{"id":6285,"date":"2020-08-25T09:27:10","date_gmt":"2020-08-25T14:27:10","guid":{"rendered":"https:\/\/uamscaregiving.org\/springdale\/?page_id=6285"},"modified":"2026-02-06T12:42:46","modified_gmt":"2026-02-06T18:42:46","slug":"cts","status":"publish","type":"page","link":"https:\/\/uamscaregiving.org\/springdale\/cts\/","title":{"rendered":"Caregiver Training Survey"},"content":{"rendered":"<p>Here is a survey you will complete <em>before<\/em> and <em>after<\/em> your class. There are three pages. Click NEXT after each page and then click SUBMIT.<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_69' ><div id='gf_69' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_69'  action='\/springdale\/wp-json\/wp\/v2\/pages\/6285#gf_69' data-formid='69' novalidate>\n        <div id='gf_progressbar_wrapper_69' 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'>4<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_69_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_69' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_69_23\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_23\" ><label class='gfield_label gform-field-label' for='input_69_23'>What is today&#039;s date?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_69_23'><strong><i>(MM\/DD\/YYYY)<\/i><\/strong><\/div><div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_69_23_dmessage' name='input_23' id='input_69_23' type='text' value='04\/25\/2026' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_69_23_date_format gfield_description_69_23\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_69_23_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_69_23' class='gform_hidden' value='https:\/\/uamscaregiving.org\/springdale\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_69_18\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_18\" ><label class='gfield_label gform-field-label' for='input_69_18'>Enter your birthday<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_69_18'><strong><i>(MM\/DD\/YYYY)<\/i><\/strong><\/div><div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_69_18_dmessage' name='input_18' id='input_69_18' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_69_18_date_format gfield_description_69_18\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_69_18_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_69_18' class='gform_hidden' value='https:\/\/uamscaregiving.org\/springdale\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_69_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_40\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >How did you hear about caregiver training classes from the Schmieding Center?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_69_40'><li class='gchoice gchoice_69_40_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Internet\/web search'  id='choice_69_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_69_40_1' id='label_69_40_1' class='gform-field-label gform-field-label--type-inline'>Internet\/web search<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_69_40_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='Agency referral'  id='choice_69_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_69_40_2' id='label_69_40_2' class='gform-field-label gform-field-label--type-inline'>Agency referral<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_69_40_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='Word of mouth'  id='choice_69_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_69_40_3' id='label_69_40_3' class='gform-field-label gform-field-label--type-inline'>Word of mouth<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_69_40_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.4' type='checkbox'  value='Sign at the Schmieding Center'  id='choice_69_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_69_40_4' id='label_69_40_4' class='gform-field-label gform-field-label--type-inline'>Sign at the Schmieding Center<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_69_40_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.5' type='checkbox'  value='Newspaper\/Magazine Ad'  id='choice_69_40_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_69_40_5' id='label_69_40_5' class='gform-field-label gform-field-label--type-inline'>Newspaper\/Magazine Ad<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_69_40_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_40.6' type='checkbox'  value='Other'  id='choice_69_40_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_69_40_6' id='label_69_40_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_20\" ><label class='gfield_label gform-field-label' >What class are you taking now?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_69_20'><strong><i>Mark the current or most recent class<\/strong><\/i><\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_20'>\n\t\t\t<li class='gchoice gchoice_69_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='In-Home Assistant'  id='choice_69_20_0'    \/>\n\t\t\t\t<label for='choice_69_20_0' id='label_69_20_0' class='gform-field-label gform-field-label--type-inline'>In-Home Assistant<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='In-Home Assistant - Independent Study'  id='choice_69_20_1'    \/>\n\t\t\t\t<label for='choice_69_20_1' id='label_69_20_1' class='gform-field-label gform-field-label--type-inline'>In-Home Assistant - Independent Study<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_20_2'>\n\t\t\t\t<input name='input_20' type='radio' value='Alzheimers\/Dementia'  id='choice_69_20_2'    \/>\n\t\t\t\t<label for='choice_69_20_2' id='label_69_20_2' class='gform-field-label gform-field-label--type-inline'>Alzheimers\/Dementia<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_20_3'>\n\t\t\t\t<input name='input_20' type='radio' value='Alzheimers\/Dementia - Independent Study'  id='choice_69_20_3'    \/>\n\t\t\t\t<label for='choice_69_20_3' id='label_69_20_3' class='gform-field-label gform-field-label--type-inline'>Alzheimers\/Dementia - Independent Study<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_20_4'>\n\t\t\t\t<input name='input_20' type='radio' value='Home Care Assistant'  id='choice_69_20_4'    \/>\n\t\t\t\t<label for='choice_69_20_4' id='label_69_20_4' class='gform-field-label gform-field-label--type-inline'>Home Care Assistant<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_20_5'>\n\t\t\t\t<input name='input_20' type='radio' value='Family Caregiver Workshop - Dementia'  id='choice_69_20_5'    \/>\n\t\t\t\t<label for='choice_69_20_5' id='label_69_20_5' class='gform-field-label gform-field-label--type-inline'>Family Caregiver Workshop - Dementia<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_20_6'>\n\t\t\t\t<input name='input_20' type='radio' value='Family Caregiver Workshop - Basic Skills'  id='choice_69_20_6'    \/>\n\t\t\t\t<label for='choice_69_20_6' id='label_69_20_6' class='gform-field-label gform-field-label--type-inline'>Family Caregiver Workshop - Basic Skills<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_20_7'>\n\t\t\t\t<input name='input_20' type='radio' value='CNA Fast Track (91 hours)'  id='choice_69_20_7'    \/>\n\t\t\t\t<label for='choice_69_20_7' id='label_69_20_7' class='gform-field-label gform-field-label--type-inline'>CNA Fast Track (91 hours)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_21\" ><label class='gfield_label gform-field-label' >Where is this class located?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='gfield_description' id='gfield_description_69_21'><strong><i>Mark the location where you are tested or demonstrate skills<\/strong><\/i><\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_21'>\n\t\t\t<li class='gchoice gchoice_69_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='at the Schmieding Center (Springdale)'  id='choice_69_21_0'    \/>\n\t\t\t\t<label for='choice_69_21_0' id='label_69_21_0' class='gform-field-label gform-field-label--type-inline'>at the Schmieding Center (Springdale)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='at the Veterans Administration'  id='choice_69_21_1'    \/>\n\t\t\t\t<label for='choice_69_21_1' id='label_69_21_1' class='gform-field-label gform-field-label--type-inline'>at the Veterans Administration<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_21_2'>\n\t\t\t\t<input name='input_21' type='radio' value='gf_other_choice'  id='choice_69_21_2'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_69_21_other' name='input_21_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_24\" ><label class='gfield_label gform-field-label' >What best describes your reason for taking this class?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_24'>\n\t\t\t<li class='gchoice gchoice_69_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='I plan to work as a paid caregiver'  id='choice_69_24_0'    \/>\n\t\t\t\t<label for='choice_69_24_0' id='label_69_24_0' class='gform-field-label gform-field-label--type-inline'>I plan to work as a paid caregiver<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='I am caring for a friend or family member'  id='choice_69_24_1'    \/>\n\t\t\t\t<label for='choice_69_24_1' id='label_69_24_1' class='gform-field-label gform-field-label--type-inline'>I am caring for a friend or family member<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_24_2'>\n\t\t\t\t<input name='input_24' type='radio' value='gf_other_choice'  id='choice_69_24_2'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_69_24_other' name='input_24_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_36\" ><label class='gfield_label gform-field-label' >Based on your current knowledge of this class, do you believe that the class content will enable you to fulfill your role as a paid or family caregiver?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_36'>\n\t\t\t<li class='gchoice gchoice_69_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='Yes'  id='choice_69_36_0'    \/>\n\t\t\t\t<label for='choice_69_36_0' id='label_69_36_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_69_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='No'  id='choice_69_36_1'    \/>\n\t\t\t\t<label for='choice_69_36_1' id='label_69_36_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_36_2'>\n\t\t\t\t<input name='input_36' type='radio' value='Cannot judge at this time'  id='choice_69_36_2'    \/>\n\t\t\t\t<label for='choice_69_36_2' id='label_69_36_2' class='gform-field-label gform-field-label--type-inline'>Cannot judge at this time<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_36_3'>\n\t\t\t\t<input name='input_36' type='radio' value='gf_other_choice'  id='choice_69_36_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_69_36_other' name='input_36_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_69_29' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_69\").val(\"2\");  jQuery(\"#gform_69\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_69\").val(\"2\");  jQuery(\"#gform_69\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_69_2' class='gform_page' data-js='page-field-id-29' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_69_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_69_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_25\" ><label class='gfield_label gform-field-label' >Which answer best describes your current level of confidence caring for an older adult?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_25'>\n\t\t\t<li class='gchoice gchoice_69_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='Very High'  id='choice_69_25_0'    \/>\n\t\t\t\t<label for='choice_69_25_0' id='label_69_25_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='High'  id='choice_69_25_1'    \/>\n\t\t\t\t<label for='choice_69_25_1' id='label_69_25_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_25_2'>\n\t\t\t\t<input name='input_25' type='radio' value='Average'  id='choice_69_25_2'    \/>\n\t\t\t\t<label for='choice_69_25_2' id='label_69_25_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_25_3'>\n\t\t\t\t<input name='input_25' type='radio' value='Low'  id='choice_69_25_3'    \/>\n\t\t\t\t<label for='choice_69_25_3' id='label_69_25_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_25_4'>\n\t\t\t\t<input name='input_25' type='radio' value='Very Low'  id='choice_69_25_4'    \/>\n\t\t\t\t<label for='choice_69_25_4' id='label_69_25_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_26\" ><label class='gfield_label gform-field-label' >How would you rate your current knowledge of caregiving topics?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_26'>\n\t\t\t<li class='gchoice gchoice_69_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Very High'  id='choice_69_26_0'    \/>\n\t\t\t\t<label for='choice_69_26_0' id='label_69_26_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='High'  id='choice_69_26_1'    \/>\n\t\t\t\t<label for='choice_69_26_1' id='label_69_26_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_26_2'>\n\t\t\t\t<input name='input_26' type='radio' value='Average'  id='choice_69_26_2'    \/>\n\t\t\t\t<label for='choice_69_26_2' id='label_69_26_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_26_3'>\n\t\t\t\t<input name='input_26' type='radio' value='Low'  id='choice_69_26_3'    \/>\n\t\t\t\t<label for='choice_69_26_3' id='label_69_26_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_26_4'>\n\t\t\t\t<input name='input_26' type='radio' value='Very Low'  id='choice_69_26_4'    \/>\n\t\t\t\t<label for='choice_69_26_4' id='label_69_26_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_27\" ><label class='gfield_label gform-field-label' >How would you rate your current understanding about aging topics?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_27'>\n\t\t\t<li class='gchoice gchoice_69_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Very High'  id='choice_69_27_0'    \/>\n\t\t\t\t<label for='choice_69_27_0' id='label_69_27_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='High'  id='choice_69_27_1'    \/>\n\t\t\t\t<label for='choice_69_27_1' id='label_69_27_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_27_2'>\n\t\t\t\t<input name='input_27' type='radio' value='Average'  id='choice_69_27_2'    \/>\n\t\t\t\t<label for='choice_69_27_2' id='label_69_27_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_27_3'>\n\t\t\t\t<input name='input_27' type='radio' value='Low'  id='choice_69_27_3'    \/>\n\t\t\t\t<label for='choice_69_27_3' id='label_69_27_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_27_4'>\n\t\t\t\t<input name='input_27' type='radio' value='Very Low'  id='choice_69_27_4'    \/>\n\t\t\t\t<label for='choice_69_27_4' id='label_69_27_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_69_37' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_69\").val(\"1\");  jQuery(\"#gform_69\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_69\").val(\"1\");  jQuery(\"#gform_69\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_69_37' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_69\").val(\"3\");  jQuery(\"#gform_69\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_69\").val(\"3\");  jQuery(\"#gform_69\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_69_3' class='gform_page' data-js='page-field-id-37' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_69_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_69_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_28\" ><label class='gfield_label gform-field-label' >How confident are you using a gait belt?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_28'>\n\t\t\t<li class='gchoice gchoice_69_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='Very High'  id='choice_69_28_0'    \/>\n\t\t\t\t<label for='choice_69_28_0' id='label_69_28_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='High'  id='choice_69_28_1'    \/>\n\t\t\t\t<label for='choice_69_28_1' id='label_69_28_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_28_2'>\n\t\t\t\t<input name='input_28' type='radio' value='Average'  id='choice_69_28_2'    \/>\n\t\t\t\t<label for='choice_69_28_2' id='label_69_28_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_28_3'>\n\t\t\t\t<input name='input_28' type='radio' value='Low'  id='choice_69_28_3'    \/>\n\t\t\t\t<label for='choice_69_28_3' id='label_69_28_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_28_4'>\n\t\t\t\t<input name='input_28' type='radio' value='Very Low'  id='choice_69_28_4'    \/>\n\t\t\t\t<label for='choice_69_28_4' id='label_69_28_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_28_5'>\n\t\t\t\t<input name='input_28' type='radio' value='No confidence'  id='choice_69_28_5'    \/>\n\t\t\t\t<label for='choice_69_28_5' id='label_69_28_5' class='gform-field-label gform-field-label--type-inline'>No confidence<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_30\" ><label class='gfield_label gform-field-label' >How confident are you giving a bath to an immobile person?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_30'>\n\t\t\t<li class='gchoice gchoice_69_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='Very High'  id='choice_69_30_0'    \/>\n\t\t\t\t<label for='choice_69_30_0' id='label_69_30_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='High'  id='choice_69_30_1'    \/>\n\t\t\t\t<label for='choice_69_30_1' id='label_69_30_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_30_2'>\n\t\t\t\t<input name='input_30' type='radio' value='Average'  id='choice_69_30_2'    \/>\n\t\t\t\t<label for='choice_69_30_2' id='label_69_30_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_30_3'>\n\t\t\t\t<input name='input_30' type='radio' value='Low'  id='choice_69_30_3'    \/>\n\t\t\t\t<label for='choice_69_30_3' id='label_69_30_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_30_4'>\n\t\t\t\t<input name='input_30' type='radio' value='Very Low'  id='choice_69_30_4'    \/>\n\t\t\t\t<label for='choice_69_30_4' id='label_69_30_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_30_5'>\n\t\t\t\t<input name='input_30' type='radio' value='No confidence'  id='choice_69_30_5'    \/>\n\t\t\t\t<label for='choice_69_30_5' id='label_69_30_5' class='gform-field-label gform-field-label--type-inline'>No confidence<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_31\" ><label class='gfield_label gform-field-label' >Rate your current skill level in transferring a dependent person?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_31'>\n\t\t\t<li class='gchoice gchoice_69_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='Very High'  id='choice_69_31_0'    \/>\n\t\t\t\t<label for='choice_69_31_0' id='label_69_31_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='High'  id='choice_69_31_1'    \/>\n\t\t\t\t<label for='choice_69_31_1' id='label_69_31_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_31_2'>\n\t\t\t\t<input name='input_31' type='radio' value='Average'  id='choice_69_31_2'    \/>\n\t\t\t\t<label for='choice_69_31_2' id='label_69_31_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_31_3'>\n\t\t\t\t<input name='input_31' type='radio' value='Low'  id='choice_69_31_3'    \/>\n\t\t\t\t<label for='choice_69_31_3' id='label_69_31_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_31_4'>\n\t\t\t\t<input name='input_31' type='radio' value='Very Low'  id='choice_69_31_4'    \/>\n\t\t\t\t<label for='choice_69_31_4' id='label_69_31_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_31_5'>\n\t\t\t\t<input name='input_31' type='radio' value='No skill'  id='choice_69_31_5'    \/>\n\t\t\t\t<label for='choice_69_31_5' id='label_69_31_5' class='gform-field-label gform-field-label--type-inline'>No skill<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_32\" ><label class='gfield_label gform-field-label' >Rate your current ability to care for a person with memory impairment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_32'>\n\t\t\t<li class='gchoice gchoice_69_32_0'>\n\t\t\t\t<input name='input_32' type='radio' value='Very High'  id='choice_69_32_0'    \/>\n\t\t\t\t<label for='choice_69_32_0' id='label_69_32_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_32_1'>\n\t\t\t\t<input name='input_32' type='radio' value='High'  id='choice_69_32_1'    \/>\n\t\t\t\t<label for='choice_69_32_1' id='label_69_32_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_32_2'>\n\t\t\t\t<input name='input_32' type='radio' value='Average'  id='choice_69_32_2'    \/>\n\t\t\t\t<label for='choice_69_32_2' id='label_69_32_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_32_3'>\n\t\t\t\t<input name='input_32' type='radio' value='Low'  id='choice_69_32_3'    \/>\n\t\t\t\t<label for='choice_69_32_3' id='label_69_32_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_32_4'>\n\t\t\t\t<input name='input_32' type='radio' value='Very Low'  id='choice_69_32_4'    \/>\n\t\t\t\t<label for='choice_69_32_4' id='label_69_32_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_32_5'>\n\t\t\t\t<input name='input_32' type='radio' value='No ability'  id='choice_69_32_5'    \/>\n\t\t\t\t<label for='choice_69_32_5' id='label_69_32_5' class='gform-field-label gform-field-label--type-inline'>No ability<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_33\" ><label class='gfield_label gform-field-label' >How confident are you providing person-centered care for an older adult?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_33'>\n\t\t\t<li class='gchoice gchoice_69_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='Very High'  id='choice_69_33_0'    \/>\n\t\t\t\t<label for='choice_69_33_0' id='label_69_33_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='High'  id='choice_69_33_1'    \/>\n\t\t\t\t<label for='choice_69_33_1' id='label_69_33_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_33_2'>\n\t\t\t\t<input name='input_33' type='radio' value='Average'  id='choice_69_33_2'    \/>\n\t\t\t\t<label for='choice_69_33_2' id='label_69_33_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_33_3'>\n\t\t\t\t<input name='input_33' type='radio' value='Low'  id='choice_69_33_3'    \/>\n\t\t\t\t<label for='choice_69_33_3' id='label_69_33_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_33_4'>\n\t\t\t\t<input name='input_33' type='radio' value='Very Low'  id='choice_69_33_4'    \/>\n\t\t\t\t<label for='choice_69_33_4' id='label_69_33_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_69_33_5'>\n\t\t\t\t<input name='input_33' type='radio' value='No confidence'  id='choice_69_33_5'    \/>\n\t\t\t\t<label for='choice_69_33_5' id='label_69_33_5' class='gform-field-label gform-field-label--type-inline'>No confidence<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_69_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_69_34\" ><label class='gfield_label gform-field-label' >Rate your ability to dress a person who requires assistance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_69_34'>\n\t\t\t<li class='gchoice 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