{"id":6304,"date":"2020-08-26T12:36:28","date_gmt":"2020-08-26T17:36:28","guid":{"rendered":"https:\/\/uamscaregiving.org\/springdale\/?page_id=6304"},"modified":"2026-02-06T13:43:56","modified_gmt":"2026-02-06T19:43:56","slug":"sts","status":"publish","type":"page","link":"https:\/\/uamscaregiving.org\/springdale\/sts\/","title":{"rendered":"Student Trainee Survey"},"content":{"rendered":"<p>Here is a survey we ask that you complete.\u00a0 There are 2 pages.\u00a0 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_71' ><div id='gf_71' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_71'  action='\/springdale\/wp-json\/wp\/v2\/pages\/6304#gf_71' data-formid='71' novalidate>\n        <div id='gf_progressbar_wrapper_71' 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'>2<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_71_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_71' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_71_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_71_23\" ><label class='gfield_label gform-field-label' for='input_71_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_71_23'><strong><i>(MM\/DD\/YYYY)<\/i><\/strong><\/div><div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_71_23_dmessage' name='input_23' id='input_71_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_71_23_date_format gfield_description_71_23\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_71_23_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_71_23' class='gform_hidden' value='https:\/\/uamscaregiving.org\/springdale\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_71_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_71_20\" ><label class='gfield_label gform-field-label' >What is your age range?<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_71_20'>\n\t\t\t<li class='gchoice gchoice_71_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='17 or younger'  id='choice_71_20_0'    \/>\n\t\t\t\t<label for='choice_71_20_0' id='label_71_20_0' class='gform-field-label gform-field-label--type-inline'>17 or younger<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='18-20'  id='choice_71_20_1'    \/>\n\t\t\t\t<label for='choice_71_20_1' id='label_71_20_1' class='gform-field-label gform-field-label--type-inline'>18-20<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_20_2'>\n\t\t\t\t<input name='input_20' type='radio' value='21-29'  id='choice_71_20_2'    \/>\n\t\t\t\t<label for='choice_71_20_2' id='label_71_20_2' class='gform-field-label gform-field-label--type-inline'>21-29<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_20_3'>\n\t\t\t\t<input name='input_20' type='radio' value='30-39'  id='choice_71_20_3'    \/>\n\t\t\t\t<label for='choice_71_20_3' id='label_71_20_3' class='gform-field-label gform-field-label--type-inline'>30-39<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_20_4'>\n\t\t\t\t<input name='input_20' type='radio' value='40-49'  id='choice_71_20_4'    \/>\n\t\t\t\t<label for='choice_71_20_4' id='label_71_20_4' class='gform-field-label gform-field-label--type-inline'>40-49<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_20_5'>\n\t\t\t\t<input name='input_20' type='radio' value='50-59'  id='choice_71_20_5'    \/>\n\t\t\t\t<label for='choice_71_20_5' id='label_71_20_5' class='gform-field-label gform-field-label--type-inline'>50-59<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_20_6'>\n\t\t\t\t<input name='input_20' type='radio' value='60 or older'  id='choice_71_20_6'    \/>\n\t\t\t\t<label for='choice_71_20_6' id='label_71_20_6' class='gform-field-label gform-field-label--type-inline'>60 or older<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_71_21\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_71_21\" ><label class='gfield_label gform-field-label' >What is the highest level of education\/training you have completed or the highest degree you have received?<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_71_21'>\n\t\t\t<li class='gchoice gchoice_71_21_0'>\n\t\t\t\t<input name='input_21' type='radio' value='Less than high school'  id='choice_71_21_0'    \/>\n\t\t\t\t<label for='choice_71_21_0' id='label_71_21_0' class='gform-field-label gform-field-label--type-inline'>Less than high school<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_21_1'>\n\t\t\t\t<input name='input_21' type='radio' value='High school diploma or equivalent (e.g., GED)'  id='choice_71_21_1'    \/>\n\t\t\t\t<label for='choice_71_21_1' id='label_71_21_1' class='gform-field-label gform-field-label--type-inline'>High school diploma or equivalent (e.g., GED)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_21_2'>\n\t\t\t\t<input name='input_21' type='radio' value='Some college but no degree'  id='choice_71_21_2'    \/>\n\t\t\t\t<label for='choice_71_21_2' id='label_71_21_2' class='gform-field-label gform-field-label--type-inline'>Some college but no degree<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_21_3'>\n\t\t\t\t<input name='input_21' type='radio' value='Associate degree'  id='choice_71_21_3'    \/>\n\t\t\t\t<label for='choice_71_21_3' id='label_71_21_3' 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_71_21_4'>\n\t\t\t\t<input name='input_21' type='radio' value='Bachelor&#039;s degree or higher'  id='choice_71_21_4'    \/>\n\t\t\t\t<label for='choice_71_21_4' id='label_71_21_4' class='gform-field-label gform-field-label--type-inline'>Bachelor's degree or higher<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_71_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_71_24\" ><label class='gfield_label gform-field-label' >What is your ethnicity?<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_71_24'>\n\t\t\t<li class='gchoice gchoice_71_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='American Indian or Alaskan Native'  id='choice_71_24_0'    \/>\n\t\t\t\t<label for='choice_71_24_0' id='label_71_24_0' class='gform-field-label gform-field-label--type-inline'>American Indian or Alaskan Native<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='Asian or Pacific Islander'  id='choice_71_24_1'    \/>\n\t\t\t\t<label for='choice_71_24_1' id='label_71_24_1' class='gform-field-label gform-field-label--type-inline'>Asian or Pacific Islander<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_24_2'>\n\t\t\t\t<input name='input_24' type='radio' value='Black or African-American'  id='choice_71_24_2'    \/>\n\t\t\t\t<label for='choice_71_24_2' id='label_71_24_2' class='gform-field-label gform-field-label--type-inline'>Black or African-American<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_24_3'>\n\t\t\t\t<input name='input_24' type='radio' value='Hispanic or Latino'  id='choice_71_24_3'    \/>\n\t\t\t\t<label for='choice_71_24_3' id='label_71_24_3' class='gform-field-label gform-field-label--type-inline'>Hispanic or Latino<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_24_4'>\n\t\t\t\t<input name='input_24' type='radio' value='White or Caucasian'  id='choice_71_24_4'    \/>\n\t\t\t\t<label for='choice_71_24_4' id='label_71_24_4' class='gform-field-label gform-field-label--type-inline'>White or Caucasian<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_24_5'>\n\t\t\t\t<input name='input_24' type='radio' value='Prefer not to answer'  id='choice_71_24_5'    \/>\n\t\t\t\t<label for='choice_71_24_5' id='label_71_24_5' class='gform-field-label gform-field-label--type-inline'>Prefer not to answer<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_24_6'>\n\t\t\t\t<input name='input_24' type='radio' value='gf_other_choice'  id='choice_71_24_6'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_71_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_71_40\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_71_40\" ><label class='gfield_label gform-field-label' for='input_71_40'>In what zip code is your home located? (enter 5-digit ZIP code; e.g., 00544 or 94305)<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_text'><input name='input_40' id='input_71_40' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_71_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_71_25\" ><label class='gfield_label gform-field-label' >How convenient is our location for you?<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_71_25'>\n\t\t\t<li class='gchoice gchoice_71_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='Extremely convenient'  id='choice_71_25_0'    \/>\n\t\t\t\t<label for='choice_71_25_0' id='label_71_25_0' class='gform-field-label gform-field-label--type-inline'>Extremely convenient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='Very convenient'  id='choice_71_25_1'    \/>\n\t\t\t\t<label for='choice_71_25_1' id='label_71_25_1' class='gform-field-label gform-field-label--type-inline'>Very convenient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_25_2'>\n\t\t\t\t<input name='input_25' type='radio' value='Moderately convenient'  id='choice_71_25_2'    \/>\n\t\t\t\t<label for='choice_71_25_2' id='label_71_25_2' class='gform-field-label gform-field-label--type-inline'>Moderately convenient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_25_3'>\n\t\t\t\t<input name='input_25' type='radio' value='Slightly convenient'  id='choice_71_25_3'    \/>\n\t\t\t\t<label for='choice_71_25_3' id='label_71_25_3' class='gform-field-label gform-field-label--type-inline'>Slightly convenient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_25_4'>\n\t\t\t\t<input name='input_25' type='radio' value='Not at all convenient'  id='choice_71_25_4'    \/>\n\t\t\t\t<label for='choice_71_25_4' id='label_71_25_4' class='gform-field-label gform-field-label--type-inline'>Not at all convenient<\/label>\n\t\t\t<\/li><\/ul><\/div><\/fieldset><\/li><li id=\"field_71_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_71_26\" ><label class='gfield_label gform-field-label' >How did you hear about the Schmieding Center for Senior Health and Education training classes?<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_71_26'>\n\t\t\t<li class='gchoice gchoice_71_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Internet\/Web search'  id='choice_71_26_0'    \/>\n\t\t\t\t<label for='choice_71_26_0' id='label_71_26_0' class='gform-field-label gform-field-label--type-inline'>Internet\/Web search<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='Through an agency who hires caregivers'  id='choice_71_26_1'    \/>\n\t\t\t\t<label for='choice_71_26_1' id='label_71_26_1' class='gform-field-label gform-field-label--type-inline'>Through an agency who hires caregivers<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_26_2'>\n\t\t\t\t<input name='input_26' type='radio' value='Word of mouth'  id='choice_71_26_2'    \/>\n\t\t\t\t<label for='choice_71_26_2' id='label_71_26_2' class='gform-field-label gform-field-label--type-inline'>Word of mouth<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_26_3'>\n\t\t\t\t<input name='input_26' type='radio' value='gf_other_choice'  id='choice_71_26_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_71_26_other' name='input_26_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_71_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_71_36\" ><label class='gfield_label gform-field-label' >What is your preference for class schedules?<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_71_36'>\n\t\t\t<li class='gchoice gchoice_71_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='8:30am - 1pm daily (7 weeks of classes)'  id='choice_71_36_0'    \/>\n\t\t\t\t<label for='choice_71_36_0' id='label_71_36_0' class='gform-field-label gform-field-label--type-inline'>8:30am - 1pm daily (7 weeks of classes)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='8:30am - 2pm daily (6 weeks of classes)'  id='choice_71_36_1'    \/>\n\t\t\t\t<label for='choice_71_36_1' id='label_71_36_1' class='gform-field-label gform-field-label--type-inline'>8:30am - 2pm daily (6 weeks of classes)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_36_2'>\n\t\t\t\t<input name='input_36' type='radio' value='8:30am - 3pm daily (5 weeks of classes)'  id='choice_71_36_2'    \/>\n\t\t\t\t<label for='choice_71_36_2' id='label_71_36_2' class='gform-field-label gform-field-label--type-inline'>8:30am - 3pm daily (5 weeks of classes)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_36_3'>\n\t\t\t\t<input name='input_36' type='radio' value='8:30am - 4pm daily (4.5 weeks of classes)'  id='choice_71_36_3'    \/>\n\t\t\t\t<label for='choice_71_36_3' id='label_71_36_3' class='gform-field-label gform-field-label--type-inline'>8:30am - 4pm daily (4.5 weeks of classes)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_36_4'>\n\t\t\t\t<input name='input_36' type='radio' value='8:30am - 5pm daily (3.5 to 4 weeks of classes)'  id='choice_71_36_4'    \/>\n\t\t\t\t<label for='choice_71_36_4' id='label_71_36_4' class='gform-field-label gform-field-label--type-inline'>8:30am - 5pm daily (3.5 to 4 weeks of classes)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_36_5'>\n\t\t\t\t<input name='input_36' type='radio' value='gf_other_choice'  id='choice_71_36_5'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_71_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><li id=\"field_71_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_71_27\" ><label class='gfield_label gform-field-label' >How did you pay for 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_71_27'>\n\t\t\t<li class='gchoice gchoice_71_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Self-pay'  id='choice_71_27_0'    \/>\n\t\t\t\t<label for='choice_71_27_0' id='label_71_27_0' class='gform-field-label gform-field-label--type-inline'>Self-pay<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Agency sponsorship'  id='choice_71_27_1'    \/>\n\t\t\t\t<label for='choice_71_27_1' id='label_71_27_1' class='gform-field-label gform-field-label--type-inline'>Agency sponsorship<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_27_2'>\n\t\t\t\t<input name='input_27' type='radio' value='Scholarship'  id='choice_71_27_2'    \/>\n\t\t\t\t<label for='choice_71_27_2' id='label_71_27_2' class='gform-field-label gform-field-label--type-inline'>Scholarship<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_27_3'>\n\t\t\t\t<input name='input_27' type='radio' value='Combination of above options'  id='choice_71_27_3'    \/>\n\t\t\t\t<label for='choice_71_27_3' id='label_71_27_3' class='gform-field-label gform-field-label--type-inline'>Combination of above options<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_71_27_4'>\n\t\t\t\t<input name='input_27' type='radio' value='gf_other_choice'  id='choice_71_27_4'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_71_27_other' name='input_27_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_71_38' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_71\").val(\"2\");  jQuery(\"#gform_71\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_71\").val(\"2\");  jQuery(\"#gform_71\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_71_2' class='gform_page' data-js='page-field-id-38' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_71_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_71_39\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_71_39\" ><label class='gfield_label gform-field-label' for='input_71_39'>Are there other aging education topics you suggest for our program?<\/label><div class='gfield_description' id='gfield_description_71_39'><strong><i>Please begin on a new line and number each new item. <\/strong><\/i><\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_39' id='input_71_39' class='textarea medium'  aria-describedby=\"gfield_description_71_39\"  placeholder='1. Replace this example with your new item.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_71_11\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_71_11\" ><label class='gfield_label gform-field-label' for='input_71_11'>Are there other comments, questions, or suggestions you would like to share?<\/label><div class='gfield_description' id='gfield_description_71_11'><strong><i>Begin on a new line and number each new item. <\/strong><\/i><\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_71_11' class='textarea medium'  aria-describedby=\"gfield_description_71_11\"  placeholder='1. 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