{"id":522,"date":"2022-08-25T13:53:16","date_gmt":"2022-08-25T20:53:16","guid":{"rendered":"https:\/\/depts.washington.edu\/chaplain\/wordpress\/?page_id=522"},"modified":"2022-08-25T13:53:17","modified_gmt":"2022-08-25T20:53:17","slug":"apply-for-residency-returning-harborview-students","status":"publish","type":"page","link":"https:\/\/depts.washington.edu\/chaplain\/clinical-pastoral-education\/apply-online-pay-fees\/submit-application\/apply-for-residency-returning-harborview-students\/","title":{"rendered":"Apply for Residency\u2013Returning Harborview Students"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),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),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_4' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Apply for Residency-Returning Harborview Students<\/h2>\n                            <span class='gform_description'><\/span>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/chaplain\/wp-json\/wp\/v2\/pages\/522' novalidate>\n                        <div class='gform_body gform-body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_above'><div id=\"field_4_1\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_1\"><label class='gfield_label' for='input_4_1' >Residency Year<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_1'>(e.g. August 2023 \u2013 August 2024)<\/div><div class='ginput_container ginput_container_text'><input name='input_1' id='input_4_1' type='text' value='' class='large'  aria-describedby=\"gfield_description_4_1\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_3\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_3\"><label class='gfield_label' for='input_4_3' >Full Legal Name<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_3' id='input_4_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_4\"  class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_4\"><label class='gfield_label' for='input_4_4' >Full Preferred Name<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_4_4' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_5\"  class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_5\"><label class='gfield_label' for='input_4_5' >Pronouns<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_4_5' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_4_6\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_6\"><label class='gfield_label' for='input_4_6' >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_6' id='input_4_6' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_7\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_7\"><label class='gfield_label' for='input_4_7' >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_7' id='input_4_7' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_15\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_15\"><label class='gfield_label' for='input_4_15' >Mailing Address<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_15' id='input_4_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_4_20\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_20\"><legend class='gfield_label gfield_label_before_complex'  >CPE Experience Confirmation<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_4_20'><div class='gchoice gchoice_4_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='I confirm I am a current Harborview CPE student or have completed a CPE unit at Harborview in the past 12 months (no application fee required).'  id='choice_4_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_20_1' id='label_4_20_1'>I confirm I am a current Harborview CPE student or have completed a CPE unit at Harborview in the past 12 months (no application fee required).<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_11\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_11\"><label class='gfield_label' for='input_4_11' >ACPE Facesheet \/ Application<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='2097152' \/><input name='input_11' id='input_4_11' type='file' class='large' aria-describedby=\"gfield_upload_rules_4_11\" onchange='javascript:gformValidateFileSize( this, 2097152 );'  \/><span class='gform_fileupload_rules' id='gfield_upload_rules_4_11'>Accepted file types: pdf, Max. file size: 2 MB.<\/span><div class='validation_message validation_message--hidden-on-empty' id='live_validation_message_4_11'><\/div><\/div><\/div><div id=\"field_4_21\"  class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\"  data-js-reload=\"field_4_21\"><label class='gfield_label' for='input_4_21' >Supplemental Application Questions<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_21'>Compiled in a single document:\nKey Learnings:  your Key Learnings so far from your current unit. Residency Learning Goals:  your potential Learning Goals for your Residency. 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