{"id":9751,"date":"2024-08-07T16:34:54","date_gmt":"2024-08-07T21:34:54","guid":{"rendered":"https:\/\/uamscaregiving.org\/springdale\/?page_id=9751"},"modified":"2024-08-07T16:34:54","modified_gmt":"2024-08-07T21:34:54","slug":"hctcr","status":"publish","type":"page","link":"https:\/\/uamscaregiving.org\/springdale\/hctcr\/","title":{"rendered":"Home Caregiver Training Class Registration"},"content":{"rendered":"<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 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class='gform_page_fields'><div id='gform_fields_349' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_349_23\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_23\" ><label class='gfield_label gform-field-label' for='input_349_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_349_23'><strong><i>(MM\/DD\/YYYY)<\/i><\/strong><\/div><div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_349_23_dmessage' name='input_23' 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data-js-reload=\"field_349_18\" ><label class='gfield_label gform-field-label' for='input_349_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_349_18'><strong><i>(MM\/DD\/YYYY)<\/i><\/strong><\/div><div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_349_18_dmessage' name='input_18' id='input_349_18' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_349_18_date_format gfield_description_349_18\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_349_18_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_349_18' class='gform_hidden' value='https:\/\/uamscaregiving.org\/springdale\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_349_46\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_46\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_349_46'>\n                            \n                            <span id='input_349_46_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_46.3' id='input_349_46_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_349_46_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_349_46_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_46.6' id='input_349_46_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_349_46_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><\/fieldset><div id=\"field_349_47\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_47\" ><label class='gfield_label gform-field-label' for='input_349_47'>Email<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_email'>\n                            <input name='input_47' id='input_349_47' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_349_48\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_48\" ><label class='gfield_label gform-field-label' for='input_349_48'>Phone<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_phone'><input name='input_48' id='input_349_48' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_349_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_49\" ><label class='gfield_label gform-field-label' for='input_349_49'>Email<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_49' id='input_349_49' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_349_50\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_50\" ><label class='gfield_label gform-field-label' for='input_349_50'>Phone<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_phone'><input name='input_50' id='input_349_50' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_349_51\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_51\" ><label class='gfield_label gform-field-label' for='input_349_51'>Residence County<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_select'><select name='input_51' id='input_349_51' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Benton' >Benton<\/option><option value='Washington' >Washington<\/option><option value='Baxter' >Baxter<\/option><option value='Boone' >Boone<\/option><option value='Carroll' >Carroll<\/option><option value='Izard' >Izard<\/option><option value='Marion' >Marion<\/option><option value='Newton' >Newton<\/option><option value='Searcy' >Searcy<\/option><option value='Stone' >Stone<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_349_52\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_52\" ><label class='gfield_label gform-field-label' for='input_349_52'>Profession<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_select'><select name='input_52' id='input_349_52' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Public\/Community' >Public\/Community<\/option><option value='Dietician' >Dietician<\/option><option value='Medical Student' >Medical Student<\/option><option value='Nursing' >Nursing<\/option><option value='Nursing Home Administration' >Nursing Home Administration<\/option><option value='Paraprofessional' >Paraprofessional<\/option><option value='Patient' >Patient<\/option><option value='Physical Therapy' >Physical Therapy<\/option><option value='Physician' >Physician<\/option><option value='Resident' >Resident<\/option><option value='Social Work' >Social Work<\/option><option value='Student' >Student<\/option><\/select><\/div><\/div><div id=\"field_349_53\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_53\" ><label class='gfield_label gform-field-label' for='input_349_53'>Gender<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_select'><select name='input_53' id='input_349_53' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='First Choice' >First Choice<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_349_54\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_54\" ><label class='gfield_label gform-field-label' for='input_349_54'>Race<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_select'><select name='input_54' id='input_349_54' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='African-American' >African-American<\/option><option value='American Indian' >American Indian<\/option><option value='Asian\/Pacific Islander' >Asian\/Pacific Islander<\/option><option value='Caucasian' >Caucasian<\/option><option value='Hispanic' >Hispanic<\/option><option value='Middle Eastern' >Middle Eastern<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><fieldset id=\"field_349_56\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_56\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >How did you learn of this program?<\/legend><div class='gfield_description' id='gfield_description_349_56'>(check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_349_56'><div class='gchoice gchoice_349_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.1' type='checkbox'  value='Facebook'  id='choice_349_56_1'   aria-describedby=\"gfield_description_349_56\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_349_56_1' id='label_349_56_1' class='gform-field-label gform-field-label--type-inline'>Facebook<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_56_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.2' type='checkbox'  value='Website'  id='choice_349_56_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_56_2' id='label_349_56_2' class='gform-field-label gform-field-label--type-inline'>Website<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_56_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.3' type='checkbox'  value='Word of mouth'  id='choice_349_56_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_56_3' id='label_349_56_3' class='gform-field-label gform-field-label--type-inline'>Word of mouth<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_56_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.4' type='checkbox'  value='My Center on Aging (Schmieding Center)'  id='choice_349_56_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_56_4' id='label_349_56_4' class='gform-field-label gform-field-label--type-inline'>My Center on Aging (Schmieding Center)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_56_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.5' type='checkbox'  value='My healthcare provider (e.g., doctor, nurse, etc.)'  id='choice_349_56_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_56_5' id='label_349_56_5' class='gform-field-label gform-field-label--type-inline'>My healthcare provider (e.g., doctor, nurse, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_56_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.6' type='checkbox'  value='Other'  id='choice_349_56_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_56_6' id='label_349_56_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_349_57' class='gform_next_button gform-theme-button button' value='Next complete the survey'  onclick='jQuery(\"#gform_target_page_number_349\").val(\"2\");  jQuery(\"#gform_349\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_349\").val(\"2\");  jQuery(\"#gform_349\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_349_2' class='gform_page' data-js='page-field-id-57' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_349_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_349_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_41\" ><strong><h4><mark>Survey data is required by our funder to offer this program at no cost to participants. Only aggregate (group) data from this survey is reported.<\/mark><\/h4><\/strong><\/div><fieldset id=\"field_349_40\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_40\" ><legend 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><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_349_40'><div class='gchoice gchoice_349_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_349_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_40_1' id='label_349_40_1' class='gform-field-label gform-field-label--type-inline'>Internet\/web search<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_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_349_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_40_2' id='label_349_40_2' class='gform-field-label gform-field-label--type-inline'>Agency referral<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_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_349_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_40_3' id='label_349_40_3' class='gform-field-label gform-field-label--type-inline'>Word of mouth<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_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_349_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_40_4' id='label_349_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<\/div><div class='gchoice gchoice_349_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_349_40_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_40_5' id='label_349_40_5' class='gform-field-label gform-field-label--type-inline'>Newspaper\/Magazine Ad<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_349_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_349_40_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_349_40_6' id='label_349_40_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_24\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_24'>\n\t\t\t<div class='gchoice gchoice_349_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='I plan to work as a paid caregiver'  id='choice_349_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_24_0' id='label_349_24_0' class='gform-field-label gform-field-label--type-inline'>I plan to work as a paid caregiver<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='I am caring for a friend or family member'  id='choice_349_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_24_1' id='label_349_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<\/div>\n\t\t\t<div class='gchoice gchoice_349_24_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='gf_other_choice'  id='choice_349_24_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_24_2' id='label_349_24_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_349_24_other' class='gchoice_other_control' name='input_24_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_36\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_36\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_36'>\n\t\t\t<div class='gchoice gchoice_349_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Yes'  id='choice_349_36_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_36_0' id='label_349_36_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='No'  id='choice_349_36_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_36_1' id='label_349_36_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_36_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Cannot judge at this time'  id='choice_349_36_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_36_2' id='label_349_36_2' class='gform-field-label gform-field-label--type-inline'>Cannot judge at this time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_36_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='gf_other_choice'  id='choice_349_36_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_36_3' id='label_349_36_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_349_36_other' class='gchoice_other_control' name='input_36_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><div id=\"field_349_42\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_42\" ><br><br><\/div><fieldset id=\"field_349_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_26\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_26'>\n\t\t\t<div class='gchoice gchoice_349_26_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Very High'  id='choice_349_26_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_26_0' id='label_349_26_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_26_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='High'  id='choice_349_26_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_26_1' id='label_349_26_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_26_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Average'  id='choice_349_26_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_26_2' id='label_349_26_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_26_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Low'  id='choice_349_26_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_26_3' id='label_349_26_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_26_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_26' type='radio' value='Very Low'  id='choice_349_26_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_26_4' id='label_349_26_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_27\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_27'>\n\t\t\t<div class='gchoice gchoice_349_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Very High'  id='choice_349_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_27_0' id='label_349_27_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='High'  id='choice_349_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_27_1' id='label_349_27_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Average'  id='choice_349_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_27_2' id='label_349_27_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Low'  id='choice_349_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_27_3' id='label_349_27_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_27_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Very Low'  id='choice_349_27_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_27_4' id='label_349_27_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_28\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_28'>\n\t\t\t<div class='gchoice gchoice_349_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Very High'  id='choice_349_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_28_0' id='label_349_28_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='High'  id='choice_349_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_28_1' id='label_349_28_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Average'  id='choice_349_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_28_2' id='label_349_28_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Low'  id='choice_349_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_28_3' id='label_349_28_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_28_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Very Low'  id='choice_349_28_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_28_4' id='label_349_28_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_28_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='No confidence'  id='choice_349_28_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_28_5' id='label_349_28_5' class='gform-field-label gform-field-label--type-inline'>No confidence<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_30\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_30'>\n\t\t\t<div class='gchoice gchoice_349_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Very High'  id='choice_349_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_30_0' id='label_349_30_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='High'  id='choice_349_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_30_1' id='label_349_30_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_30_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Average'  id='choice_349_30_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_30_2' id='label_349_30_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_30_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Low'  id='choice_349_30_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_30_3' id='label_349_30_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_30_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Very Low'  id='choice_349_30_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_30_4' id='label_349_30_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_30_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='No confidence'  id='choice_349_30_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_30_5' id='label_349_30_5' class='gform-field-label gform-field-label--type-inline'>No confidence<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_31\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_31'>\n\t\t\t<div class='gchoice gchoice_349_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Very High'  id='choice_349_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_31_0' id='label_349_31_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='High'  id='choice_349_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_31_1' id='label_349_31_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Average'  id='choice_349_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_31_2' id='label_349_31_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_31_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Low'  id='choice_349_31_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_31_3' id='label_349_31_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_31_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Very Low'  id='choice_349_31_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_31_4' id='label_349_31_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_31_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No skill'  id='choice_349_31_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_31_5' id='label_349_31_5' class='gform-field-label gform-field-label--type-inline'>No skill<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_32\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_32'>\n\t\t\t<div class='gchoice gchoice_349_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Very High'  id='choice_349_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_32_0' id='label_349_32_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='High'  id='choice_349_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_32_1' id='label_349_32_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_32_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Average'  id='choice_349_32_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_32_2' id='label_349_32_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_32_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Low'  id='choice_349_32_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_32_3' id='label_349_32_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_32_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Very Low'  id='choice_349_32_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_32_4' id='label_349_32_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_32_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='No ability'  id='choice_349_32_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_32_5' id='label_349_32_5' class='gform-field-label gform-field-label--type-inline'>No ability<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_33\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_33'>\n\t\t\t<div class='gchoice gchoice_349_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Very High'  id='choice_349_33_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_33_0' id='label_349_33_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_33_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='High'  id='choice_349_33_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_33_1' id='label_349_33_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_33_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Average'  id='choice_349_33_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_33_2' id='label_349_33_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_33_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Low'  id='choice_349_33_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_33_3' id='label_349_33_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_33_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Very Low'  id='choice_349_33_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_33_4' id='label_349_33_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_33_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='No confidence'  id='choice_349_33_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_33_5' id='label_349_33_5' class='gform-field-label gform-field-label--type-inline'>No confidence<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_34\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_34'>\n\t\t\t<div class='gchoice gchoice_349_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Very High'  id='choice_349_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_34_0' id='label_349_34_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='High'  id='choice_349_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_34_1' id='label_349_34_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_34_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Average'  id='choice_349_34_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_34_2' id='label_349_34_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_34_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Low'  id='choice_349_34_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_34_3' id='label_349_34_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_34_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Very Low'  id='choice_349_34_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_34_4' id='label_349_34_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_34_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='No ability'  id='choice_349_34_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_34_5' id='label_349_34_5' class='gform-field-label gform-field-label--type-inline'>No ability<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_35\" ><legend class='gfield_label gform-field-label' >How would you rate your current understanding of chronic disease?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\"> * <span class='sr-only'> Required<\/span><\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_35'>\n\t\t\t<div class='gchoice gchoice_349_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Very High'  id='choice_349_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_35_0' id='label_349_35_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='High'  id='choice_349_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_35_1' id='label_349_35_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_35_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Average'  id='choice_349_35_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_35_2' id='label_349_35_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_35_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Low'  id='choice_349_35_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_35_3' id='label_349_35_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_35_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Very Low'  id='choice_349_35_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_35_4' id='label_349_35_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><fieldset id=\"field_349_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_25\" ><legend 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><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_349_25'>\n\t\t\t<div class='gchoice gchoice_349_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Very High'  id='choice_349_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_25_0' id='label_349_25_0' class='gform-field-label gform-field-label--type-inline'>Very High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='High'  id='choice_349_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_25_1' id='label_349_25_1' class='gform-field-label gform-field-label--type-inline'>High<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_25_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Average'  id='choice_349_25_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_25_2' id='label_349_25_2' class='gform-field-label gform-field-label--type-inline'>Average<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_25_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Low'  id='choice_349_25_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_25_3' id='label_349_25_3' class='gform-field-label gform-field-label--type-inline'>Low<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_349_25_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Very Low'  id='choice_349_25_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_349_25_4' id='label_349_25_4' class='gform-field-label gform-field-label--type-inline'>Very Low<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/fieldset><div id=\"field_349_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_44\" ><br><br><\/div><div id=\"field_349_4\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_4\" ><label class='gfield_label gform-field-label' for='input_349_4'>Do you have comments, questions, or suggestions about the registration process for this class?<\/label><div class='gfield_description' id='gfield_description_349_4'><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_4' id='input_349_4' class='textarea medium'  aria-describedby=\"gfield_description_349_4\"  placeholder='1. Replace this example with your new item.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_349_39\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_39\" ><label class='gfield_label gform-field-label' for='input_349_39'>Are there other aging education topics you suggest for our program?<\/label><div class='gfield_description' id='gfield_description_349_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_349_39' class='textarea medium'  aria-describedby=\"gfield_description_349_39\"  placeholder='1. Replace this example with your new item.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_349_11\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_349_11\" ><label class='gfield_label gform-field-label' for='input_349_11'>Are there other comments, questions, or suggestions you would like to share?<\/label><div class='gfield_description' id='gfield_description_349_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_349_11' class='textarea medium'  aria-describedby=\"gfield_description_349_11\"  placeholder='1. Replace this example with your new item.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_349' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_349\"]){return false;}  if( !jQuery(\"#gform_349\")[0].checkValidity || jQuery(\"#gform_349\")[0].checkValidity()){window[\"gf_submitting_349\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_349\"]){return false;} if( !jQuery(\"#gform_349\")[0].checkValidity || jQuery(\"#gform_349\")[0].checkValidity()){window[\"gf_submitting_349\"]=true;}  jQuery(\"#gform_349\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_349' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_349\"]){return false;}  if( !jQuery(\"#gform_349\")[0].checkValidity || jQuery(\"#gform_349\")[0].checkValidity()){window[\"gf_submitting_349\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_349\"]){return false;} if( !jQuery(\"#gform_349\")[0].checkValidity || jQuery(\"#gform_349\")[0].checkValidity()){window[\"gf_submitting_349\"]=true;}  jQuery(\"#gform_349\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=349&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_349' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='349' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_349' 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