{"id":855,"date":"2025-12-01T12:15:06","date_gmt":"2025-12-01T18:15:06","guid":{"rendered":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/?page_id=855"},"modified":"2025-12-01T12:15:17","modified_gmt":"2025-12-01T18:15:17","slug":"cooper-green-student-inquiry-form","status":"publish","type":"page","link":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/cooper-green-student-inquiry-form\/","title":{"rendered":"Cooper Green Student Inquiry Form"},"content":{"rendered":"<script type=\"text\/javascript\">if(!gform){document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0});var gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),null==t&&(t=10),gform.hooks[o][n].push({tag:i,callable:r,priority:t})},doHook:function(o,n,r){if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[o][n]){var 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gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" >If you are interested in other student opportunities such as job shadowing, volunteering, or preceptorship experiences, please submit an inquiry here.<\/br><\/br>\nWhen you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.<\/div><fieldset id=\"field_230_2\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_230_2'>\n                            \n                            <span 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aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_230_5\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_230_5' >School or Institution<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_5' id='input_230_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_230_7\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Area (s) of Interest (Select up to 3)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_230_7'><div class='gchoice gchoice_230_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Urgent Care'  id='choice_230_7_1'   aria-describedby=\"gfield_description_230_7\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_1' id='label_230_7_1'>Urgent Care<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Imaging'  id='choice_230_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_2' id='label_230_7_2'>Imaging<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Behavioral Health'  id='choice_230_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_3' id='label_230_7_3'>Behavioral Health<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='Specialty Clinics'  id='choice_230_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_4' id='label_230_7_4'>Specialty Clinics<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.5' type='checkbox'  value='Pharmacy'  id='choice_230_7_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_5' id='label_230_7_5'>Pharmacy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.6' type='checkbox'  value='Lab'  id='choice_230_7_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_6' id='label_230_7_6'>Lab<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.7' type='checkbox'  value='Nursing Education\/Clinical support'  id='choice_230_7_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_7' id='label_230_7_7'>Nursing Education\/Clinical support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.8' type='checkbox'  value='Rehab'  id='choice_230_7_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_8' id='label_230_7_8'>Rehab<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.9' type='checkbox'  value='Administrative\/non-clinical'  id='choice_230_7_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_9' id='label_230_7_9'>Administrative\/non-clinical<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_230_7_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.11' type='checkbox'  value='Other'  id='choice_230_7_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_230_7_11' id='label_230_7_11'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_230_7'>Please select 3 options.<\/div><\/fieldset><div id=\"field_230_8\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_230_8' >Other<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_230_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_230_9\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Type of Experience You Are Requesting<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_230_9'>\n\t\t\t<div class='gchoice gchoice_230_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Job Shadowing'  id='choice_230_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_230_9_0' id='label_230_9_0'>Job Shadowing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_230_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Volunteering'  id='choice_230_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_230_9_1' id='label_230_9_1'>Volunteering<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_230_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Clinical Preceptorship'  id='choice_230_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_230_9_2' id='label_230_9_2'>Clinical Preceptorship<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_230_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' 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