{"id":2757,"date":"2024-04-03T11:37:25","date_gmt":"2024-04-03T16:37:25","guid":{"rendered":"https:\/\/www.marshall.edu\/help\/?page_id=2757"},"modified":"2024-08-20T14:06:16","modified_gmt":"2024-08-20T19:06:16","slug":"mu-h-e-l-p-program-absence-report","status":"publish","type":"page","link":"https:\/\/www.marshall.edu\/help\/mu-h-e-l-p-program-absence-report\/","title":{"rendered":"MU H.E.L.P Program Absence Report"},"content":{"rendered":"\t<div\n\t\t\n\t\tclass=\"herdpress-block wp-block-herdpress-gravity-form has-white-background-color has-background herdpress-gravity-form py-12 lg:py-18\"\n\t>\n\t\t<div class=\"w-full px-6 lg:px-0\">\n\t\t\t\n\t\t\t\t\t\t\t<div class=\"mt-8 lg:mt-12 \">\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_16' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Marshall University H.E.L.P. Program Absence Report<\/h2>\n                            <p class='gform_description'>For all questions regarding absence reports, please contact Hillary Adams (brown235@marshall.edu).<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_16'  action='\/help\/wp-json\/wp\/v2\/pages\/2757' data-formid='16' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_16' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_16_1\" class=\"gfield gfield--type-name gfield--input-type-name 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 gfield_label_before_complex' ><span class='gform-field-label__text'>Tutor&#039;s name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_16_1'>\n                            \n                            <span id='input_16_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_16_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_16_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_16_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_16_3\" class=\"gfield gfield--type-email gfield--input-type-email 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_16_3'><span class='gform-field-label__text'>Tutor&#039;s Email<\/span><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_16_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_16_5\" class=\"gfield gfield--type-name gfield--input-type-name 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 gfield_label_before_complex' ><span class='gform-field-label__text'>Student&#039;s name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_16_5'>\n                            \n                            <span id='input_16_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_16_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_5_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_16_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_16_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_16_5_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_16_6\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon 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_16_6'><span class='gform-field-label__text'>Original Appointment Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_16_6'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_6'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_16_6' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_16_6' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_16_6' aria-label='Original Appointment Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_16_7\" class=\"gfield gfield--type-time gfield--input-type-time 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 gfield_label_before_complex' ><span class='gform-field-label__text'>Original Appointment Time<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_16_7'>\n                            <input type='number' name='input_7[]' id='input_16_7_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_16_7_1'>Hours<\/label>\n                        <\/div>\n                        <div class=\"above hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_7[]' id='input_16_7_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_16_7_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time above gform-grid-col' >\n                                \n                                <select name='input_7[]' id='input_16_7_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select>\n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_16_7_3'>AM\/PM<\/label>\n                           <\/div>\n                    <\/div><\/fieldset><fieldset id=\"field_16_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Length of Scheduled Session<\/span><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_16_9'>\n\t\t\t<div class='gchoice gchoice_16_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='15 minutes'  id='choice_16_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_9_0' id='label_16_9_0' class='gform-field-label gform-field-label--type-inline'>15 minutes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='30 minutes'  id='choice_16_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_9_1' id='label_16_9_1' class='gform-field-label gform-field-label--type-inline'>30 minutes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='1 hour'  id='choice_16_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_9_2' id='label_16_9_2' class='gform-field-label gform-field-label--type-inline'>1 hour<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='1.5 hours'  id='choice_16_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_9_3' id='label_16_9_3' class='gform-field-label gform-field-label--type-inline'>1.5 hours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='2 hours'  id='choice_16_9_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_9_4' id='label_16_9_4' class='gform-field-label gform-field-label--type-inline'>2 hours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_9_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='3 hours'  id='choice_16_9_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_9_5' id='label_16_9_5' class='gform-field-label gform-field-label--type-inline'>3 hours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_9_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gf_other_choice'  id='choice_16_9_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_9_6' id='label_16_9_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_16_9_other' class='gchoice_other_control' name='input_9_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_16_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Reason for Absence<\/span><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_16_10'>\n\t\t\t<div class='gchoice gchoice_16_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No-show'  id='choice_16_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_10_0' id='label_16_10_0' class='gform-field-label gform-field-label--type-inline'>No-show<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Canceled'  id='choice_16_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_10_1' id='label_16_10_1' class='gform-field-label gform-field-label--type-inline'>Canceled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Rescheduled'  id='choice_16_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_10_2' id='label_16_10_2' class='gform-field-label gform-field-label--type-inline'>Rescheduled<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Working on Rescheduling'  id='choice_16_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_10_3' id='label_16_10_3' class='gform-field-label gform-field-label--type-inline'>Working on Rescheduling<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_16_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='gf_other_choice'  id='choice_16_10_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_16_10_4' id='label_16_10_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_16_10_other' class='gchoice_other_control' name='input_10_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_16_11\" class=\"gfield gfield--type-number gfield--input-type-number 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_16_11'><span class='gform-field-label__text'>Number of absences this semester<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_11' id='input_16_11' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_16_12\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon 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_16_12'><span class='gform-field-label__text'>Date for next scheduled appointment<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_16_12'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_12'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_16_12' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_16_12' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_16_12' aria-label='Date for next scheduled appointment: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_16_13\" class=\"gfield gfield--type-time gfield--input-type-time 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' ><span class='gform-field-label__text'>Time for next scheduled appointment<\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_16_13'>\n                            <input type='number' name='input_13[]' id='input_16_13_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='false'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_16_13_1'>Hours<\/label>\n                        <\/div>\n                        <div class=\"above hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_13[]' id='input_16_13_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_16_13_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time above gform-grid-col' >\n                                \n                                <select name='input_13[]' id='input_16_13_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select>\n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_16_13_3'>AM\/PM<\/label>\n                           <\/div>\n                    <\/div><\/fieldset><div id=\"field_16_14\" 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_16_14'><span class='gform-field-label__text'>Any additional comments<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_16_14' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type=\"submit\" id=\"gform_submit_button_16\" class=\"button button--primary gform_button button\" onclick=\"gform.submission.handleButtonClick(this);\" data-submission-type=\"submit\">Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_16' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_16' id='gform_theme_16' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_16' id='gform_style_settings_16' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_16' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='16' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' 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\/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_16' id='gform_target_page_number_16' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_16' id='gform_source_page_number_16' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        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