{"id":3677,"date":"2025-03-26T17:30:48","date_gmt":"2025-03-26T17:30:48","guid":{"rendered":"https:\/\/depts.washington.edu\/uwhatc\/?page_id=3677"},"modified":"2025-03-26T17:37:05","modified_gmt":"2025-03-26T17:37:05","slug":"registration","status":"publish","type":"page","link":"http:\/\/depts.washington.edu\/uwhatc\/healthy-connections-a-harborview-abuse-trauma-center-sexual-health-education-curriculum\/registration\/","title":{"rendered":"Healthy Connections: Registration"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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Curriculum by the Harborview Abuse & Trauma Center<\/h2>\n<p>Thank you for your interest in the Healthy Connections: A Sexual Health Education Curriculum by the Harborview Abuse & Trauma Center. For more information about the curriculum, or to gain access to the resources, please complete the form below.<\/p>\n<\/div><div id=\"field_2_1\" class=\"gfield gfield--type-text gfield--input-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'>Name (First &amp; Last)<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_1' id='input_2_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_3'>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_3' id='input_2_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_2_3\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_2_3'>By adding your email, you will be added to the Healthy Connections listserv. You will receive periodic emails about the curriculum (emails should be infrequent). You may also request to be removed from the listserv at any time. <\/div><\/div><div id=\"field_2_4\" 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_2_4'>Phone<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_2_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_5\" class=\"gfield gfield--type-textarea gfield--input-type-textarea 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_2_5'>Which school\/organization do you work for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_2_5' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_2_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >What is your role?<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_2_6'>\n\t\t\t<div class='gchoice gchoice_2_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Educator'  id='choice_2_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_0' id='label_2_6_0' class='gform-field-label gform-field-label--type-inline'>Educator<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Administrator'  id='choice_2_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_1' id='label_2_6_1' class='gform-field-label gform-field-label--type-inline'>Administrator<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Social Worker'  id='choice_2_6_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_2' id='label_2_6_2' class='gform-field-label gform-field-label--type-inline'>Social Worker<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Sexual Assault Advocate'  id='choice_2_6_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_3' id='label_2_6_3' class='gform-field-label gform-field-label--type-inline'>Sexual Assault Advocate<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='School Counselor'  id='choice_2_6_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_4' id='label_2_6_4' class='gform-field-label gform-field-label--type-inline'>School Counselor<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_6_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='gf_other_choice'  id='choice_2_6_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_6_5' id='label_2_6_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_2_6_other' class='gchoice_other_control' name='input_6_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full 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' >What grade-level(s) do you plan to teach the lesson(s) in? (Check all that apply.)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_7'><div class='gchoice gchoice_2_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='9th'  id='choice_2_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_7_1' id='label_2_7_1' class='gform-field-label gform-field-label--type-inline'>9th<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='10th'  id='choice_2_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_7_2' id='label_2_7_2' class='gform-field-label gform-field-label--type-inline'>10th<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='11th'  id='choice_2_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_7_3' id='label_2_7_3' class='gform-field-label gform-field-label--type-inline'>11th<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='12th'  id='choice_2_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_7_4' id='label_2_7_4' class='gform-field-label gform-field-label--type-inline'>12th<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_8\" class=\"gfield gfield--type-textarea gfield--input-type-textarea 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_8'>How did you hear about this curriculum?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_8' id='input_2_8' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer 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