{"id":8458,"date":"2025-07-01T14:31:20","date_gmt":"2025-07-01T18:31:20","guid":{"rendered":"https:\/\/new.umaine.edu\/socialwork\/?page_id=8458"},"modified":"2025-11-17T07:30:27","modified_gmt":"2025-11-17T12:30:27","slug":"forms","status":"publish","type":"page","link":"https:\/\/umaine.edu\/socialwork\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<style>.kb-row-layout-wrap.wp-block-kadence-rowlayout.kb-row-layout-id8458_bbf65b-c1{margin-top:0px;margin-bottom:0px;}.kb-row-layout-id8458_bbf65b-c1 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id8458_bbf65b-c1 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id8458_bbf65b-c1 > .kt-row-column-wrap{column-gap:60px;row-gap:var(--global-kb-gap-md, 2rem);max-width:1268px;padding-top:50px;padding-bottom:75px;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id8458_bbf65b-c1{background-image:linear-gradient(60deg,rgb(8,46,88) 47%,rgb(65,118,161) 93%);}.kb-row-layout-id8458_bbf65b-c1 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id8458_bbf65b-c1 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-sm, 1rem);grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id8458_bbf65b-c1 > .kt-row-column-wrap{padding-top:0px;padding-right:0px;padding-bottom:25px;padding-left:0px;grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id8458_bbf65b-c1 alignfull kt-row-has-bg um-UMBHHeaderNoImage wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column8458_869e97-87 > .kt-inside-inner-col,.kadence-column8458_869e97-87 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_869e97-87 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_869e97-87 > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_869e97-87 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_869e97-87 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_869e97-87{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_869e97-87 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column8458_869e97-87 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column8458_869e97-87\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71, .wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71[data-kb-block=\"kb-adv-heading8458_7ff131-71\"]{padding-top:0px;padding-bottom:0px;text-align:center;font-size:45px;font-weight:900;font-style:normal;font-family:stratum-1-web;text-transform:uppercase;}.wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71[data-kb-block=\"kb-adv-heading8458_7ff131-71\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71[data-kb-block=\"kb-adv-heading8458_7ff131-71\"] img.kb-inline-image{width:150px;vertical-align:baseline;}@media all and (max-width: 1024px){.wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71, .wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71[data-kb-block=\"kb-adv-heading8458_7ff131-71\"]{text-align:center!important;}}@media all and (max-width: 767px){.wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71, .wp-block-kadence-advancedheading.kt-adv-heading8458_7ff131-71[data-kb-block=\"kb-adv-heading8458_7ff131-71\"]{padding-right:25px;padding-left:25px;text-align:center!important;}}<\/style>\n<h2 class=\"kt-adv-heading8458_7ff131-71 wp-block-kadence-advancedheading has-white-color has-text-color\" data-kb-block=\"kb-adv-heading8458_7ff131-71\">Forms<\/h2>\n<\/div><\/div>\n\n<\/div><\/div>\n\n<style>.kb-row-layout-id8458_c77f1d-a1 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id8458_c77f1d-a1 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id8458_c77f1d-a1 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-lg, 4rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:1250px;margin-left:auto;margin-right:auto;padding-top:75px;padding-right:70px;padding-bottom:60px;padding-left:70px;grid-template-columns:repeat(3, minmax(0, 1fr));}.kb-row-layout-id8458_c77f1d-a1{background-color:#faf4ec;}.kb-row-layout-id8458_c77f1d-a1 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id8458_c77f1d-a1 > .kt-row-column-wrap{grid-template-columns:repeat(3, minmax(0, 1fr));}}@media all and (max-width: 767px){.kb-row-layout-id8458_c77f1d-a1 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id8458_c77f1d-a1 alignfull kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-6-columns kt-row-layout-three-grid kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column8458_b719b0-b3 > .kt-inside-inner-col,.kadence-column8458_b719b0-b3 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_b719b0-b3 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_b719b0-b3 > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_b719b0-b3 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_b719b0-b3 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_b719b0-b3{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_b719b0-b3 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column8458_b719b0-b3 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column8458_b719b0-b3\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedbtn.kb-btns8458_a168f9-fb{padding-left:0px;gap:25px;justify-content:flex-start;align-items:center;}.kt-btns8458_a168f9-fb .kt-button{font-weight:normal;font-style:normal;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kt-btns8458_a168f9-fb, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_a168f9-fb, .wp-block-kadence-advancedbtn.kb-btns8458_a168f9-fb, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_a168f9-fb{margin-bottom:0px;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kb-btns8458_a168f9-fb{padding-right:50px;padding-left:50px;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn.kt-btns8458_a168f9-fb, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_a168f9-fb, .wp-block-kadence-advancedbtn.kb-btns8458_a168f9-fb, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_a168f9-fb{margin-bottom:0px;}.wp-block-kadence-advancedbtn.kb-btns8458_a168f9-fb{padding-right:25px;padding-left:25px;}}<\/style>\n<div class=\"wp-block-kadence-advancedbtn kb-buttons-wrap kb-btns8458_a168f9-fb um-UMBHBlueButton\"><style>ul.menu .wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button{width:initial;}.wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button{color:#082e58;background:#79bde8;font-size:16px;font-family:'Chakra Petch';font-weight:600;text-transform:uppercase;border-top-left-radius:20px;border-top-right-radius:20px;border-bottom-right-radius:20px;border-bottom-left-radius:20px;border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;margin-bottom:20px;}.wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button:focus{color:#ffffff;background:#082e58;border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}.wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_8968cd-9b.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}<\/style><a class=\"kb-button kt-button button kb-btn8458_8968cd-9b kt-btn-size-standard kt-btn-width-type-full kb-btn-global-outline  kt-btn-has-text-true kt-btn-has-svg-false  wp-block-kadence-singlebtn\" href=\"https:\/\/umainesystem.sharepoint.com\/:w:\/s\/UM-OnlineDocs\/ESYltgV7HwdDlviraIyvU_4BTJ3lfq8Uq0hOOWt5caGMyQ?e=KUEki3\"><span class=\"kt-btn-inner-text\"><strong>Worksite-based Application<\/strong><\/span><\/a><\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column8458_0911c5-7b > .kt-inside-inner-col,.kadence-column8458_0911c5-7b > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_0911c5-7b > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_0911c5-7b > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_0911c5-7b > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_0911c5-7b > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_0911c5-7b{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_0911c5-7b > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column8458_0911c5-7b > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column8458_0911c5-7b\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedbtn.kb-btns8458_415a66-a2{padding-left:0px;gap:25px;justify-content:flex-start;align-items:center;}.kt-btns8458_415a66-a2 .kt-button{font-weight:normal;font-style:normal;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kt-btns8458_415a66-a2, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_415a66-a2, .wp-block-kadence-advancedbtn.kb-btns8458_415a66-a2, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_415a66-a2{margin-bottom:0px;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kb-btns8458_415a66-a2{padding-right:50px;padding-left:50px;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn.kt-btns8458_415a66-a2, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_415a66-a2, .wp-block-kadence-advancedbtn.kb-btns8458_415a66-a2, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_415a66-a2{margin-bottom:0px;}.wp-block-kadence-advancedbtn.kb-btns8458_415a66-a2{padding-right:25px;padding-left:25px;}}<\/style>\n<div class=\"wp-block-kadence-advancedbtn kb-buttons-wrap kb-btns8458_415a66-a2 um-UMBHBlueButton\"><style>ul.menu .wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button{width:initial;}.wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button{color:#082e58;background:#79bde8;font-size:16px;font-family:'Chakra Petch';font-weight:600;text-transform:uppercase;border-top-left-radius:20px;border-top-right-radius:20px;border-bottom-right-radius:20px;border-bottom-left-radius:20px;border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;margin-bottom:20px;}.wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button:focus{color:#ffffff;background:#082e58;border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}.wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_b3d4c8-be.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}<\/style><a class=\"kb-button kt-button button kb-btn8458_b3d4c8-be kt-btn-size-standard kt-btn-width-type-full kb-btn-global-outline  kt-btn-has-text-true kt-btn-has-svg-false  wp-block-kadence-singlebtn\" href=\"https:\/\/umainesystem.sharepoint.com\/:w:\/s\/UM-OnlineDocs\/EUUjXyjdBplGt0_qoXwfcrIB2M9wycZcgjEtoPwanG9dTQ?e=kDVoLO\"><span class=\"kt-btn-inner-text\"><strong>SWK 495 Log Form<\/strong><\/span><\/a><\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column8458_c7a653-0c > .kt-inside-inner-col,.kadence-column8458_c7a653-0c > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_c7a653-0c > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_c7a653-0c > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_c7a653-0c > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_c7a653-0c > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_c7a653-0c{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_c7a653-0c > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column8458_c7a653-0c > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column8458_c7a653-0c\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedbtn.kb-btns8458_12b117-66{padding-left:0px;gap:25px;justify-content:flex-start;align-items:center;}.kt-btns8458_12b117-66 .kt-button{font-weight:normal;font-style:normal;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kt-btns8458_12b117-66, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_12b117-66, .wp-block-kadence-advancedbtn.kb-btns8458_12b117-66, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_12b117-66{margin-bottom:0px;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kb-btns8458_12b117-66{padding-right:50px;padding-left:50px;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn.kt-btns8458_12b117-66, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_12b117-66, .wp-block-kadence-advancedbtn.kb-btns8458_12b117-66, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_12b117-66{margin-bottom:0px;}.wp-block-kadence-advancedbtn.kb-btns8458_12b117-66{padding-right:25px;padding-left:25px;}}<\/style>\n<div class=\"wp-block-kadence-advancedbtn kb-buttons-wrap kb-btns8458_12b117-66 um-UMBHBlueButton\"><style>ul.menu .wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button{width:initial;}.wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button{color:#082e58;background:#79bde8;font-size:16px;font-family:'Chakra Petch';font-weight:600;text-transform:uppercase;border-top-left-radius:20px;border-top-right-radius:20px;border-bottom-right-radius:20px;border-bottom-left-radius:20px;border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;margin-bottom:20px;}.wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button:focus{color:#ffffff;background:#082e58;border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}.wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_d67294-f8.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}<\/style><a class=\"kb-button kt-button button kb-btn8458_d67294-f8 kt-btn-size-standard kt-btn-width-type-full kb-btn-global-outline  kt-btn-has-text-true kt-btn-has-svg-false  wp-block-kadence-singlebtn\" href=\"https:\/\/umainesystem.sharepoint.com\/:w:\/s\/UM-OnlineDocs\/EZbHnfRtGURChhLyz547OQ4B9poS_VMT_n3XKwfXdbyJHw?e=IbHjh6\"><span class=\"kt-btn-inner-text\"><strong>SWK 595 Log Form<\/strong><\/span><\/a><\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column8458_688382-d5 > .kt-inside-inner-col,.kadence-column8458_688382-d5 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_688382-d5 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_688382-d5 > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_688382-d5 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_688382-d5 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_688382-d5{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_688382-d5 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column8458_688382-d5 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column8458_688382-d5\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedbtn.kb-btns8458_5546f6-52{padding-left:0px;gap:25px;justify-content:flex-start;align-items:center;}.kt-btns8458_5546f6-52 .kt-button{font-weight:normal;font-style:normal;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kt-btns8458_5546f6-52, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_5546f6-52, .wp-block-kadence-advancedbtn.kb-btns8458_5546f6-52, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_5546f6-52{margin-bottom:0px;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kb-btns8458_5546f6-52{padding-right:50px;padding-left:50px;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn.kt-btns8458_5546f6-52, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_5546f6-52, .wp-block-kadence-advancedbtn.kb-btns8458_5546f6-52, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_5546f6-52{margin-bottom:0px;}.wp-block-kadence-advancedbtn.kb-btns8458_5546f6-52{padding-right:25px;padding-left:25px;}}<\/style>\n<div class=\"wp-block-kadence-advancedbtn kb-buttons-wrap kb-btns8458_5546f6-52 um-UMBHBlueButton\"><style>ul.menu .wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button{width:initial;}.wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button{color:#082e58;background:#79bde8;font-size:16px;font-family:'Chakra Petch';font-weight:600;text-transform:uppercase;border-top-left-radius:20px;border-top-right-radius:20px;border-bottom-right-radius:20px;border-bottom-left-radius:20px;border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;margin-bottom:20px;}.wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button:focus{color:#ffffff;background:#082e58;border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}.wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_2065dd-f2.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}<\/style><a class=\"kb-button kt-button button kb-btn8458_2065dd-f2 kt-btn-size-standard kt-btn-width-type-full kb-btn-global-outline  kt-btn-has-text-true kt-btn-has-svg-false  wp-block-kadence-singlebtn\" href=\"https:\/\/umainesystem.sharepoint.com\/:w:\/s\/UM-OnlineDocs\/EcKy8Y0h7O9Nptxi_mxxmK8Bhcbvbu_XK9MN2Fh3TaFVbA?e=m4SyKq\"><span class=\"kt-btn-inner-text\"><strong>SWK 695 Log Form<\/strong><\/span><\/a><\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column8458_f5f52c-62 > .kt-inside-inner-col,.kadence-column8458_f5f52c-62 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_f5f52c-62 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_f5f52c-62 > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_f5f52c-62 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_f5f52c-62 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_f5f52c-62{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_f5f52c-62 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column8458_f5f52c-62 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column8458_f5f52c-62\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedbtn.kb-btns8458_e7aed0-cd{padding-left:0px;gap:25px;justify-content:flex-start;align-items:center;}.kt-btns8458_e7aed0-cd .kt-button{font-weight:normal;font-style:normal;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kt-btns8458_e7aed0-cd, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_e7aed0-cd, .wp-block-kadence-advancedbtn.kb-btns8458_e7aed0-cd, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_e7aed0-cd{margin-bottom:0px;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kb-btns8458_e7aed0-cd{padding-right:50px;padding-left:50px;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn.kt-btns8458_e7aed0-cd, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_e7aed0-cd, .wp-block-kadence-advancedbtn.kb-btns8458_e7aed0-cd, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_e7aed0-cd{margin-bottom:0px;}.wp-block-kadence-advancedbtn.kb-btns8458_e7aed0-cd{padding-right:25px;padding-left:25px;}}<\/style>\n<div class=\"wp-block-kadence-advancedbtn kb-buttons-wrap kb-btns8458_e7aed0-cd um-UMBHBlueButton\"><style>ul.menu .wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button{width:initial;}.wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button{color:#082e58;background:#79bde8;font-size:16px;font-family:'Chakra Petch';font-weight:600;text-transform:uppercase;border-top-left-radius:20px;border-top-right-radius:20px;border-bottom-right-radius:20px;border-bottom-left-radius:20px;border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;margin-bottom:20px;}.wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button:focus{color:#ffffff;background:#082e58;border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}.wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_eb5386-ef.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}<\/style><a class=\"kb-button kt-button button kb-btn8458_eb5386-ef kt-btn-size-standard kt-btn-width-type-full kb-btn-global-outline  kt-btn-has-text-true kt-btn-has-svg-false  wp-block-kadence-singlebtn\" href=\"https:\/\/umainesystem.sharepoint.com\/:w:\/s\/UM-OnlineDocs\/IQC_UQfBjMizTaOubgI8_h0vAeHSYF5SOxNxoFnL5fECbEQ?e=47ElBi\"><span class=\"kt-btn-inner-text\"><strong>BSW Internship guide<\/strong><\/span><\/a><\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column8458_1f90a8-81 > .kt-inside-inner-col,.kadence-column8458_1f90a8-81 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_1f90a8-81 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_1f90a8-81 > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_1f90a8-81 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_1f90a8-81 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_1f90a8-81{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_1f90a8-81 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column8458_1f90a8-81 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column8458_1f90a8-81\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedbtn.kb-btns8458_72317b-c6{padding-left:0px;gap:25px;justify-content:flex-start;align-items:center;}.kt-btns8458_72317b-c6 .kt-button{font-weight:normal;font-style:normal;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kt-btns8458_72317b-c6, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_72317b-c6, .wp-block-kadence-advancedbtn.kb-btns8458_72317b-c6, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_72317b-c6{margin-bottom:0px;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn.kb-btns8458_72317b-c6{padding-right:50px;padding-left:50px;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn.kt-btns8458_72317b-c6, .site .entry-content .wp-block-kadence-advancedbtn.kt-btns8458_72317b-c6, .wp-block-kadence-advancedbtn.kb-btns8458_72317b-c6, .site .entry-content .wp-block-kadence-advancedbtn.kb-btns8458_72317b-c6{margin-bottom:0px;}.wp-block-kadence-advancedbtn.kb-btns8458_72317b-c6{padding-right:25px;padding-left:25px;}}<\/style>\n<div class=\"wp-block-kadence-advancedbtn kb-buttons-wrap kb-btns8458_72317b-c6 um-UMBHBlueButton\"><style>ul.menu .wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button{width:initial;}.wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button{color:#082e58;background:#79bde8;font-size:16px;font-family:'Chakra Petch';font-weight:600;text-transform:uppercase;border-top-left-radius:20px;border-top-right-radius:20px;border-bottom-right-radius:20px;border-bottom-left-radius:20px;border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;margin-bottom:20px;}.wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button:focus{color:#ffffff;background:#082e58;border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}}@media all and (max-width: 1024px){.wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}@media all and (max-width: 767px){.wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button{border-top:2px solid #79bde8;border-right:2px solid #79bde8;border-bottom:2px solid #79bde8;border-left:2px solid #79bde8;}.wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button:hover, .wp-block-kadence-advancedbtn .kb-btn8458_9db85c-3f.kb-button:focus{border-top-color:#082e58;border-top-style:solid;border-right-color:#082e58;border-right-style:solid;border-bottom-color:#082e58;border-bottom-style:solid;border-left-color:#082e58;border-left-style:solid;}}<\/style><a class=\"kb-button kt-button button kb-btn8458_9db85c-3f kt-btn-size-standard kt-btn-width-type-full kb-btn-global-outline  kt-btn-has-text-true kt-btn-has-svg-false  wp-block-kadence-singlebtn\" href=\"https:\/\/umainesystem.sharepoint.com\/:w:\/s\/UM-OnlineDocs\/IQCv08izehDFS56ysTIN1kCXAY5UZIAbtuieG8HA2KcEZok?e=PUHVXs\"><span class=\"kt-btn-inner-text\"><strong>MSW Internship Guide<\/strong><\/span><\/a><\/div>\n<\/div><\/div>\n\n<\/div><\/div>\n\n<style>.kb-row-layout-id8458_cfb19b-27 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id8458_cfb19b-27 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id8458_cfb19b-27 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:1100px;margin-left:auto;margin-right:auto;padding-top:75px;padding-bottom:75px;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id8458_cfb19b-27{background-color:#e5f0f9;}.kb-row-layout-id8458_cfb19b-27 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id8458_cfb19b-27 > .kt-row-column-wrap{padding-right:50px;padding-left:50px;grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id8458_cfb19b-27 > .kt-row-column-wrap{padding-top:50px;padding-right:25px;padding-bottom:50px;padding-left:25px;grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id8458_cfb19b-27 alignfull kt-row-has-bg um-UMBlueHorizonsLightBlueTextBox wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column8458_2c6507-db > .kt-inside-inner-col,.kadence-column8458_2c6507-db > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_2c6507-db > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_2c6507-db > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_2c6507-db > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_2c6507-db > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_2c6507-db{position:relative;}@media all and (max-width: 1024px){.kadence-column8458_2c6507-db > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 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> .kt-row-column-wrap{padding-bottom:35px;grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id8458_88231b-bc alignnone has-white-background-color kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column8458_5ff688-7d > .kt-inside-inner-col,.kadence-column8458_5ff688-7d > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column8458_5ff688-7d > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column8458_5ff688-7d > .kt-inside-inner-col{flex-direction:column;}.kadence-column8458_5ff688-7d > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column8458_5ff688-7d > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column8458_5ff688-7d{position:relative;}@media all and 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                        <h2 class=\"gform_title\">Student Internship Information Form<\/h2>\n                            <p class='gform_description'>This form gathers information about a student&#8217;s internship to ensure timely communication between the 91±¬ΑΟ School of Social Work and Internship Agency. It is important to complete this form as accurately as possible.  \r\n\r\n<b> Please note: <\/b> <i>If any of information about the student, agency, or staff changes during the internship students must complete another field placement information form. <\/i><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/socialwork\/wp-json\/wp\/v2\/pages\/8458' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_2\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon 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_2'>Today&#039;s Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_2' id='input_4_2' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_2_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_2_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_2' class='gform_hidden' value='https:\/\/umaine.edu\/socialwork\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_4_12\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Student Information<\/h3><\/div><fieldset id=\"field_4_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Student&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_4_3'>\n                            \n                            <span id='input_4_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_4_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_4_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_4_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Student&#039;s Preferred Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_4_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>Student&#039;s 91±¬ΑΟ Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_4_5' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full 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_40'>Student Emergency Contact<\/label><div class='gfield_description' id='gfield_description_4_40'>Please list the name and phone number of an emergency contact you give the University and your internship site permission to contact in case of an emergency. <\/div><div class='ginput_container ginput_container_text'><input name='input_40' id='input_4_40' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_40\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_54\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_54'>Please select your program, course, and internship semesters from the list below:<\/label><div class='ginput_container ginput_container_select'><select name='input_54' id='input_4_54' class='large gfield_select'     aria-invalid=\"false\" ><option value='BSW on-campus (SWK 495) Fall &amp; Spring' >BSW on-campus (SWK 495) Fall &amp; Spring<\/option><option value='BSW online (SWK 495) Fall &amp; Spring' >BSW online (SWK 495) Fall &amp; Spring<\/option><option value='MSW generalist on-campus (SWK 595) Fall &amp; Spring' >MSW generalist on-campus (SWK 595) Fall &amp; Spring<\/option><option value='MSW generalist online-blended (SWK 595) Summer &amp; Fall' >MSW generalist online-blended (SWK 595) Summer &amp; Fall<\/option><option value='MSW speclializtion on-campus (SWK 695) Fall &amp; Spring' >MSW specialization on-campus (SWK 695) Fall &amp; Spring<\/option><option value='MSW specialization on-campus (SWK 695) Summer block' >MSW specialization on-campus (SWK 695) Summer block<\/option><option value='MSW specialization online-blended (SWK 695) Fall &amp; Spring' >MSW specialization online-blended (SWK 695) Fall &amp; Spring<\/option><option value='MSW specialization online-blended (SWK 695) Summer block' >MSW specialization online-blended (SWK 695) Summer block<\/option><\/select><\/div><\/div><div id=\"field_4_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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'>Minimum Number of Internship Hours<\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_4_45' class='large gfield_select'     aria-invalid=\"false\" ><option value='BSW - 400 hours' >BSW &#8211; 400 hours<\/option><option value='MSW Generalist - 400 hours' >MSW Generalist &#8211; 400 hours<\/option><option value='MSW Specialization - 500 Hours' >MSW Specialization &#8211; 500 Hours<\/option><\/select><\/div><\/div><div id=\"field_4_6\" class=\"gfield gfield--type-select gfield--input-type-select 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'>Beginning semester in internship<\/label><div class='gfield_description' id='gfield_description_4_6'>Please enter the semester you will begin your internship. IMPORTANT: If you are updating this form or changing a current internship choose the semester you began your internship. <\/div><div class='ginput_container ginput_container_select'><select name='input_6' id='input_4_6' class='medium gfield_select'  aria-describedby=\"gfield_description_4_6\"   aria-invalid=\"false\" ><option value='Select One' >Select One<\/option><option value='Summer 2025' >Summer 2025<\/option><option value='Fall 2025' >Fall 2025<\/option><option value='Spring 2026' >Spring 2026<\/option><option value='Summer 2026' >Summer 2026<\/option><option value='Fall 2026' >Fall 2026<\/option><option value='Spring 2027' >Spring 2027<\/option><option value='Summer 2027' >Summer 2027<\/option><option value='Fall 2027' >Fall 2027<\/option><option value='Spring 2028' >Spring 2028<\/option><option value='Summer 2028' >Summer 2028<\/option><option value='Fall 2028' >Fall 2028<\/option><\/select><\/div><\/div><div id=\"field_4_49\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full 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_49'>Are you completing this form for a new internship, updating information about a current internship, or because you are changing a current internship?<\/label><div class='ginput_container ginput_container_select'><select name='input_49' id='input_4_49' class='large gfield_select'     aria-invalid=\"false\" ><option value='Select One' >Select One<\/option><option value='New Internship' >New Internship<\/option><option value='Updating information about a current internship' >Updating information about a current internship<\/option><option value='Changing a current internship' >Changing a current internship<\/option><\/select><\/div><\/div><div id=\"field_4_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Agency Information<\/h3><\/div><div id=\"field_4_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_11'>Full name of agency<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_4_11' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_14\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_14'>Department, if applicable<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_4_14' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_15\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_15'>Geographical Region of Agency<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_4_15' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Augusta, Waterville\/Kennebec County' >Augusta\/Waterville (Kennebec County)<\/option><option value='Bangor\/Lower Penobscot County' >Bangor (lower Penobscot County)<\/option><option value='Dover-Foxcroft\/Piscataquis County' >Biddeford\/Sanford (York County)<\/option><option value='Down East\/Washington County\/Machias, Calais' >Dover-Foxcroft (Piscataquis County)<\/option><option value='Ellsworth\/Hancock County' >Machias\/Calais (Washington County\/Downeast)<\/option><option value='Farmington\/Franklin County' >Ellsworth (Hancock County)<\/option><option value='Lewiston\/Androscoggin County' >Farmington (Franklin County)<\/option><option value='Lower Aroostook County\/Houlton' >Houlton (Lower Aroostook County)<\/option><option value='Mid Coast\/Lincoln\/Knox\/Waldo Counties' >Lewiston (Androscoggin County)<\/option><option value='Millinocket\/Upper Penobscot County' >Midcoast (Lincoln, Waldo, and\/or Knox County)<\/option><option value='Portland\/Cumberland County\/Sagadahoc County' >Millinocket (upper Penobscot County)<\/option><option value='Rumford\/Oxford County' >Portland (Cumberland\/Sagahadoc County)<\/option><option value='Skowhegan\/Somerset County' >Presque Isle\/Fort Kent (upper Aroostook County)<\/option><option value='Upper Aroostook County\/Presque Isle\/Fort Kent' >Rumford (Oxford County)<\/option><option value='York County' >Skowhegan (Somerset County)<\/option><option value='Other (outside of Maine)' >Outside of Maine<\/option><\/select><\/div><\/div><fieldset id=\"field_4_13\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agency&#039;s Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \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_13' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_13_1_container' >\n                                        <input type='text' name='input_13.1' id='input_4_13_1' value=''    aria-required='true'    \/>\n                                        <label for='input_4_13_1' id='input_4_13_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_13_2_container' >\n                                        <input type='text' name='input_13.2' id='input_4_13_2' value=''     aria-required='false'   \/>\n                                        <label for='input_4_13_2' id='input_4_13_2_label' class='gform-field-label gform-field-label--type-sub '>P.O. Box or Suite #<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_13_3_container' >\n                                    <input type='text' name='input_13.3' id='input_4_13_3' value=''    aria-required='true'    \/>\n                                    <label for='input_4_13_3' id='input_4_13_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_13_4_container' >\n                                        <input type='text' name='input_13.4' id='input_4_13_4' value=''      aria-required='true'    \/>\n                                        <label for='input_4_13_4' id='input_4_13_4_label' class='gform-field-label gform-field-label--type-sub '>State\/Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_13_5_container' >\n                                    <input type='text' name='input_13.5' id='input_4_13_5' value=''    aria-required='true'    \/>\n                                    <label for='input_4_13_5' id='input_4_13_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_13.6' id='input_4_13_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_16\" class=\"gfield gfield--type-phone gfield--input-type-phone 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_16'>Agency&#039;s Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_16'>Please enter the agency&#8217;s phone number.<\/div><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_4_16' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_4_16\"  \/><\/div><\/div><div id=\"field_4_18\" class=\"gfield gfield--type-website gfield--input-type-website field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_18'>Agency&#039;s Website (if applicable)<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_18' id='input_4_18' type='url' value='' class='medium'    placeholder='http:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_4_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Supervisor at the Agency<\/h3><div class='gsection_description' id='gfield_description_4_17'>INSTRUCTIONS: Please provide the following information about the person at your internship site who will give you tasks, meet with you weekly for supervision, complete the internship visit with you and your faculty liaison to talk about your progress, and complete your student progress evaluation at the end of each semester.\n<\/div><\/div><fieldset id=\"field_4_19\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Supervisor&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name has_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_4_19'>\n                            \n                            <span id='input_4_19_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_19.3' id='input_4_19_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_19_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_19_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_19.6' id='input_4_19_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_19_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <span id='input_4_19_8_container' class='name_suffix  gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_19.8' id='input_4_19_8' value=''   aria-required='false'     \/>\n                                                    <label for='input_4_19_8' class='gform-field-label gform-field-label--type-sub '>Suffix<\/label>\n                                                <\/span>\n                        <\/div><\/fieldset><div id=\"field_4_20\" class=\"gfield gfield--type-email gfield--input-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_20'>Supervisor&#039;s Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_20' id='input_4_20' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_22'>Supervisor&#039;s Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_4_22' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_56\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Supervisor&#039;s degree<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_4_56'>Please select all degrees held:<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_56'><div class='gchoice gchoice_4_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.1' type='checkbox'  value='BSW'  id='choice_4_56_1'   aria-describedby=\"gfield_description_4_56\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_4_56_1' id='label_4_56_1' class='gform-field-label gform-field-label--type-inline'>BSW<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_56_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.2' type='checkbox'  value='MSW'  id='choice_4_56_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_56_2' id='label_4_56_2' class='gform-field-label gform-field-label--type-inline'>MSW<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_56_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.3' type='checkbox'  value='Degree in another profession (Not a BSW or MSW)'  id='choice_4_56_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_56_3' id='label_4_56_3' class='gform-field-label gform-field-label--type-inline'>Degree in another profession (Not a BSW or MSW)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_56_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.4' type='checkbox'  value='Ph.D. or Ed.D.'  id='choice_4_56_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_56_4' id='label_4_56_4' class='gform-field-label gform-field-label--type-inline'>Ph.D. or Ed.D.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">BSW\/MSW Consultant<\/h3><div class='gsection_description' id='gfield_description_4_59'>INSTRUCTIONS: If your Supervisor does not hold a BSW or MSW Degree with two years of social work practice experience, please list the name and info for your BSW or MSW Consultant.<\/div><\/div><fieldset id=\"field_4_60\" 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\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >BSW\/MSW Consultant&#039;s name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/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_4_60'>\n                            \n                            <span id='input_4_60_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_60.3' id='input_4_60_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_60_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_4_60_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_60.6' id='input_4_60_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_4_60_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_4_61\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full 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_61'>BSW\/MSW Consultant&#039;s email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_61' id='input_4_61' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_62\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full 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_62'>BSW\/MSW Consultant&#039;s phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_62' id='input_4_62' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_64\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >BSW\/MSW Consultant&#039;s degree<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_4_64'>Please select all degrees held:<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_64'><div 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='BSW'  id='choice_4_64_1'   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'>BSW<\/label>\n\t\t\t\t\t\t\t<\/div><div 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='MSW'  id='choice_4_64_2'   \/>\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'>MSW<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_64_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_64.5' type='checkbox'  value='Ph.D. or Ed.D.'  id='choice_4_64_3'   \/>\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'>Ph.D. or Ed.D.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Have you been told that you will need to attend the BSW or MSW supervision group?<\/legend><div class='gfield_description' id='gfield_description_4_65'>Choose one if applicable<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_65'>\n\t\t\t<div class='gchoice gchoice_4_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='No'  id='choice_4_65_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_65\"   \/>\n\t\t\t\t\t<label for='choice_4_65_0' id='label_4_65_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Yes, BSW Supervision Group'  id='choice_4_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_65_1' id='label_4_65_1' class='gform-field-label gform-field-label--type-inline'>Yes, BSW Supervision Group<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_65_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Yes, MSW Generalist Supervision Group'  id='choice_4_65_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_65_2' id='label_4_65_2' class='gform-field-label gform-field-label--type-inline'>Yes, MSW Generalist Supervision Group<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_65_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='I&#039;m not sure'  id='choice_4_65_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label 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I may receive a stipend from a 91±¬ΑΟ Grant Funded project (Like SWISSI or RIHBPC)'  id='choice_4_33_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_33_0' id='label_4_33_0' class='gform-field-label gform-field-label--type-inline'>Normal MOA: I an not an employee of my internship and my internship site is not providing me with a stipend or wage. 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