{"id":1237,"date":"2020-10-16T15:21:46","date_gmt":"2020-10-16T19:21:46","guid":{"rendered":"https:\/\/achena.org\/?page_id=1237"},"modified":"2020-10-16T15:21:46","modified_gmt":"2020-10-16T19:21:46","slug":"cpd-course-approval-application","status":"publish","type":"page","link":"https:\/\/achena.org\/refresh\/forms\/cpd-course-approval-application\/","title":{"rendered":"CPD Course Approval Application"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_4' style='display:none'><div id='gf_4' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_4' id='gform_4'  action='\/refresh\/wp-json\/wp\/v2\/pages\/1237#gf_4' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_4_2\" 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\"  ><label class='gfield_label gform-field-label' >Is this a Renewal Application?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_2'>\n\t\t\t<li class='gchoice gchoice_4_2_0'>\n\t\t\t\t<input name='input_2' type='radio' value='Yes'  id='choice_4_2_0' tabindex='49'   \/>\n\t\t\t\t<label for='choice_4_2_0' id='label_4_2_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_4_2_1'>\n\t\t\t\t<input name='input_2' type='radio' value='No'  id='choice_4_2_1' tabindex='50'   \/>\n\t\t\t\t<label for='choice_4_2_1' id='label_4_2_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_3\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>The following information will be used for the ACHENA Approved Course Listing. Please complete this section exactly how you would like it to be listed on the ACHENA website.<\/p><\/li><li id=\"field_4_4\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Course Title:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_4_4' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_4\" tabindex='51'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_4_4'>Note: This course title is used to identify which other form submissions (Instructor Bio, Financial Disclosure, etc) are to be paired with this application. Please make sure the course title entered in those form submissions match the title entered here exactly. <\/div><\/li><li id=\"field_4_7\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_7'>Course Provider(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_4_7' type='text' value='' class='medium'   tabindex='52'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_6\" class=\"gfield gfield--type-text inline-desc field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_6'>Course Presenter(s)<\/label><div class='gfield_description' id='gfield_description_4_6'>(if different from provider)<\/div><div class='ginput_container ginput_container_text'><input name='input_6' id='input_4_6' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_6\" tabindex='53'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_5\" class=\"gfield gfield--type-text inline-desc field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>Course Date(s)<\/label><div class='gfield_description' id='gfield_description_4_5'>(if live)<\/div><div class='ginput_container ginput_container_text'><input name='input_5' id='input_4_5' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_5\" tabindex='54'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_8\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_8'>Course Registration link<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_4_8' type='text' value='' class='medium'   tabindex='55'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_9\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_9'>Number of CPD hours you are applying for:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_4_9' type='text' value='' class='medium'   tabindex='56'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Type of Training<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_11'>(check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_11'><li class='gchoice gchoice_4_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Live training'  id='choice_4_11_1' tabindex='57'  aria-describedby=\"gfield_description_4_11\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_11_1' id='label_4_11_1' class='gform-field-label gform-field-label--type-inline'>Live training<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Pre-Recorded Training (enduring materials or activities)'  id='choice_4_11_2' tabindex='58'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_11_2' id='label_4_11_2' class='gform-field-label gform-field-label--type-inline'>Pre-Recorded Training (enduring materials or activities)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_12\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Live Training<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_12'><li class='gchoice gchoice_4_12_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.1' type='checkbox'  value='In-person ONLY Conference\/Seminar (no online attendance)'  id='choice_4_12_1' tabindex='59'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_12_1' id='label_4_12_1' class='gform-field-label gform-field-label--type-inline'>In-person ONLY Conference\/Seminar (no online attendance)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_12_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.2' type='checkbox'  value='Live Webinar (online attendance)'  id='choice_4_12_2' tabindex='60'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_12_2' id='label_4_12_2' class='gform-field-label gform-field-label--type-inline'>Live Webinar (online attendance)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_12_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_12.3' type='checkbox'  value='In-person AND online attendance'  id='choice_4_12_3' tabindex='61'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_12_3' id='label_4_12_3' class='gform-field-label gform-field-label--type-inline'>In-person AND online attendance<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Pre-Recorded Training<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_13'><li class='gchoice gchoice_4_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Recording of live training offered subsequently'  id='choice_4_13_1' tabindex='62'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_13_1' id='label_4_13_1' class='gform-field-label gform-field-label--type-inline'>Recording of live training offered subsequently<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='Webinar'  id='choice_4_13_2' tabindex='63'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_13_2' id='label_4_13_2' class='gform-field-label gform-field-label--type-inline'>Webinar<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='CD\/DVD'  id='choice_4_13_3' tabindex='64'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_13_3' id='label_4_13_3' class='gform-field-label gform-field-label--type-inline'>CD\/DVD<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='Other'  id='choice_4_13_4' tabindex='65'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_13_4' id='label_4_13_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_14\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_14'>Other training type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_4_14' type='text' value='' class='medium'   tabindex='66'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_16\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Person responsible for Administering this Course:<\/h2><\/li><li id=\"field_4_17\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_17'>\n                            \n                            <span id='input_4_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_4_17_3' value='' tabindex='68'  aria-required='true'     \/>\n                                                    <label for='input_4_17_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_4_17_6' value='' tabindex='70'  aria-required='true'     \/>\n                                                    <label for='input_4_17_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_4_18\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_18'>Title<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_4_18' type='text' value='' class='medium'   tabindex='72'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_19\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_19' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_19_1_container' >\n                                        <input type='text' name='input_19.1' id='input_4_19_1' value='' tabindex='73'   aria-required='true'    \/>\n                                        <label for='input_4_19_1' id='input_4_19_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_19_2_container' >\n                                        <input type='text' name='input_19.2' id='input_4_19_2' value='' tabindex='74'    aria-required='false'   \/>\n                                        <label for='input_4_19_2' id='input_4_19_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_19_3_container' >\n                                    <input type='text' name='input_19.3' id='input_4_19_3' value='' tabindex='75'   aria-required='true'    \/>\n                                    <label for='input_4_19_3' id='input_4_19_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_4_19_4_container' >\n                                        <select name='input_19.4' id='input_4_19_4' tabindex='76'    aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' selected='selected'>New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_4_19_4' id='input_4_19_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_19_5_container' >\n                                    <input type='text' name='input_19.5' id='input_4_19_5' value='' tabindex='78'   aria-required='true'    \/>\n                                    <label for='input_4_19_5' id='input_4_19_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_19.6' id='input_4_19_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_4_20\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_20'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_20' id='input_4_20' type='tel' value='' class='medium' tabindex='79'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_21\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_21'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_21' id='input_4_21' type='email' value='' class='medium' tabindex='80'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_4_23\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><\/li><li id=\"field_4_79\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Human Resources<\/h2><\/li><li id=\"field_4_24\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_24'>Person responsible<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_24'>List the name of the individual responsible for administering this activity (include name & credentials)<\/div><div class='ginput_container ginput_container_text'><input name='input_24' id='input_4_24' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_24\" tabindex='81'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_26\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >CPD Planning Committee<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_26'>List the names of CPD planning committee members.  This application must include at least two individuals who served as CPD planners or faculty.  The individual named above as responsible for administering the activity may be included as a planning committee member. Please list the name, degrees, and credentials and attach a biographical data form with the additional required information. Planning Committee must include at least one person with active certification in homeopathy, such as CCH or other homeopathic credential. \n<br><br>\nPlease list name, degrees and credentials for each CPD Planning Committee member. \n<\/div><style type=\"text\/css\">\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_26_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_26_col_2' class='gfield_list_col_even' \/><col id='gfield_list_26_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_26_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Name<\/th><th scope=\"col\">Degree<\/th><th scope=\"col\">Credentials<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_26_cell1' data-label='Name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_26\" aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_26[]' value='' tabindex='82'  \/><\/td><td class='gfield_list_cell gfield_list_26_cell2' data-label='Degree'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_26\" aria-label='Degree, Row 1' data-aria-label-template='Degree, Row {0}' type='text' name='input_26[]' value='' tabindex='83'  \/><\/td><td class='gfield_list_cell gfield_list_26_cell3' data-label='Credentials'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_4_26\" aria-label='Credentials, Row 1' data-aria-label-template='Credentials, Row {0}' type='text' name='input_26[]' value='' tabindex='84'  \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/achena.org\/refresh\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/achena.org\/refresh\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_4_80\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Target Audience and Needs Assessment<\/h2><div class='gsection_description' id='gfield_description_4_80'>(use additional space as needed)<\/div><\/li><li id=\"field_4_28\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_28'>Intended\/target audience<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_4_28' type='text' value='' class='medium'   tabindex='85'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_89\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_89'>Evidence of Need<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_89'>(What evidence do you have of the continuing education need by healthcare professionals for this program? See Guidelines for further explanation.)<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_89' id='input_4_89' class='textarea medium' tabindex='86' aria-describedby=\"gfield_description_4_89\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_88\" class=\"gfield gfield--type-fileupload field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_88'>File<\/label><div class='gfield_description' id='gfield_description_4_88'>Evidence of Need - File upload (optional)<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='33554432' \/><input name='input_88' id='input_4_88' type='file' class='medium' aria-describedby=\"gfield_upload_rules_4_88 gfield_description_4_88\" onchange='javascript:gformValidateFileSize( this, 33554432 );' tabindex='87' \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_88'>Max. file size: 32 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_88'><\/div> <\/div><\/li><li id=\"field_4_30\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_30'>**For Renewals<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_30'>(Explain what evidence you have which demonstrates the continued need for this program since your previous application.)<\/div><div class='ginput_container ginput_container_text'><input name='input_30' id='input_4_30' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_30\" tabindex='88'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_90\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_90'>Professional Practice Gap<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_90'>(What is it that professionals do not know or are not doing that that this activity addresses? How did you identify this gap?)<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_90' id='input_4_90' class='textarea medium' tabindex='89' aria-describedby=\"gfield_description_4_90\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_32\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_32'>**For Renewals<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_32'>(Explain how you identify a continued professional practice gap since your previous application, which this activity addresses.)<\/div><div class='ginput_container ginput_container_text'><input name='input_32' id='input_4_32' type='text' value='' class='medium'  aria-describedby=\"gfield_description_4_32\" tabindex='90'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_81\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Educational Activity Overview<\/h2><div class='gsection_description' id='gfield_description_4_81'>Do not provide answers on this sheet - This information is completed in <a href=\"\/forms\/cpd-course-description-appendix-a\/\" target=\"_blank\">appendix A<\/a>.<\/div><\/li><li id=\"field_4_82\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Presenters\/Content Specialists<\/h2><div class='gsection_description' id='gfield_description_4_82'>List the names, degrees and\/or credentials of each presenter\/content specialist.<br>\n<strong>If they haven't already, please have each presenter\/content specialist fill out and submit the <a href=\"https:\/\/achena.org\/forms\/cpd-instructor-bio-appendix-b\/\" target=\"_blank\"><strong>Instructor Bio Form<\/strong> (Appendix B)<\/a> and <a href=\"https:\/\/achena.org\/forms\/cpd-financial-disclosure-appendix-c\/\" target=\"_blank\"><strong>Disclosure Form<\/strong> (Appendix C)<\/a>. <\/strong><\/div><\/li><li id=\"field_4_41\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Presenter(s) Name(s), Degrees and\/or Credentials<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_41_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_41_col_2' class='gfield_list_col_even' \/><col id='gfield_list_41_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_41_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Names<\/th><th scope=\"col\">Degrees<\/th><th scope=\"col\">Credentials<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_41_cell1' data-label='Names'><input aria-invalid='false' aria-required=\"true\"  aria-label='Names, Row 1' data-aria-label-template='Names, Row {0}' type='text' name='input_41[]' value='' tabindex='91'  \/><\/td><td class='gfield_list_cell gfield_list_41_cell2' data-label='Degrees'><input aria-invalid='false' aria-required=\"true\"  aria-label='Degrees, Row 1' data-aria-label-template='Degrees, Row {0}' type='text' name='input_41[]' value='' tabindex='92'  \/><\/td><td class='gfield_list_cell gfield_list_41_cell3' data-label='Credentials'><input aria-invalid='false' aria-required=\"true\"  aria-label='Credentials, Row 1' data-aria-label-template='Credentials, Row {0}' type='text' name='input_41[]' value='' tabindex='93'  \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/achena.org\/refresh\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/achena.org\/refresh\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_4_69\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_69'>2.\tLearners will be informed of presenters\u2019 declaration of vested interests or lack of vested interest by OTHER:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_4_69' type='text' value='' class='medium'   tabindex='94'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_83\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Commercial Support<\/h2><\/li><li id=\"field_4_70\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Does this activity have commercial support?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_70'><li class='gchoice gchoice_4_70_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.1' type='checkbox'  value='This activity HAS NO financial commercial support'  id='choice_4_70_1' tabindex='95'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_70_1' id='label_4_70_1' class='gform-field-label gform-field-label--type-inline'>This activity HAS NO financial commercial support<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_70_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.2' type='checkbox'  value='This activity HAS NO \u201cservices in-kind\u201d commercial support'  id='choice_4_70_2' tabindex='96'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_70_2' id='label_4_70_2' class='gform-field-label gform-field-label--type-inline'>This activity HAS NO \u201cservices in-kind\u201d commercial support<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_70_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.3' type='checkbox'  value='This activity HAS commercial support *'  id='choice_4_70_3' tabindex='97'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_70_3' id='label_4_70_3' class='gform-field-label gform-field-label--type-inline'>This activity HAS commercial support *<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_70_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.4' type='checkbox'  value='This activity HAS \u201cservices in-kind\u201d commercial support *'  id='choice_4_70_4' tabindex='98'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_70_4' id='label_4_70_4' class='gform-field-label gform-field-label--type-inline'>This activity HAS \u201cservices in-kind\u201d commercial support *<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_70_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.5' type='checkbox'  value='This activity HAS received support from entities &lt;strong&gt;other than&lt;\/strong&gt; commercial interests (e.g. non-profit organizations or government grants).'  id='choice_4_70_5' tabindex='99'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_70_5' id='label_4_70_5' class='gform-field-label gform-field-label--type-inline'>This activity HAS received support from entities <strong>other than<\/strong> commercial interests (e.g. non-profit organizations or government grants).<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_71\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_71'>Please specify source of support<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_4_71' type='text' value='' class='medium'   tabindex='100'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_45\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_45'>Commercial support has been provided by:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_4_45' type='text' value='' class='medium'   tabindex='101'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_47\" 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\"  ><label class='gfield_label gform-field-label' >Commercial support provided by these organizations will influence the objectives and content of this activity.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_47'>\n\t\t\t<li class='gchoice gchoice_4_47_0'>\n\t\t\t\t<input name='input_47' type='radio' value='Yes'  id='choice_4_47_0' tabindex='102'   \/>\n\t\t\t\t<label for='choice_4_47_0' id='label_4_47_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_4_47_1'>\n\t\t\t\t<input name='input_47' type='radio' value='No'  id='choice_4_47_1' tabindex='103'   \/>\n\t\t\t\t<label for='choice_4_47_1' id='label_4_47_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_48\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Learners will be informed about commercial support by:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_48'>(Please complete the following regardless of commercial support)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_48'><li class='gchoice gchoice_4_48_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.1' type='checkbox'  value='Announcement at beginning of event\/session. (There must be written verification that announcement was made.)'  id='choice_4_48_1' tabindex='104'  aria-describedby=\"gfield_description_4_48\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_1' id='label_4_48_1' class='gform-field-label gform-field-label--type-inline'>Announcement at beginning of event\/session. (There must be written verification that announcement was made.)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_48_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.2' type='checkbox'  value='Information provided on advertising.'  id='choice_4_48_2' tabindex='105'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_2' id='label_4_48_2' class='gform-field-label gform-field-label--type-inline'>Information provided on advertising.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_48_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.3' type='checkbox'  value='Information provided on handouts and\/or slides.'  id='choice_4_48_3' tabindex='106'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_3' id='label_4_48_3' class='gform-field-label gform-field-label--type-inline'>Information provided on handouts and\/or slides.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_48_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.4' type='checkbox'  value='Signs placed inside or outside of presentation or exhibit room.'  id='choice_4_48_4' tabindex='107'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_4' id='label_4_48_4' class='gform-field-label gform-field-label--type-inline'>Signs placed inside or outside of presentation or exhibit room.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_48_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.5' type='checkbox'  value='Other \u2013 Describe:'  id='choice_4_48_5' tabindex='108'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_5' id='label_4_48_5' class='gform-field-label gform-field-label--type-inline'>Other \u2013 Describe:<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_72\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_72'>4.\tLearners will be informed about commercial support or lack of commercial support by OTHER<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_4_72' type='text' value='' class='medium'   tabindex='109'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_42\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Learners will be informed of presenters\u2019 declaration of vested interests or lack of vested interest (from Appendix C Disclosure form) by (check all that apply):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_42'><li class='gchoice gchoice_4_42_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.1' type='checkbox'  value='Announcement at beginning of event\/session.'  id='choice_4_42_1' tabindex='110'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_42_1' id='label_4_42_1' class='gform-field-label gform-field-label--type-inline'>Announcement at beginning of event\/session.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_42_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.2' type='checkbox'  value='Information provided on advertising.'  id='choice_4_42_2' tabindex='111'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_42_2' id='label_4_42_2' class='gform-field-label gform-field-label--type-inline'>Information provided on advertising.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_42_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.3' type='checkbox'  value='Information provided on handouts and\/or slides.'  id='choice_4_42_3' tabindex='112'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_42_3' id='label_4_42_3' class='gform-field-label gform-field-label--type-inline'>Information provided on handouts and\/or slides.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_42_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.4' type='checkbox'  value='Signs placed inside or outside of presentation room.'  id='choice_4_42_4' tabindex='113'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_42_4' id='label_4_42_4' class='gform-field-label gform-field-label--type-inline'>Signs placed inside or outside of presentation room.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_42_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_42.5' type='checkbox'  value='Other \u2013 Describe:'  id='choice_4_42_5' tabindex='114'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_42_5' id='label_4_42_5' class='gform-field-label gform-field-label--type-inline'>Other \u2013 Describe:<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_84\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Evaluation<\/h2><div class='gsection_description' id='gfield_description_4_84'>How will this course be evaluated? (The evaluation form must be approved before the course, and you must submit a summary of the evaluations after the course.)<\/div><\/li><li id=\"field_4_50\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Check or describe the methods of evaluation to be used:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_50'>(Check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_50'><li class='gchoice gchoice_4_50_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.1' type='checkbox'  value='Participant evaluation\/satisfaction tool (required for all events.)'  id='choice_4_50_1' tabindex='115'  aria-describedby=\"gfield_description_4_50\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_1' id='label_4_50_1' class='gform-field-label gform-field-label--type-inline'>Participant evaluation\/satisfaction tool (required for all events.)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_50_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.2' type='checkbox'  value='Knowledge survey (Specify below)'  id='choice_4_50_2' tabindex='116'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_2' id='label_4_50_2' class='gform-field-label gform-field-label--type-inline'>Knowledge survey (Specify below)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_50_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.3' type='checkbox'  value='Skill and attitude change (Specify below)'  id='choice_4_50_3' tabindex='117'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_3' id='label_4_50_3' class='gform-field-label gform-field-label--type-inline'>Skill and attitude change (Specify below)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_50_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.4' type='checkbox'  value='Change in practice\/performance (Specify below)'  id='choice_4_50_4' tabindex='118'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_4' id='label_4_50_4' class='gform-field-label gform-field-label--type-inline'>Change in practice\/performance (Specify below)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_50_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.5' type='checkbox'  value='Relationship of practice change to quality of service (Specify below)'  id='choice_4_50_5' tabindex='119'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_5' id='label_4_50_5' class='gform-field-label gform-field-label--type-inline'>Relationship of practice change to quality of service (Specify below)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_50_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.6' type='checkbox'  value='Evaluation of learning outcomes (pre or post test; demonstration)'  id='choice_4_50_6' tabindex='120'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_6' id='label_4_50_6' class='gform-field-label gform-field-label--type-inline'>Evaluation of learning outcomes (pre or post test; demonstration)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_50_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.7' type='checkbox'  value='Other - Describe'  id='choice_4_50_7' tabindex='121'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_50_7' id='label_4_50_7' class='gform-field-label gform-field-label--type-inline'>Other - Describe<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_73\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_73'>Specify or describe (from above):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_73' id='input_4_73' type='text' value='' class='medium'   tabindex='122'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_74\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_74'>Submit a copy of the evaluation tool(s) to be used for this event.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_74'>It must include, at a minimum, questions about (a) achievement of objectives, (b) teaching effectiveness of each presenter, (c) whether the course was fair, unbiased and free of commercial influence, and (4) amount of time needed to complete the activity (enduring materials only).\n<br><br>\nNOTE:  See Sample Evaluation Form included on CPD Course Application page  https:\/\/achena.org\/forms\/<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='33554432' \/><input name='input_74' id='input_4_74' type='file' class='medium' aria-describedby=\"gfield_upload_rules_4_74 gfield_description_4_74\" onchange='javascript:gformValidateFileSize( this, 33554432 );' tabindex='123' \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_74'>Max. file size: 32 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_74'><\/div> <\/div><\/li><li id=\"field_4_52\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Describe how evaluation data will be used to:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_52'>(check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_52'><li class='gchoice gchoice_4_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='Revise future presentations of this course'  id='choice_4_52_1' tabindex='124'  aria-describedby=\"gfield_description_4_52\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_52_1' id='label_4_52_1' class='gform-field-label gform-field-label--type-inline'>Revise future presentations of this course<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='Create new courses'  id='choice_4_52_2' tabindex='125'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_52_2' id='label_4_52_2' class='gform-field-label gform-field-label--type-inline'>Create new courses<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='Other - Describe:'  id='choice_4_52_3' tabindex='126'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_52_3' id='label_4_52_3' class='gform-field-label gform-field-label--type-inline'>Other - Describe:<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_75\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_75'>Describe how evaluation data will be used to OTHER<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_4_75' type='text' value='' class='medium'   tabindex='127'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Learner Feedback:  Identify how feedback will be provided to the learner<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_53'><li class='gchoice gchoice_4_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Question and answers during activity'  id='choice_4_53_1' tabindex='128'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_1' id='label_4_53_1' class='gform-field-label gform-field-label--type-inline'>Question and answers during activity<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='Return results of testing'  id='choice_4_53_2' tabindex='129'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_2' id='label_4_53_2' class='gform-field-label gform-field-label--type-inline'>Return results of testing<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_53_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.3' type='checkbox'  value='Follow-up communication'  id='choice_4_53_3' tabindex='130'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_3' id='label_4_53_3' class='gform-field-label gform-field-label--type-inline'>Follow-up communication<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_53_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.4' type='checkbox'  value='Other - Describe:'  id='choice_4_53_4' tabindex='131'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_53_4' id='label_4_53_4' class='gform-field-label gform-field-label--type-inline'>Other - Describe:<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_76\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_76'>Learner Feedback OTHER<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_4_76' type='text' value='' class='medium'   tabindex='132'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_85\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">**For Renewals: Quality Improvement<\/h2><\/li><li id=\"field_4_55\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_55'>Describe any changes or improvements made to the delivery methods of this course since your previous application.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_4_55' type='text' value='' class='medium'   tabindex='133'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_56\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_56'>Describe how have you used participant evaluation feedback to make adjustments or improvements to this course.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_4_56' type='text' value='' class='medium'   tabindex='134'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_57\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_57'>If applicable, what advancements in the field of homeopathy have impacted the content of this course? How have you applied those advancements to course content?<\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_4_57' type='text' value='' class='medium'   tabindex='135'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_58\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_58'>Explain why the content of this course is still relevant to the continuing education needs of the professional homeopath.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_4_58' type='text' value='' class='medium'   tabindex='136'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_86\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Publicity<\/h2><\/li><li id=\"field_4_77\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_77'>Include a draft of brochure and\/or publicity.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_77'>ACHENA must review the brochure before it is printed. For web-based courses this information must appear BEFORE registrants log in. All publicity must clearly state what participants can expect including: \n<ul>\n<li>purpose and objectives of the course<\/li>\n<li>intended audience<\/li>\n<li>any special background requirements for attendance<\/li>\n<li>time to complete the course (average or range for web-based courses)\n<li>continuing education credit information <strong>(See Guidelines. Language is very specific and must be included in publicity when credit is to be given.)*<\/strong><\/li>\n<\/ul>\n<strong>*NOTE:<\/strong> You may not distribute any publicity with these statements until your proposal has been approved by ACHENA.<\/div><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='33554432' \/><input name='input_77' id='input_4_77' type='file' class='medium' aria-describedby=\"gfield_upload_rules_4_77 gfield_description_4_77\" onchange='javascript:gformValidateFileSize( this, 33554432 );' tabindex='137' \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_4_77'>Max. file size: 32 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_4_77'><\/div> <\/div><\/li><li id=\"field_4_87\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Verification of Participation and Successful Completion<\/h2><\/li><li id=\"field_4_61\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Indicate how participation will be verified:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_61'>(check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_61'><li class='gchoice gchoice_4_61_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.1' type='checkbox'  value='Sign-in\/attendance sheets'  id='choice_4_61_1' tabindex='138'  aria-describedby=\"gfield_description_4_61\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_61_1' id='label_4_61_1' class='gform-field-label gform-field-label--type-inline'>Sign-in\/attendance sheets<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_61_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.2' type='checkbox'  value='Completion of post- training evaluation survey'  id='choice_4_61_2' tabindex='139'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_61_2' id='label_4_61_2' class='gform-field-label gform-field-label--type-inline'>Completion of post- training evaluation survey<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_61_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.3' type='checkbox'  value='Other (describe):'  id='choice_4_61_3' tabindex='140'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_61_3' id='label_4_61_3' class='gform-field-label gform-field-label--type-inline'>Other (describe):<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_62\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_62'>Indicate how participation will be verified OTHER<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_4_62' type='text' value='' class='medium'   tabindex='141'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_63\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Criteria for successful completion:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_63'>(check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_63'><li class='gchoice gchoice_4_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='Attendance at entire event'  id='choice_4_63_1' tabindex='142'  aria-describedby=\"gfield_description_4_63\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_63_1' id='label_4_63_1' class='gform-field-label gform-field-label--type-inline'>Attendance at entire event<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_63_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.2' type='checkbox'  value='Completion\/submission of evaluation form'  id='choice_4_63_2' tabindex='143'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_63_2' id='label_4_63_2' class='gform-field-label gform-field-label--type-inline'>Completion\/submission of evaluation form<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_63_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.3' type='checkbox'  value='Achieving a passing score on the post-test (enter score below)'  id='choice_4_63_3' tabindex='144'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_63_3' id='label_4_63_3' class='gform-field-label gform-field-label--type-inline'>Achieving a passing score on the post-test (enter score below)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_63_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.4' type='checkbox'  value='Other (describe):'  id='choice_4_63_4' tabindex='145'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_63_4' id='label_4_63_4' class='gform-field-label gform-field-label--type-inline'>Other (describe):<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_66\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_66'>Passing Score or Other<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_4_66' type='text' value='' class='medium'   tabindex='146'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_64\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Participants will be informed of criteria by:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_64'>(check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_64'><li class='gchoice gchoice_4_64_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.1' type='checkbox'  value='Information on brochure\/advertising materials'  id='choice_4_64_1' tabindex='147'  aria-describedby=\"gfield_description_4_64\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_64_1' id='label_4_64_1' class='gform-field-label gform-field-label--type-inline'>Information on brochure\/advertising materials<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_64_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.2' type='checkbox'  value='Verbal statement at beginning of event'  id='choice_4_64_2' tabindex='148'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_64_2' id='label_4_64_2' class='gform-field-label gform-field-label--type-inline'>Verbal statement at beginning of event<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_64_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.3' type='checkbox'  value='Written information on handouts\/website'  id='choice_4_64_3' tabindex='149'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_64_3' id='label_4_64_3' class='gform-field-label gform-field-label--type-inline'>Written information on handouts\/website<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_64_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.4' type='checkbox'  value='Other (describe):'  id='choice_4_64_4' tabindex='150'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_64_4' id='label_4_64_4' class='gform-field-label gform-field-label--type-inline'>Other (describe):<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_65\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_65'>Participants will be informed of criteria by OTHER<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_4_65' type='text' value='' class='medium'   tabindex='151'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_4' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit' tabindex='152' \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_4_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary' tabindex='153' > Save and Continue Later<\/a><input type='hidden' name='gform_ajax' value='form_id=4&amp;title=&amp;description=&amp;tabindex=49&amp;theme=legacy&amp;styles=[]&amp;hash=f155236fd9ddf0fab298f9937d275d6a' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_4' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_4' id='gform_theme_4' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_4' id='gform_style_settings_4' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_4' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_4' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='W1r+MpUCqMo6X7qcnqEmhlb10pxlXSCF9XwMJtnhCIf1iljYd6uD8RG9IwzMXrYm8Ni1ZRa5iObfC\/H74e9fgk+9r33amsiDQHyKYZrL+6wcHzE=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_4' value='WyJbXSIsIjlkZWEzYzNhMzlmZmE3Y2FjODRmM2U0NjllYWNjZGVjIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_4' id='gform_target_page_number_4' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_4' id='gform_source_page_number_4' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_4' id='gform_ajax_frame_4' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 4, 'https:\/\/achena.org\/refresh\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_4').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_4');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_4').length > 0;var 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