{"id":21780,"date":"2020-11-30T05:35:25","date_gmt":"2020-11-30T05:35:25","guid":{"rendered":"https:\/\/tectonique.net\/agate_dev\/?page_id=21780"},"modified":"2020-11-30T05:35:27","modified_gmt":"2020-11-30T05:35:27","slug":"course-subscription-application","status":"publish","type":"page","link":"https:\/\/tectonique.net\/agate_dev\/course-subscription-application\/","title":{"rendered":"Course Subscription Application"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-21700\"><form id=\"wpforms-form-21700\" class=\"wpforms-validate wpforms-form\" data-formid=\"21700\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/agate_dev\/wp-json\/wp\/v2\/pages\/21780\" data-token=\"c442fdb79ba02d74394c5cf813d35097\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-21700-field_20-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"20\"><h3 id=\"wpforms-21700-field_20\" name=\"wpforms[fields][20]\">Applicant information<\/h3><div class=\"wpforms-field-description\">If you have seen an ONLINE course advertised on the Agate Website or elsewhere (5 days or less) that you would like to apply to attend and have Agate cover the costs, please complete this form.<br><br>Please complete all fields below and then click on the submit button to complete your application. <br><br> <\/div><\/div><div id=\"wpforms-21700-field_38-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_38\">Course Title <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-21700-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" required><\/div><div id=\"wpforms-21700-field_39-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_39\">Web address of course (URL) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-21700-field_39\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][39]\" placeholder=\"http:\/\/\" required><\/div><div id=\"wpforms-21700-field_40-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_40\">Course Registration Fee <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-21700-field_40\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][40]\" required><\/div><div id=\"wpforms-21700-field_41-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_41\">Course Fee Currency <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-21700-field_41\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][41]\" required><\/div><div id=\"wpforms-21700-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_1\">Applicant First Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-21700-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" required><div class=\"wpforms-field-description\">Name of Student Applying for Grant<\/div><\/div><div id=\"wpforms-21700-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_2\">Applicant Last Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-21700-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><div class=\"wpforms-field-description\">Last Name of Student applying for Grant<\/div><\/div><div id=\"wpforms-21700-field_8-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_8\">Applicant&#039;s Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-21700-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required><\/div><div id=\"wpforms-21700-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_6\">Student&#039;s Current Institution <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-21700-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required><\/div><div id=\"wpforms-21700-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_7\">Country of Institution <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-21700-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-21700-field_12-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_12\">Degree being sought<\/label><ul id=\"wpforms-21700-field_12\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-21700-field_12_1\" name=\"wpforms[fields][12]\" value=\"Masters\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-21700-field_12_1\">Masters<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-21700-field_12_2\" name=\"wpforms[fields][12]\" value=\"PhD\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-21700-field_12_2\">PhD<\/label><\/li><\/ul><\/div><div id=\"wpforms-21700-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_16\">Reason for attending online course <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-21700-field_16\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-words-enabled\" data-form-id=\"21700\" data-field-id=\"16\" data-text-limit=\"100\" name=\"wpforms[fields][16]\" required><\/textarea><\/div><div id=\"wpforms-21700-field_33-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"33\"><h3 id=\"wpforms-21700-field_33\" name=\"wpforms[fields][33]\">Declaration<\/h3><\/div><div id=\"wpforms-21700-field_34-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-21700-field_34\">I declare that: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-21700-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-21700-field_34_1\" name=\"wpforms[fields][34][]\" value=\"all information provided on this form and supplied documents, is true and correct \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-21700-field_34_1\">all information provided on this form and supplied documents, is true and correct <\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"21700\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-21700\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Sending application...\" data-submit-text=\"Submit my application\">Submit my application<\/button><\/div><\/form><\/div>  <!-- .wpforms-container 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