{"id":1881,"date":"2021-03-03T11:03:30","date_gmt":"2021-03-03T16:03:30","guid":{"rendered":"https:\/\/www.indianablackexpo.com\/?page_id=1881"},"modified":"2023-11-13T14:39:58","modified_gmt":"2023-11-13T19:39:58","slug":"paa-registration","status":"publish","type":"page","link":"https:\/\/www.indianablackexpo.com\/paa-registration\/","title":{"rendered":"Performing Arts Academy Registration"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row thb_divider_position=&#8221;bottom&#8221; css=&#8221;.vc_custom_1614781736175{padding-top: 10vh !important;padding-bottom: 6vh !important;background-image: url(https:\/\/www.indianablackexpo.com\/wp-content\/uploads\/2020\/08\/MusicProduction_bg_2.jpg?id=1589) !important;}&#8221;][vc_column offset=&#8221;vc_col-lg-8 vc_col-md-9&#8243; css=&#8221;.vc_custom_1614781892978{padding-left: 4% !important;}&#8221;][vc_empty_space height=&#8221;300px&#8221;][\/vc_column][\/vc_row][vc_row thb_divider_position=&#8221;bottom&#8221; css=&#8221;.vc_custom_1598532595449{padding-right: 6% !important;padding-left: 6% !important;}&#8221;][vc_column][vc_empty_space height=&#8221;64px&#8221;][vc_custom_heading text=&#8221;Register Now!&#8221; font_container=&#8221;tag:h2|font_size:50px|text_align:center|color:%23000000|line_height:58px&#8221; use_theme_fonts=&#8221;yes&#8221;][vc_column_text css=&#8221;.vc_custom_1681858248798{margin-top: 0px !important;padding-top: 0px !important;padding-right: 8% !important;}&#8221;]\n<h4 style=\"text-align: left;\">Please register using the form below.<\/h4>\n[\/vc_column_text]<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 gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_74' style='display:none'><div id='gf_74' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_74'  action='\/wp-json\/wp\/v2\/pages\/1881#gf_74' data-formid='74' novalidate>\n        <div id='gf_progressbar_wrapper_74' 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'>6<\/span><span class='gf_step_page_name'> - Student Information<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_custom' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_custom percentbar_16' style='width:16%; color:#ffffff; background-color:#34b584;'><span>16%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_74_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_74' class='gform_fields top_label form_sublabel_above description_above validation_below'><li id=\"field_74_76\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><BR><\/li><li id=\"field_74_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Student Information<\/h2><\/li><li id=\"field_74_2\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above 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 has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_74_2'>\n                            \n                            <span id='input_74_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_74_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_74_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_74_2_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.4' id='input_74_2_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_74_2_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_74_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_74_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_74_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_74_94\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Which Class(es) Are You Interested In?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_74_94'>Please use the following to select which class(es) in which you are interested. You may select up to 2 classes. <\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_74_94'><li class='gchoice gchoice_74_94_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.1' type='checkbox'  value='Acting'  id='choice_74_94_1'   aria-describedby=\"gfield_description_74_94\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_74_94_1' id='label_74_94_1' class='gform-field-label gform-field-label--type-inline'>Acting<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_94_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.2' type='checkbox'  value='Dance'  id='choice_74_94_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_94_2' id='label_74_94_2' class='gform-field-label gform-field-label--type-inline'>Dance<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_94_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.3' type='checkbox'  value='Music Production'  id='choice_74_94_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_94_3' id='label_74_94_3' class='gform-field-label gform-field-label--type-inline'>Music Production<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_94_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.4' type='checkbox'  value='Photography'  id='choice_74_94_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_94_4' id='label_74_94_4' class='gform-field-label gform-field-label--type-inline'>Photography<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_94_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.5' type='checkbox'  value='Video Production'  id='choice_74_94_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_94_5' id='label_74_94_5' class='gform-field-label gform-field-label--type-inline'>Video Production<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_94_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_94.6' type='checkbox'  value='Song Writing'  id='choice_74_94_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_94_6' id='label_74_94_6' class='gform-field-label gform-field-label--type-inline'>Song Writing<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_77\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><BR><\/li><li id=\"field_74_3\" class=\"gfield gfield--type-number gfield--input-type-number field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_3'>STN:<\/label><div class='gfield_description' id='gfield_description_74_3'>8-digit school ID<\/div><div class='ginput_container ginput_container_number'><input name='input_3' id='input_74_3' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_74_3\" \/><\/div><\/li><li id=\"field_74_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_left_half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Ethnicity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_74_7'><li class='gchoice gchoice_74_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='African-American'  id='choice_74_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_7_1' id='label_74_7_1' class='gform-field-label gform-field-label--type-inline'>African-American<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Caucasian'  id='choice_74_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_7_2' id='label_74_7_2' class='gform-field-label gform-field-label--type-inline'>Caucasian<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Hispanic'  id='choice_74_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_7_3' id='label_74_7_3' class='gform-field-label gform-field-label--type-inline'>Hispanic<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='Native-American'  id='choice_74_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_7_4' id='label_74_7_4' class='gform-field-label gform-field-label--type-inline'>Native-American<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_7_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.5' type='checkbox'  value='Asian-American'  id='choice_74_7_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_7_5' id='label_74_7_5' class='gform-field-label gform-field-label--type-inline'>Asian-American<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_7_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.6' type='checkbox'  value='Multi-Racial'  id='choice_74_7_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_7_6' id='label_74_7_6' class='gform-field-label gform-field-label--type-inline'>Multi-Racial<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_7_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.7' type='checkbox'  value='Other'  id='choice_74_7_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_7_7' id='label_74_7_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_4'>\n\t\t\t<li class='gchoice gchoice_74_4_0'>\n\t\t\t\t<input name='input_4' type='radio' value='Male'  id='choice_74_4_0'    \/>\n\t\t\t\t<label for='choice_74_4_0' id='label_74_4_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_4_1'>\n\t\t\t\t<input name='input_4' type='radio' value='Female'  id='choice_74_4_1'    \/>\n\t\t\t\t<label for='choice_74_4_1' id='label_74_4_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_4_2'>\n\t\t\t\t<input name='input_4' type='radio' value='Gender Diverse \/ Transgender'  id='choice_74_4_2'    \/>\n\t\t\t\t<label for='choice_74_4_2' id='label_74_4_2' class='gform-field-label gform-field-label--type-inline'>Gender Diverse \/ Transgender<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_78\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><BR><\/li><li id=\"field_74_5\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gf_left_half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_74_5' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_74_5_1_container'><label for='input_74_5_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_5[]' id='input_74_5_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_74_5_2_container'><label for='input_74_5_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_5[]' id='input_74_5_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_74_5_3_container'><label for='input_74_5_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_5[]' id='input_74_5_3'   aria-required='true'  ><option value=''>Year<\/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><\/div><\/li><li id=\"field_74_6\" class=\"gfield gfield--type-number gfield--input-type-number gf_right_half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_6'>Current Age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_6' id='input_74_6' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_74_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_8'>If Other Please Specify<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_74_8' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_79\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><BR><\/li><li id=\"field_74_9\" class=\"gfield gfield--type-email gfield--input-type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Student&#039;s Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_74_9_container'>\n                                <span id='input_74_9_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_9' id='input_74_9' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_74_9' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_74_9_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_9_2' id='input_74_9_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_74_9_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_74_11\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_11'>Student&#039;s Cell Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_74_11' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_82\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><BR><\/li><li id=\"field_74_10\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Student&#039;s Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_74_10' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_74_10_1_container' >\n                                        <label for='input_74_10_1' id='input_74_10_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_10.1' id='input_74_10_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_74_10_2_container' >\n                                        <label for='input_74_10_2' id='input_74_10_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_10.2' id='input_74_10_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_74_10_3_container' >\n                                    <label for='input_74_10_3' id='input_74_10_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_10.3' id='input_74_10_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_74_10_4_container' >\n                                        <label for='input_74_10_4' id='input_74_10_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_10.4' id='input_74_10_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_74_10_5_container' >\n                                    <label for='input_74_10_5' id='input_74_10_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_10.5' id='input_74_10_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_10.6' id='input_74_10_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_74_80\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><BR><\/li><li id=\"field_74_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_12'>T-Shirt Size<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_74_12' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose Size<\/option><option value='Extra Small' selected='selected'>Extra Small<\/option><option value='Small' >Small<\/option><option value='Medium' >Medium<\/option><option value='Large' >Large<\/option><option value='Extra Large' >Extra Large<\/option><option value='XXL' >XXL<\/option><option value='XXXL' >XXXL<\/option><option value='XXXXL' >XXXXL<\/option><option value='XXXXXL' >XXXXXL<\/option><\/select><\/div><\/li><li id=\"field_74_17\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_17'>Twitter Account<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_74_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_81\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><BR><\/li><li id=\"field_74_18\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_18'>TicTok Account<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_74_18' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_16\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_16'>Instagram Account<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_74_16' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_19\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_19'>Snapchat<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_74_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_21\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_21'>Facebook<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_74_21' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_22\" class=\"gfield gfield--type-select gfield--input-type-select gf_left_half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_22'>Student Employment Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_74_22' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Not Employed' >Not Employed<\/option><option value='Employed Part-Time' >Employed Part-Time<\/option><option value='Employed Full-Time' >Employed Full-Time<\/option><\/select><\/div><\/li><li id=\"field_74_23\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_23'>Name of Employer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_74_23' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you involved in extracurricular activities?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_28'>\n\t\t\t<li class='gchoice gchoice_74_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='No'  id='choice_74_28_0'    \/>\n\t\t\t\t<label for='choice_74_28_0' id='label_74_28_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='Yes'  id='choice_74_28_1'    \/>\n\t\t\t\t<label for='choice_74_28_1' id='label_74_28_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_26\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_26'>Please list your extracurricular activities.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_74_26' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_74_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have any dietary restrictions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_25'>\n\t\t\t<li class='gchoice gchoice_74_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='No'  id='choice_74_25_0'    \/>\n\t\t\t\t<label for='choice_74_25_0' id='label_74_25_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='Yes'  id='choice_74_25_1'    \/>\n\t\t\t\t<label for='choice_74_25_1' id='label_74_25_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_27\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_27'>Please list your dietary restrictions.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_74_27' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_74_29\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you a returning PAA student?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_29'>\n\t\t\t<li class='gchoice gchoice_74_29_0'>\n\t\t\t\t<input name='input_29' type='radio' value='Yes'  id='choice_74_29_0'    \/>\n\t\t\t\t<label for='choice_74_29_0' id='label_74_29_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_29_1'>\n\t\t\t\t<input name='input_29' type='radio' value='No'  id='choice_74_29_1'    \/>\n\t\t\t\t<label for='choice_74_29_1' id='label_74_29_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_74_13' 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_74_2' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_74_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><li id=\"field_74_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Parent\/Guardian Information<\/h2><\/li><li id=\"field_74_31\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_31'>Student lives with:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_74_31' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Both Parents' selected='selected'>Both Parents<\/option><option value='Mother Only' >Mother Only<\/option><option value='Father Only' >Father Only<\/option><option value='Aunt\/Uncle' >Aunt\/Uncle<\/option><option value='Grandparents' >Grandparents<\/option><option value='Guardian' >Guardian<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_74_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_33'>If Other Please Specify<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_74_33' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_86\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Parent or Guardian 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_74_86'>\n                            \n                            <span id='input_74_86_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_74_86_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_86.3' id='input_74_86_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_74_86_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_74_86_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_86.6' id='input_74_86_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_74_35\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please provide address:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_74_35' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_74_35_1_container' >\n                                        <label for='input_74_35_1' id='input_74_35_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_35.1' id='input_74_35_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_74_35_2_container' >\n                                        <label for='input_74_35_2' id='input_74_35_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_35.2' id='input_74_35_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_74_35_3_container' >\n                                    <label for='input_74_35_3' id='input_74_35_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_35.3' id='input_74_35_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_74_35_4_container' >\n                                        <label for='input_74_35_4' id='input_74_35_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_35.4' id='input_74_35_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_74_35_5_container' >\n                                    <label for='input_74_35_5' id='input_74_35_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_35.5' id='input_74_35_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_35.6' id='input_74_35_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_74_36\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_left_half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_36'>Parent\/Guardian (1) Cell Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_36' id='input_74_36' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_39\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_39'>Parent\/Guardian (2) Cell Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_39' id='input_74_39' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_38\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_left_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_38'>Parent\/Guardian (1) Work Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_38' id='input_74_38' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_40\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_40'>Parent\/Guardian (2) Work Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_40' id='input_74_40' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_37\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_left_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_37'>Parent\/Guardian (1) Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_37' id='input_74_37' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_41\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_41'>Parent\/Guardian (2) Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_41' id='input_74_41' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_42\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Parent\/Guardian (1) Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_74_42_container'>\n                                <span id='input_74_42_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_74_42' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                    <input class='' type='email' name='input_42' id='input_74_42' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <span id='input_74_42_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_74_42_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                    <input class='' type='email' name='input_42_2' id='input_74_42_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_74_43\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Parent\/Guardian (2) Email<\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_74_43_container'>\n                                <span id='input_74_43_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_74_43' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                    <input class='' type='email' name='input_43' id='input_74_43' value=''     aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <span id='input_74_43_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_74_43_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                    <input class='' type='email' name='input_43_2' id='input_74_43_2' value=''     aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_74_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_74_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_74_3' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_74_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><li id=\"field_74_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Educational Information<\/h2><\/li><li id=\"field_74_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Is the applicant currently enrolled in school?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_46'>\n\t\t\t<li class='gchoice gchoice_74_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='Yes'  id='choice_74_46_0'    \/>\n\t\t\t\t<label for='choice_74_46_0' id='label_74_46_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='No'  id='choice_74_46_1'    \/>\n\t\t\t\t<label for='choice_74_46_1' id='label_74_46_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_47\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_47'>If no, please explain.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_47' id='input_74_47' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_74_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_50'>Current School:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_74_50'>Please provide a complete school name (no acronyms) i.e. Warren Central High School, not WCHS.<\/div><div class='ginput_container ginput_container_text'><input name='input_50' id='input_74_50' type='text' value='' class='medium'  aria-describedby=\"gfield_description_74_50\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_92\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >School Counselor&#039;s Name<\/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_74_92'>\n                            \n                            <span id='input_74_92_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_74_92_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_92.3' id='input_74_92_3' value=''   aria-required='false'     \/>\n                                                <\/span>\n                            \n                            <span id='input_74_92_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_74_92_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_92.6' id='input_74_92_6' value=''   aria-required='false'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_74_93\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_93'>Counselor&#039;s Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_93' id='input_74_93' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_74_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_51'>Current Grade:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_74_51' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_52'>High School Graduation Year:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_74_52' type='text' value='' class='medium'    placeholder='20XX' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >21st Century Scholar<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_54'>\n\t\t\t<li class='gchoice gchoice_74_54_0'>\n\t\t\t\t<input name='input_54' type='radio' value='Yes'  id='choice_74_54_0'    \/>\n\t\t\t\t<label for='choice_74_54_0' id='label_74_54_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_54_1'>\n\t\t\t\t<input name='input_54' type='radio' value='No'  id='choice_74_54_1'    \/>\n\t\t\t\t<label for='choice_74_54_1' id='label_74_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_74_59' 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_74_59' 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_74_4' class='gform_page' data-js='page-field-id-59' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_74_4' class='gform_fields top_label form_sublabel_above description_above validation_below'><li id=\"field_74_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Program Information<\/h2><\/li><li id=\"field_74_60\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you participated in any other IBE programs?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_60'>\n\t\t\t<li class='gchoice gchoice_74_60_0'>\n\t\t\t\t<input name='input_60' type='radio' value='Yes'  id='choice_74_60_0'    \/>\n\t\t\t\t<label for='choice_74_60_0' id='label_74_60_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_60_1'>\n\t\t\t\t<input name='input_60' type='radio' value='No'  id='choice_74_60_1'    \/>\n\t\t\t\t<label for='choice_74_60_1' id='label_74_60_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_61'>If yes, in which programs have you participated?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_74_61' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_74_62\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >If this is your first IBE program, how did you hear about us?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_74_62'>Please check all that apply<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_74_62'><li class='gchoice gchoice_74_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='IBE Event'  id='choice_74_62_1'   aria-describedby=\"gfield_description_74_62\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_1' id='label_74_62_1' class='gform-field-label gform-field-label--type-inline'>IBE Event<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.2' type='checkbox'  value='Church'  id='choice_74_62_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_2' id='label_74_62_2' class='gform-field-label gform-field-label--type-inline'>Church<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.3' type='checkbox'  value='Community Event\/Organization'  id='choice_74_62_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_3' id='label_74_62_3' class='gform-field-label gform-field-label--type-inline'>Community Event\/Organization<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.4' type='checkbox'  value='PAA'  id='choice_74_62_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_4' id='label_74_62_4' class='gform-field-label gform-field-label--type-inline'>PAA<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.5' type='checkbox'  value='Newspaper'  id='choice_74_62_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_5' id='label_74_62_5' class='gform-field-label gform-field-label--type-inline'>Newspaper<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.6' type='checkbox'  value='Radio'  id='choice_74_62_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_6' id='label_74_62_6' class='gform-field-label gform-field-label--type-inline'>Radio<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.7' type='checkbox'  value='School'  id='choice_74_62_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_7' id='label_74_62_7' class='gform-field-label gform-field-label--type-inline'>School<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.8' type='checkbox'  value='Social Media'  id='choice_74_62_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_8' id='label_74_62_8' class='gform-field-label gform-field-label--type-inline'>Social Media<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.9' type='checkbox'  value='TV'  id='choice_74_62_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_9' id='label_74_62_9' class='gform-field-label gform-field-label--type-inline'>TV<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.11' type='checkbox'  value='Walk-In'  id='choice_74_62_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_11' id='label_74_62_11' class='gform-field-label gform-field-label--type-inline'>Walk-In<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.12' type='checkbox'  value='Website'  id='choice_74_62_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_12' id='label_74_62_12' class='gform-field-label gform-field-label--type-inline'>Website<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_62_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.13' type='checkbox'  value='Other'  id='choice_74_62_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_62_13' id='label_74_62_13' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_63'>If &quot;other&quot; please specify:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_74_63' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_74_65' 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_74_65' 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_74_5' class='gform_page' data-js='page-field-id-65' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_74_5' class='gform_fields top_label form_sublabel_above description_above validation_below'><li id=\"field_74_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Confidential Information<\/h2><div class='gsection_description' id='gfield_description_74_64'>The following information is <strong>REQUIRED<\/strong> for IBE to obtain funding as a Non-Profit Organization. Names are never used and the information is completely confidential.  Your cooperation in providing this information is both appreciated and necessary.\t<\/div><\/li><li id=\"field_74_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Parent\/guardian Employment Status:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_66'>\n\t\t\t<li class='gchoice gchoice_74_66_0'>\n\t\t\t\t<input name='input_66' type='radio' value='Employed Full-Time (35 hours or more per week)'  id='choice_74_66_0'    \/>\n\t\t\t\t<label for='choice_74_66_0' id='label_74_66_0' class='gform-field-label gform-field-label--type-inline'>Employed Full-Time (35 hours or more per week)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_66_1'>\n\t\t\t\t<input name='input_66' type='radio' value='Employed Part-Time (Less than 35 hours per week)'  id='choice_74_66_1'    \/>\n\t\t\t\t<label for='choice_74_66_1' id='label_74_66_1' class='gform-field-label gform-field-label--type-inline'>Employed Part-Time (Less than 35 hours per week)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_66_2'>\n\t\t\t\t<input name='input_66' type='radio' value='Unemployed (seeking employment)'  id='choice_74_66_2'    \/>\n\t\t\t\t<label for='choice_74_66_2' id='label_74_66_2' class='gform-field-label gform-field-label--type-inline'>Unemployed (seeking employment)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_66_3'>\n\t\t\t\t<input name='input_66' type='radio' value='Not in the workforce (homemaker, disabled, or retired)'  id='choice_74_66_3'    \/>\n\t\t\t\t<label for='choice_74_66_3' id='label_74_66_3' class='gform-field-label gform-field-label--type-inline'>Not in the workforce (homemaker, disabled, or retired)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_66_4'>\n\t\t\t\t<input name='input_66' type='radio' value='Other (entrepreneur or business owner)'  id='choice_74_66_4'    \/>\n\t\t\t\t<label for='choice_74_66_4' id='label_74_66_4' class='gform-field-label gform-field-label--type-inline'>Other (entrepreneur or business owner)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_87\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Parents Education Level<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_74_87'>Please indicate your highest level of education<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_87'>\n\t\t\t<li class='gchoice gchoice_74_87_0'>\n\t\t\t\t<input name='input_87' type='radio' value='High School Diploma or Equivilent'  id='choice_74_87_0'    \/>\n\t\t\t\t<label for='choice_74_87_0' id='label_74_87_0' class='gform-field-label gform-field-label--type-inline'>High School Diploma or Equivilent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_87_1'>\n\t\t\t\t<input name='input_87' type='radio' value='Associate Degree'  id='choice_74_87_1'    \/>\n\t\t\t\t<label for='choice_74_87_1' id='label_74_87_1' class='gform-field-label gform-field-label--type-inline'>Associate Degree<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_87_2'>\n\t\t\t\t<input name='input_87' type='radio' value='Bachelors Degree'  id='choice_74_87_2'    \/>\n\t\t\t\t<label for='choice_74_87_2' id='label_74_87_2' class='gform-field-label gform-field-label--type-inline'>Bachelors Degree<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_87_3'>\n\t\t\t\t<input name='input_87' type='radio' value='Advanced Degree (Master, Ph. D or Law)'  id='choice_74_87_3'    \/>\n\t\t\t\t<label for='choice_74_87_3' id='label_74_87_3' class='gform-field-label gform-field-label--type-inline'>Advanced Degree (Master, Ph. D or Law)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_67\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_67'>Total number of individuals living in household:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_67' id='input_74_67' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_74_68\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does the applicant receive Free or Reduced lunch?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_74_68'>\n\t\t\t<li class='gchoice gchoice_74_68_0'>\n\t\t\t\t<input name='input_68' type='radio' value='Yes'  id='choice_74_68_0'    \/>\n\t\t\t\t<label for='choice_74_68_0' id='label_74_68_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_74_68_1'>\n\t\t\t\t<input name='input_68' type='radio' value='No'  id='choice_74_68_1'    \/>\n\t\t\t\t<label for='choice_74_68_1' id='label_74_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_74_69\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_69'>Annual Household Income:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_69' id='input_74_69' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_74_70\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_2col gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Check all programs that apply:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_74_70'>Please check all that apply<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_74_70'><li class='gchoice gchoice_74_70_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.1' type='checkbox'  value='TANF'  id='choice_74_70_1'   aria-describedby=\"gfield_description_74_70\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_1' id='label_74_70_1' class='gform-field-label gform-field-label--type-inline'>TANF<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_70_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.2' type='checkbox'  value='Food Stamps'  id='choice_74_70_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_2' id='label_74_70_2' class='gform-field-label gform-field-label--type-inline'>Food Stamps<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_70_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.3' type='checkbox'  value='Medicaid'  id='choice_74_70_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_3' id='label_74_70_3' class='gform-field-label gform-field-label--type-inline'>Medicaid<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_70_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.4' type='checkbox'  value='SSI'  id='choice_74_70_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_4' id='label_74_70_4' class='gform-field-label gform-field-label--type-inline'>SSI<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_70_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.5' type='checkbox'  value='SSDI'  id='choice_74_70_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_5' id='label_74_70_5' class='gform-field-label gform-field-label--type-inline'>SSDI<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_70_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.6' type='checkbox'  value='Veterans Compensation'  id='choice_74_70_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_6' id='label_74_70_6' class='gform-field-label gform-field-label--type-inline'>Veterans Compensation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_70_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.7' type='checkbox'  value='Unemployment Compensation'  id='choice_74_70_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_7' id='label_74_70_7' class='gform-field-label gform-field-label--type-inline'>Unemployment Compensation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_74_70_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.8' type='checkbox'  value='None'  id='choice_74_70_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_70_8' id='label_74_70_8' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_74_72' 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_74_72' 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_74_6' class='gform_page' data-js='page-field-id-72' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_74_6' class='gform_fields top_label form_sublabel_above description_above validation_below'><li id=\"field_74_89\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Academic Records and General Release<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description gfield_consent_description' id='gfield_consent_description_74_89' tabindex='0'>Academic Records and General Release: I hereby give permission for my child, named above, to attend and participate in the IBE programs, activities and initiatives. For the purposes of marketing IBE programs, I hereby give permission for my child to be photographed and\/or recorded. I also hereby give my permission for Indiana Black Expo, Inc., to secure copies of grades, attendance, discipline referral, suspension information, and school counselor\u2019s reports from my child\u2019s school. Student information collected by IBE from various vehicles is private and confidential. The data collected as well as the work product created is the sole property of IBE. <br \/>\n<\/div><div class='ginput_container ginput_container_consent'><input name='input_89.1' id='input_74_89_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_74_89\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_74_89_1' >I agree to the terms of the Academid Records and General Release<\/label><input type='hidden' name='input_89.2' value='I agree to the terms of the Academid Records and General Release' class='gform_hidden' \/><input type='hidden' name='input_89.3' value='23' class='gform_hidden' \/><\/div><\/li><li id=\"field_74_90\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Medical Release<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description gfield_consent_description' id='gfield_consent_description_74_90' tabindex='0'>Medical Release: I am the natural parent or legal guardian having custody of said child. In consideration of my child participating in IBE programs, I hereby voluntarily release and agree to hold harmless and indemnify IBE, each of its directors, officers, employees, volunteers and its partner organizations, or of said child. In the event that I cannot be reached in an emergency, I hereby give permission to the IBE staff\/volunteer(s) to order x-rays, routine tests, treatment, to release any records necessary for insurance purposes and to provide or arrange necessary related transportation for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician or nurse selected by IBE staff\/volunteer(s) to secure and administer treatment including hospitalization for the youth listed above. I do hereby agree to hold free from any and all liability all respective officers, employees and members. I hereby on behalf of my child waive, release and forever discharge any and all rights and claims for damages w<\/div><div class='ginput_container ginput_container_consent'><input name='input_90.1' id='input_74_90_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_74_90\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_74_90_1' >I agree to the terms of the Medical Release<\/label><input type='hidden' name='input_90.2' value='I agree to the terms of the Medical Release' class='gform_hidden' \/><input type='hidden' name='input_90.3' value='23' class='gform_hidden' \/><\/div><\/li><li id=\"field_74_91\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_91'>Parent Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_74_91_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_74_91_valid' id='input_74_91_valid' \/><canvas id='input_74_91' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/www.indianablackexpo.com\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_74_91_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_74_91_resetbutton' src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\" 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style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ class=\"lazyload\" ><\/div><input type='hidden' id='input_74_91_data' name='input_74_91_data' value=''><\/div><\/li><li id=\"field_74_95\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_95'>Email<\/label><div class='gfield_description' id='gfield_description_74_95'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_95' id='input_74_95' type='text' value='' autocomplete='new-password'\/><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_74' class='gform_previous_button gform-theme-button gform-theme-button--secondary 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