{"id":454,"date":"2020-01-09T16:37:27","date_gmt":"2020-01-09T16:37:27","guid":{"rendered":"http:\/\/www.prattnortham.org\/pratt-northam-foundation-2023\/?page_id=454"},"modified":"2023-01-13T20:24:34","modified_gmt":"2023-01-13T20:24:34","slug":"student-registration-form","status":"publish","type":"page","link":"https:\/\/www.prattnortham.org\/pratt-northam-foundation-2023\/student-registration-form\/","title":{"rendered":"Student Registration"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f649-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/pratt-northam-foundation-2023\/wp-json\/wp\/v2\/pages\/454#wpcf7-f649-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"649\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.7.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f649-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<h2 style=\"text-align:center\">Workership Program\n<\/h2>\n<h3 style=\"text-align:center\"><u>STUDENT INFORMATON REGISTRATION<\/u>\n<\/h3>\n<p><label>Employer: <span class=\"wpcf7-form-control-wrap\" data-name=\"Employer\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Employer\" \/><\/span> <\/label>\n<\/p>\n<p><label>Job Title: <span class=\"wpcf7-form-control-wrap\" data-name=\"JobTitle\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"JobTitle\" \/><\/span> <\/label>\n<\/p>\n<p><label>Direct Supervisor: <span class=\"wpcf7-form-control-wrap\" data-name=\"DirectSupervisor\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"DirectSupervisor\" \/><\/span> <\/label>\n<\/p>\n<p><label>Phone # <span class=\"wpcf7-form-control-wrap\" data-name=\"Phone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Phone\" \/><\/span><\/label>\n<\/p>\n<p><label>Email: <span class=\"wpcf7-form-control-wrap\" data-name=\"myemail\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"myemail\" \/><\/span><\/label>\n<\/p>\n<p>(Please complete all items and one form for each workership position; this information is for Pratt Northam Foundation use only \u2013 the information will not be shared with any other agency or business.)\n<\/p>\n<p><label>Student\u2019s Name: (required) <span class=\"wpcf7-form-control-wrap\" data-name=\"StudentsName\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"StudentsName\" \/><\/span> <\/label>\n<\/p>\n<p><label>Home Address: <span class=\"wpcf7-form-control-wrap\" data-name=\"HomeAddress\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"HomeAddress\" \/><\/span> <\/label>\n<\/p>\n<p><label>Phone: <span class=\"wpcf7-form-control-wrap\" data-name=\"StudentsPhone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"StudentsPhone\" \/><\/span><\/label>\n<\/p>\n<p><label> E-Mail: <span class=\"wpcf7-form-control-wrap\" data-name=\"Studentsemail\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Studentsemail\" \/><\/span><\/label>\n<\/p>\n<p><label>College of Enrollment \u2013 Fall 2020: <span class=\"wpcf7-form-control-wrap\" data-name=\"CollegeofEnrollment\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CollegeofEnrollment\" \/><\/span> <\/label>\n<\/p>\n<p><label>College Major: <span class=\"wpcf7-form-control-wrap\" data-name=\"CollegeMajor\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CollegeMajor\" \/><\/span><\/label>\n<\/p>\n<p><label>Year of Study:<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"YearofStudy\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"YearofStudy[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"YearofStudy[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"YearofStudy[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"YearofStudy[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"YearofStudy[]\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"YearofStudy[]\" value=\"6\" \/><span class=\"wpcf7-list-item-label\">6<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label># of previous summers in this workership position<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"workershipposition\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"workershipposition[]\" value=\"0\" \/><span class=\"wpcf7-list-item-label\">0<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"workershipposition[]\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"workershipposition[]\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"workershipposition[]\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"workershipposition[]\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label>Notes<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"notes\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"notes\"><\/textarea><\/span> <\/label>\n<\/p>\n<h5 style=\"text-align:center\"><u>Please fill out and return to the Pratt Northam Foundation by June15,2020<\/u>\n<\/h5>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"math-quiz\"><label><span class=\"wpcf7-quiz-label\">5+12=?<\/span> <input size=\"40\" class=\"wpcf7-form-control wpcf7-quiz\" autocomplete=\"off\" aria-required=\"true\" aria-invalid=\"false\" type=\"text\" name=\"math-quiz\" \/><\/label><input type=\"hidden\" name=\"_wpcf7_quiz_answer_math-quiz\" value=\"51029c37c64ca9e27531c9e96b177fab\" \/><\/span><br \/>\n<span id=\"wpcf7-69eccef2ee27b-wrapper\" class=\"wpcf7-form-control-wrap honeypot-276-wrap\" style=\"display:none !important; visibility:hidden !important;\"><label for=\"wpcf7-69eccef2ee27b-field\" class=\"hp-message\">Please leave this field empty.<\/label><input id=\"wpcf7-69eccef2ee27b-field\"  class=\"wpcf7-form-control wpcf7-text\" type=\"text\" name=\"honeypot-276\" value=\"\" size=\"40\" tabindex=\"-1\" autocomplete=\"new-password\" \/><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control has-spinner wpcf7-submit\" type=\"submit\" value=\"Send\" \/>\n<\/p><input type=\"hidden\" id=\"ct_checkjs_cf7_93db85ed909c13838ff95ccfa94cebd9\" name=\"ct_checkjs_cf7\" value=\"0\" \/><script >setTimeout(function(){var ct_input_name = \"ct_checkjs_cf7_93db85ed909c13838ff95ccfa94cebd9\";if (document.getElementById(ct_input_name) !== null) {var ct_input_value = document.getElementById(ct_input_name).value;document.getElementById(ct_input_name).value = document.getElementById(ct_input_name).value.replace(ct_input_value, '1700266809');}}, 1000);<\/script><input\n                    class=\"apbct_special_field apbct_email_id__wp_contact_form_7\"\n                    name=\"apbct__email_id__wp_contact_form_7\"\n                    aria-label=\"apbct__label_id__wp_contact_form_7\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":231,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-full.php","meta":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Student Registration | The Pratt-Northam Foundation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.prattnortham.org\/pratt-northam-foundation-2023\/student-registration-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Student Registration | The Pratt-Northam Foundation\" \/>\n<meta property=\"og:url\" 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