{"id":277,"date":"2024-02-08T11:53:36","date_gmt":"2024-02-08T16:53:36","guid":{"rendered":"https:\/\/studentlife-wds-prd.utk.edu\/counselingcenter\/?page_id=277"},"modified":"2025-01-21T12:37:14","modified_gmt":"2025-01-21T17:37:14","slug":"outreach-request-form","status":"publish","type":"page","link":"https:\/\/studentlife.utk.edu\/counselingcenter\/outreach-request-form\/","title":{"rendered":"Outreach Request Form"},"content":{"rendered":"<script>\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 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data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Community Intervention \/Outreach<\/h3>\n                            <p class='gform_description'>Please complete this form to request a program from the SCC.  \r\n\r\nNOTE:  The staff at the counseling center will not be able to fulfill requests for interviews for class assignments\/papers\/projects.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/counselingcenter\/wp-json\/wp\/v2\/pages\/277' data-formid='2' novalidate>\t\t\t\t\t<div style=\"display: none !important;\" class=\"akismet-fields-container gf_invisible\" data-prefix=\"ak_\">\n\t\t\t\t\t\t<label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"250\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LeKvjYqAAAAAMelPWN7OusmcrXFtNXv8hYRuFy6' data-tabindex='0'><input id=\"input_82373f5ac5e09977bfd4a6856a47209b\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_82373f5ac5e09977bfd4a6856a47209b\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_2_13\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_13'>Phone<\/label><div class='ginput_container'><input name='input_13' id='input_2_13' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_13'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_2_1\" 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_2_1'>Your Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_2_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_2\" 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_2_2'>Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_2_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_3\" 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' >Anticipated Audience<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_2_3'>\n\t\t\t<li class='gchoice gchoice_2_3_0'>\n\t\t\t\t<input name='input_3' type='radio' value='Faculty'  id='choice_2_3_0'    \/>\n\t\t\t\t<label for='choice_2_3_0' id='label_2_3_0' class='gform-field-label gform-field-label--type-inline'>Faculty<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_3_1'>\n\t\t\t\t<input name='input_3' type='radio' value='Undergraduate Students'  id='choice_2_3_1'    \/>\n\t\t\t\t<label for='choice_2_3_1' id='label_2_3_1' class='gform-field-label gform-field-label--type-inline'>Undergraduate Students<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_3_2'>\n\t\t\t\t<input name='input_3' type='radio' value='Graduate Students'  id='choice_2_3_2'    \/>\n\t\t\t\t<label for='choice_2_3_2' id='label_2_3_2' class='gform-field-label gform-field-label--type-inline'>Graduate Students<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_3_3'>\n\t\t\t\t<input name='input_3' type='radio' value='Parents'  id='choice_2_3_3'    \/>\n\t\t\t\t<label for='choice_2_3_3' id='label_2_3_3' class='gform-field-label gform-field-label--type-inline'>Parents<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_3_4'>\n\t\t\t\t<input name='input_3' type='radio' value='Community'  id='choice_2_3_4'    \/>\n\t\t\t\t<label for='choice_2_3_4' id='label_2_3_4' class='gform-field-label gform-field-label--type-inline'>Community<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_3_5'>\n\t\t\t\t<input name='input_3' type='radio' value='Other (explain in &quot;other Information&quot;)'  id='choice_2_3_5'    \/>\n\t\t\t\t<label for='choice_2_3_5' id='label_2_3_5' class='gform-field-label gform-field-label--type-inline'>Other (explain in \"other Information\")<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_3_6'>\n\t\t\t\t<input name='input_3' type='radio' value='gf_other_choice'  id='choice_2_3_6'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_2_3_other' name='input_3_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { 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                   <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_8' class='gform_hidden' value='https:\/\/studentlife.utk.edu\/counselingcenter\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_2_9\" class=\"gfield gfield--type-time 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' >Time of Event<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_container ginput_complex gform-grid-row\"><div class=\"clear-multi\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_2_9'>\n                            <input type='number' name='input_9[]' id='input_2_9_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   \/> <i>:<\/i>\n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_2_9_1'>Hours<\/label>\n                        <\/div>\n                        \n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_9[]' id='input_2_9_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_2_9_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_9[]' id='input_2_9_3'  >\n                             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