='label_2_45_2' class='gform-field-label gform-field-label--type-inline'>Social Media<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_45_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.3' type='checkbox'  value='SHAW Overview'  id='choice_2_45_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_3' id='label_2_45_3' class='gform-field-label gform-field-label--type-inline'>SHAW Overview<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_45_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.4' type='checkbox'  value='Website'  id='choice_2_45_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_4' id='label_2_45_4' class='gform-field-label gform-field-label--type-inline'>Website<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_45_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.5' type='checkbox'  value='Colleague Recommendation'  id='choice_2_45_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_5' id='label_2_45_5' class='gform-field-label gform-field-label--type-inline'>Colleague Recommendation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_45_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_45.6' type='checkbox'  value='Other'  id='choice_2_45_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_45_6' id='label_2_45_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_29\" class=\"gfield gfield--type-captcha gfield--input-type-captcha 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_2_29'>CAPTCHA<\/label><div id='input_2_29' class='ginput_container ginput_recaptcha' data-sitekey='6Lc5RgQAAAAAADdHs22J548J7nTXMFNcMIjuIdJV'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' 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='submit' id='gform_submit_button_2' 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_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' 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