{"id":1995,"date":"2023-09-12T10:37:16","date_gmt":"2023-09-12T14:37:16","guid":{"rendered":"https:\/\/www.gcc.mass.edu\/registrar\/?page_id=1995"},"modified":"2025-09-22T13:22:00","modified_gmt":"2025-09-22T17:22:00","slug":"internships","status":"publish","type":"page","link":"https:\/\/www.gcc.mass.edu\/registrar\/forms\/internships\/","title":{"rendered":"Internship Proposal\/Application"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n\n\/\/----------------------------------------------------------\n\/\/------ JAVASCRIPT HOOK FUNCTIONS FOR GRAVITY FORMS -------\n\/\/----------------------------------------------------------\n\nif ( ! gform ) {\n\tdocument.addEventListener( 'gform_main_scripts_loaded', function() { gform.scriptsLoaded = true; } );\n\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', function() { gform.themeScriptsLoaded = true; } );\n\twindow.addEventListener( 'DOMContentLoaded', function() { gform.domLoaded = true; } 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{\n\t\t\t\tvar hooks = gform.hooks[hookType][action], hook;\n\t\t\t\t\/\/sort by priority\n\t\t\t\thooks.sort(function(a,b){return a[\"priority\"]-b[\"priority\"]});\n\n\t\t\t\thooks.forEach( function( hookItem ) {\n\t\t\t\t\thook = hookItem.callable;\n\n\t\t\t\t\tif(typeof hook != 'function')\n\t\t\t\t\t\thook = window[hook];\n\t\t\t\t\tif ( 'action' == hookType ) {\n\t\t\t\t\t\thook.apply(null, args);\n\t\t\t\t\t} else {\n\t\t\t\t\t\targs[0] = hook.apply(null, args);\n\t\t\t\t\t}\n\t\t\t\t} );\n\t\t\t}\n\t\t\tif ( 'filter'==hookType ) {\n\t\t\t\treturn args[0];\n\t\t\t}\n\t\t},\n\t\tremoveHook: function( hookType, action, priority, tag ) {\n\t\t\tif ( undefined != gform.hooks[hookType][action] ) {\n\t\t\t\tvar hooks = gform.hooks[hookType][action];\n\t\t\t\thooks = hooks.filter( function(hook, index, arr) {\n\t\t\t\t\tvar removeHook = (undefined==tag||tag==hook.tag) && (undefined==priority||priority==hook.priority);\n\t\t\t\t\treturn !removeHook;\n\t\t\t\t} );\n\t\t\t\tgform.hooks[hookType][action] = hooks;\n\t\t\t}\n\t\t}\n\t};\n}\n\n\/* ]]> *\/\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_19' style='display:none'><div id='gf_19' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/registrar\/wp-json\/wp\/v2\/pages\/1995#gf_19' data-formid='19' novalidate>\n        <div id='gf_progressbar_wrapper_19' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_19_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_19_60\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Admin Only<\/h3><\/div><div id=\"field_19_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_47'>CRN<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_47' id='input_19_47' type='text' value='' class='large'   tabindex='1000'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_63'>Amount<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_63' id='input_19_63' type='text' value='' class='large'   tabindex='1001'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_65'>Fund #<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_65' id='input_19_65' type='text' value='' class='large'   tabindex='1002'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Application<\/h3><\/div><fieldset id=\"field_19_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<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_19_1'>\n                            \n                            <span id='input_19_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_19_1_3' value='' tabindex='1004'  aria-required='true'     \/>\n                                                    <label for='input_19_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_19_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_19_1_6' value='' tabindex='1006'  aria-required='true'     \/>\n                                                    <label for='input_19_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_19_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_19_3_container'>\n                                <span id='input_19_3_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3' id='input_19_3' value='' tabindex='1008'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_3' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_19_3_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3_2' id='input_19_3_2' value='' tabindex='1009'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_3_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_19_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_4'>Student ID #<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_4' id='input_19_4' type='text' value='' class='large'   tabindex='1010'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_59\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_59'>Major<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_59' id='input_19_59' class='large gfield_select' tabindex='1011'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Please choose<\/option><option value='Addiction Studies Certificate (ASC) CERT' >Addiction Studies Certificate (ASC) CERT<\/option><option value='Adventure Education (ADE) AS' >Adventure Education (ADE) AS<\/option><option value='Allied Health (ALH) AS' >Allied Health (ALH) AS<\/option><option value='Allied Health\/Dental Assisting Intent (ALH) AS' >Allied Health\/Dental Assisting Intent (ALH) AS<\/option><option value='Allied Health\/Kinesiology Transfer Intent (ALH) AS' >Allied Health\/Kinesiology Transfer Intent (ALH) AS<\/option><option value='Allied Health\/LPN Intent (ALH) AS' >Allied Health\/LPN Intent (ALH) AS<\/option><option value='Allied Health\/Nutrition Transfer Intent (ALH) AS' >Allied Health\/Nutrition Transfer Intent (ALH) AS<\/option><option value='Allied Health\/PMC Intent (ALH) AS' >Allied Health\/PMC Intent (ALH) AS<\/option><option value='Allied Health\/Physical Therapy Assistant Intent (ALH) AS' >Allied Health\/Physical Therapy Assistant Intent (ALH) AS<\/option><option value='Allied Health\/Public Health Transfer Intent (ALH) AS' >Allied Health\/Public Health Transfer Intent (ALH) AS<\/option><option value='Allied Health\/Radiologic Technology Intent (ALH) AS' >Allied Health\/Radiologic Technology Intent (ALH) AS<\/option><option value='Allied Health\/Respiratory Therapy Intent (ALH) AS' >Allied Health\/Respiratory Therapy Intent (ALH) AS<\/option><option value='Allied Health\/RN Intent (ALH) AS' >Allied Health\/RN Intent (ALH) AS<\/option><option value='Allied Health\/SGT (ALH) AS' >Allied Health\/SGT (ALH) AS<\/option><option value='Art\/Visual Art Transfer Block (AVC) AS' >Art\/Visual Art Transfer Block (AVC) AS<\/option><option value='Art\/Visual Arts (AVA) AS' >Art\/Visual Arts (AVA) AS<\/option><option value='Biology (BIO) AS' >Biology (BIO) AS<\/option><option value='Business Administration General (BAG) AS' >Business Administration General (BAG) AS<\/option><option value='Business Administration Transfer (BAT) AA' >Business Administration Transfer (BAT) AA<\/option><option value='Chemistry (CHE) AS' >Chemistry (CHE) AS<\/option><option value='Computer Science (CSC) AS' >Computer Science (CSC) AS<\/option><option value='Early Childhood Education (ECE) AS' >Early Childhood Education (ECE) AS<\/option><option value='Early Childhood Education Certificate (CECE) CERT' >Early Childhood Education Certificate (CECE) CERT<\/option><option value='Engineering Science (EGS) AS' >Engineering Science (EGS) AS<\/option><option value='Environmental Conservation (ENC) AS' >Environmental Conservation (ENC) AS<\/option><option value='Farm and Food Systems (LFF) AA' >Farm and Food Systems (LFF) AA<\/option><option value='Fire Science Technology (FST) AS' >Fire Science Technology (FST) AS<\/option><option value='Human Services (HSE) AS' >Human Services (HSE) AS<\/option><option value='Justice Studies (JUS) AS' >Justice Studies (JUS) AS<\/option><option value='Liberal Arts (LIB) AA' >Liberal Arts (LIB) AA<\/option><option value='Liberal Arts\/Contemporary Music Studies (LCMS) AA' >Liberal Arts\/Contemporary Music Studies (LCMS) AA<\/option><option value='Liberal Arts\/Education (LEO) AA' >Liberal Arts\/Education (LEO) AA<\/option><option value='Liberal Arts\/English (LAE) AA' >Liberal Arts\/English (LAE) AA<\/option><option value='Liberal Arts\/Farm and Food Systems (LFF) AA' >Liberal Arts\/Farm and Food Systems (LFF) AA<\/option><option value='Liberal Arts\/History (LHI) AA' >Liberal Arts\/History (LHI) AA<\/option><option value='Liberal Arts\/Mathematics (LMA) AA' >Liberal Arts\/Mathematics (LMA) AA<\/option><option value='Liberal Arts\/Social Sciences (LSS) AA' >Liberal Arts\/Social Sciences (LSS) AA<\/option><option value='Liberal Arts\/Theater (LAT) AA' >Liberal Arts\/Theater (LAT) AA<\/option><option value='Management Certificate (MGT) CERT' >Management Certificate (MGT) CERT<\/option><option value='Medical Assistant Certificate (MAC) CERT' >Medical Assistant Certificate (MAC) CERT<\/option><option value='Music Recording and Production Certificate (MRP) CERT' >Music Recording and Production Certificate (MRP) CERT<\/option><option value='Outdoor Leadership Certificate (OLP) CERT' >Outdoor Leadership Certificate (OLP) CERT<\/option><option value='Plant &amp; Soil Science (PSS) AS' >Plant &amp; Soil Science (PSS) AS<\/option><option value='Pre-Nursing (NUC) CERT' >Pre-Nursing (NUC) CERT<\/option><option value='Pre-Nursing\/ADN Intent (NUC) CERT' >Pre-Nursing\/ADN Intent (NUC) CERT<\/option><option value='Pre-Nursing\/LPN Intent (NUC) CERT' >Pre-Nursing\/LPN Intent (NUC) CERT<\/option><option value='Pre-Nursing\/Nursing Bridge Intent (NUC) CERT ** ONLY AVAILABLE FOR PRACTICAL NURSES **' >Pre-Nursing\/Nursing Bridge Intent (NUC) CERT ** ONLY AVAILABLE FOR PRACTICAL NURSES **<\/option><option value='Visual Arts Certificate (VAC) CERT' >Visual Arts Certificate (VAC) CERT<\/option><option value='Web Development &amp; Design Certificate (WDD) CERT' >Web Development &amp; Design Certificate (WDD) CERT<\/option><option value='World Language in French (WFR) CERT' >World Language in French (WFR) CERT<\/option><option value='World Language in Spanish (WSP) CERT' >World Language in Spanish (WSP) CERT<\/option><\/select><\/div><\/div><div id=\"field_19_9\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_9'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_19_9' type='tel' value='' class='large' tabindex='1012'   aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Age<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_19_40'>\n\t\t\t<div class='gchoice gchoice_19_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Under 18'  id='choice_19_40_0' onchange='gformToggleRadioOther( this )'  tabindex='1013'  \/>\n\t\t\t\t\t<label for='choice_19_40_0' id='label_19_40_0' class='gform-field-label gform-field-label--type-inline'>Under 18<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_19_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Over 18'  id='choice_19_40_1' onchange='gformToggleRadioOther( this )'  tabindex='1014'  \/>\n\t\t\t\t\t<label for='choice_19_40_1' id='label_19_40_1' class='gform-field-label gform-field-label--type-inline'>Over 18<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_41\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent\/Guardian Name<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_19_41'>\n                            \n                            <span id='input_19_41_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.3' id='input_19_41_3' value='' tabindex='1016'  aria-required='true'     \/>\n                                                    <label for='input_19_41_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_19_41_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.6' id='input_19_41_6' value='' tabindex='1018'  aria-required='true'     \/>\n                                                    <label for='input_19_41_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_19_42\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent\/Guardian Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_19_42_container'>\n                                <span id='input_19_42_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_42' id='input_19_42' value='' tabindex='1020'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_42' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_19_42_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_42_2' id='input_19_42_2' value='' tabindex='1021'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_42_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_19_20\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"alert alert-info\" style=\"margin-top:20px; margin-bottom:-20px;\"><p>A 294-level internship indicates you have <em>already<\/em> completed a 293-level internship in the same field of study. E.g., after completing BIO 293 Internship in Biology you would then take BIO 294 Internship in Biology. Refer to the <a href=\"\/webdocs\/internships\/GCC-Internship-Overview.pdf\" target=\"_blank\">Internship Overview<\/a> document for more information.<\/p> <\/div><\/div><div id=\"field_19_6\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_6'>Course Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_19_6' class='large gfield_select' tabindex='1022'   aria-required=\"true\" aria-invalid=\"false\" ><option value='293 - Internship I' selected='selected'>293 - Internship I<\/option><option value='294 - Internship II' >294 - Internship II<\/option><\/select><\/div><\/div><div id=\"field_19_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_7'>Subject<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_19_7' class='large gfield_select' tabindex='1023'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Please Choose<\/option><option value='ACC' >ACC<\/option><option value='ACS' >ACS<\/option><option value='AGR' >AGR<\/option><option value='AHS' >AHS<\/option><option value='ALH' >ALH<\/option><option value='ANT' >ANT<\/option><option value='ART' >ART<\/option><option value='ASL' >ASL<\/option><option value='BIO' >BIO<\/option><option value='BUS' >BUS<\/option><option value='CHE' >CHE<\/option><option value='CIS' >CIS<\/option><option value='CMN' >CMN<\/option><option value='CRJ' >CRJ<\/option><option value='CSC' >CSC<\/option><option value='ECO' >ECO<\/option><option value='EDU' >EDU<\/option><option value='EGR' >EGR<\/option><option value='EGT' >EGT<\/option><option value='EMS' >EMS<\/option><option value='ENG' >ENG<\/option><option value='EVS' >EVS<\/option><option value='FRE' >FRE<\/option><option value='FST' >FST<\/option><option value='GEO' >GEO<\/option><option value='GWS' >GWS<\/option><option value='HIS' >HIS<\/option><option value='HSV' >HSV<\/option><option value='HUD' >HUD<\/option><option value='HUM' >HUM<\/option><option value='JUS' >JUS<\/option><option value='LAT' >LAT<\/option><option value='MAC' >MAC<\/option><option value='MAT' >MAT<\/option><option value='MOM' >MOM<\/option><option value='MUS' >MUS<\/option><option value='NUR' >NUR<\/option><option value='OLP' >OLP<\/option><option value='PCS' >PCS<\/option><option value='PHI' >PHI<\/option><option value='PHY' >PHY<\/option><option value='POL' >POL<\/option><option value='PSY' >PSY<\/option><option value='REE' >REE<\/option><option value='SCI' >SCI<\/option><option value='SGT' >SGT<\/option><option value='SOC' >SOC<\/option><option value='SPA' >SPA<\/option><option value='THE' >THE<\/option><\/select><\/div><\/div><fieldset id=\"field_19_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Dean<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_53'>\n\t\t\t<div class='gchoice gchoice_19_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Nursing' checked='checked' id='choice_19_53_0' onchange='gformToggleRadioOther( this )'  tabindex='1024'  \/>\n\t\t\t\t\t<label for='choice_19_53_0' id='label_19_53_0' class='gform-field-label gform-field-label--type-inline'>Nursing<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Dean<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_52'>\n\t\t\t<div class='gchoice gchoice_19_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Allied Health' checked='checked' id='choice_19_52_0' onchange='gformToggleRadioOther( this )'  tabindex='1025'  \/>\n\t\t\t\t\t<label for='choice_19_52_0' id='label_19_52_0' class='gform-field-label gform-field-label--type-inline'>Allied Health<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Dean<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_54'>\n\t\t\t<div class='gchoice gchoice_19_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Liberal Arts' checked='checked' id='choice_19_54_0' onchange='gformToggleRadioOther( this )'  tabindex='1026'  \/>\n\t\t\t\t\t<label for='choice_19_54_0' id='label_19_54_0' class='gform-field-label gform-field-label--type-inline'>Liberal Arts<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Grouping<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_55'>\n\t\t\t<div class='gchoice gchoice_19_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Melanie' checked='checked' id='choice_19_55_0' onchange='gformToggleRadioOther( this )'  tabindex='1027'  \/>\n\t\t\t\t\t<label for='choice_19_55_0' id='label_19_55_0' class='gform-field-label gform-field-label--type-inline'>Melanie<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Grouping<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_58'>\n\t\t\t<div class='gchoice gchoice_19_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Amy' checked='checked' id='choice_19_58_0' onchange='gformToggleRadioOther( this )'  tabindex='1028'  \/>\n\t\t\t\t\t<label for='choice_19_58_0' id='label_19_58_0' class='gform-field-label gform-field-label--type-inline'>Amy<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_19_56\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><legend class='gfield_label gform-field-label' >Grouping<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_19_56'>\n\t\t\t<div class='gchoice gchoice_19_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Jan' checked='checked' id='choice_19_56_0' onchange='gformToggleRadioOther( this )'  tabindex='1029'  \/>\n\t\t\t\t\t<label for='choice_19_56_0' id='label_19_56_0' class='gform-field-label gform-field-label--type-inline'>Jan<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_10'>Credits<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_19_10' class='medium gfield_select' tabindex='1030'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Please Choose<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><\/select><\/div><\/div><div id=\"field_19_11\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_11'>Term<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_19_11' class='medium gfield_select' tabindex='1031'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' >Please Choose<\/option><option value='Fall' >Fall<\/option><option value='Spring' >Spring<\/option><option value='Summer I' >Summer I<\/option><option value='Summer II' >Summer II<\/option><option value='Full Summer (I &amp; II)' >Full Summer (I &amp; II)<\/option><\/select><\/div><\/div><div id=\"field_19_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_12'>Year<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_19_12' class='medium gfield_select' tabindex='1032'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Please Choose' >Please Choose<\/option><option value='2026' >2026<\/option><\/select><\/div><\/div><fieldset id=\"field_19_14\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Faculty Mentor<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_19_14'>\n                            \n                            <span id='input_19_14_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.3' id='input_19_14_3' value='' tabindex='1034'  aria-required='true'     \/>\n                                                    <label for='input_19_14_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_19_14_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.6' id='input_19_14_6' value='' tabindex='1036'  aria-required='true'     \/>\n                                                    <label for='input_19_14_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_19_17\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Faculty Mentor Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_19_17'><strong>Make sure to get this part right!<\/strong> Your mentor will be sent a copy of your application to approve; if their address is not accurate, they won't get the email!<\/div><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_19_17_container'>\n                                <span id='input_19_17_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_17' id='input_19_17' value='' tabindex='1038'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_19_17\" \/>\n                                    <label for='input_19_17' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_19_17_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_17_2' id='input_19_17_2' value='' tabindex='1039'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_19_17\" \/>\n                                    <label for='input_19_17_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_19_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_15'>Internship Site<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_19_15'>Name of company\/organization & location<\/div><div class='ginput_container ginput_container_text'><input name='input_15' id='input_19_15' type='text' value='' class='large'  aria-describedby=\"gfield_description_19_15\" tabindex='1040'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_19_16\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Site Supervisor<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_19_16'>\n                            \n                            <span id='input_19_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_19_16_3' value='' tabindex='1042'  aria-required='true'     \/>\n                                                    <label for='input_19_16_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_19_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_19_16_6' value='' tabindex='1044'  aria-required='true'     \/>\n                                                    <label for='input_19_16_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_19_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Site Supervisor Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_19_13'><strong>Make sure to get this part right!<\/strong> Your site contact will be sent a copy of your proposal to approve; if their address is not accurate, they won't get the email!<\/div><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_19_13_container'>\n                                <span id='input_19_13_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_13' id='input_19_13' value='' tabindex='1046'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_19_13\" \/>\n                                    <label for='input_19_13' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_19_13_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_13_2' id='input_19_13_2' value='' tabindex='1047'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_19_13\" \/>\n                                    <label for='input_19_13_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_19_32\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_32'>Site Contact 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_32' id='input_19_32' type='tel' value='' class='large' tabindex='1048'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_19_8\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"alert alert-info\" style=\"margin-bottom:-20px; margin-top:20px;\"><p>Complete the next section in consultation with your Faculty Mentor.<\/p> <\/div><\/div><div id=\"field_19_18\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_18'>Field of Focus or Area of Study<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_18' id='input_19_18' class='textarea small' tabindex='1049'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_19_19\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_19'>Mentor Meetings<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_19_19'>How often and for what purpose will you meet with or contact your Faculty Mentor?<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_19_19' class='textarea small' tabindex='1050' aria-describedby=\"gfield_description_19_19\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_19_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half 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_19_23'>Length of Internship<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_23' id='input_19_23' type='text' value='' class='large'  aria-describedby=\"gfield_description_19_23\" tabindex='1051'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_19_23'>Approximately how many weeks will the internship last?<\/div><\/div><div id=\"field_19_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half 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_19_22'>Weekly Hours<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_22' id='input_19_22' type='text' value='' class='large'  aria-describedby=\"gfield_description_19_22\" tabindex='1052'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_19_22'>Approximately how many hours per week will you be working? List min\/max hours per week as well.<\/div><\/div><div id=\"field_19_24\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half 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_19_24'>Start Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_24' id='input_19_24' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='1053'  placeholder='mm\/dd\/yyyy' aria-describedby=\"input_19_24_date_format gfield_description_19_24\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_24_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_24' class='gform_hidden' value='https:\/\/www.gcc.mass.edu\/registrar\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_19_24'>The start date of your internship can not be before the first day of classes for the term<\/div><\/div><div id=\"field_19_25\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half 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_19_25'>End Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_25' id='input_19_25' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='1054'  placeholder='mm\/dd\/yyyy' aria-describedby=\"input_19_25_date_format gfield_description_19_25\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_19_25_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_25' class='gform_hidden' value='https:\/\/www.gcc.mass.edu\/registrar\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_19_25'>The end date of your internship can not be after the last day of classes for the term\u2014however please indicate the <strong>actual end date<\/strong> if you will complete your internships prior to the end of the term<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_19_26' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next' tabindex='1055' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_19_2' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_19_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_19_27\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Learning Plan<\/h3><\/div><div id=\"field_19_28\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_28'>What do you hope to gain from this internship?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_19_28'>List specific learning objectives<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_19_28' class='textarea medium' tabindex='1056' aria-describedby=\"gfield_description_19_28\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_19_29\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_29'>What will your internship site gain?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_19_29'>How will the organization or company benefit from your placement?<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_19_29' class='textarea medium' tabindex='1057' aria-describedby=\"gfield_description_19_29\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_19_30\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_30'>How will you demonstrate success in achieving these learning objectives?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_19_30'>Examples could include a daily journal of your experiences, research papers, a portfolio of creations, etc.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_19_30' class='textarea medium' tabindex='1058' aria-describedby=\"gfield_description_19_30\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_19_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Acknowledgement &amp; Attestation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_19_31'><div class=\"content_block\" id=\"custom_post_widget-1993\"><p>By submitting this application you attest that you have read and\/or helped to draft the learning plan and agree to fulfill and demonstrate success in fulfilling the objectives.<\/p>\n<p><em>I recognize that, as an intern from Greenfield Community College, I represent the college to the community. I therefore agree to conduct myself professionally on the job. I will meet the expectations of behavior, dress, punctuality, and industriousness commensurate with the responsibilities that I have been given. I will treat my placement workers and supervisors and the company\u2019s\/organization\u2019s customers\/clients with utmost respect.<\/em><\/p>\n<p><strong>Criminal Offender Record Information Checks<\/strong><br \/>\nStudents interested in participating in an academic internship that involves working with children, the disabled, or the elderly, or includes a clinical affiliation with a private or public health care provider, will be required to undergo a Criminal Offender Record Information (CORI) check. Depending on the contents of a student\u2019s CORI report, participation in an internship, may be denied.<\/p>\n<p><em>I understand that my internship site may require a CORI check and I agree to provide the necessary documentation if requested. I also underdtand that a CORI check may be done directly by the host site company or organization. CORI checks may be performed pursuant to Mass. General Laws, Chapter 6, Sections 167- 178B, and consistent with guidelines of the Executive Office for Health and Human Services, and\/or the Commonwealth\u2019s Department of Public Health. For more information, please contact Laura Earl, CORI Officer, at (413) 775-1816.<\/em><\/p>\n<p><strong>Medical Records\/Immunizations<\/strong><br \/>\nStudents interested in interning in health care settings, including medical offices, may be required to provide additional health information and immunization records, as determined by the facility, to be eligible. The College does not monitor or maintain records for students participating in internships, though you may be able to obtain proof of immunization and other test results from Health Records (N348) if you provided them to the college.<\/p>\n<p><strong>Title IX\/Affirmative Action<\/strong><br \/>\nInternship students must read and understand the college's <a href=\"https:\/\/www.gcc.mass.edu\/hr\/college-policies\/\" target=\"_blank\" rel=\"noopener\">Title IX and Affirmative Action<\/a> policies.<\/p>\n<\/div><\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_19_31'><div class='gchoice gchoice_19_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='CORI'  id='choice_19_31_1' tabindex='1059'  aria-describedby=\"gfield_description_19_31\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_19_31_1' id='label_19_31_1' class='gform-field-label gform-field-label--type-inline'>I understand I may be subject to and will comply with CORI requirements<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_19_31_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.2' type='checkbox'  value='Health\/Immunization'  id='choice_19_31_2' tabindex='1060'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_31_2' id='label_19_31_2' class='gform-field-label gform-field-label--type-inline'>I understand I may be required to and will submit additional health and immunization information<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_19_31_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.3' type='checkbox'  value='Title IX\/AA\/EO'  id='choice_19_31_3' tabindex='1061'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_31_3' id='label_19_31_3' class='gform-field-label gform-field-label--type-inline'>I have read and understand GCC's Title IX\/Affirmative Action policies<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_19_31_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.4' type='checkbox'  value='Attestation'  id='choice_19_31_4' tabindex='1062'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_31_4' id='label_19_31_4' class='gform-field-label gform-field-label--type-inline'>I attest that the information in this application is correct<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_19_33\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_33'>Internship Coordinator<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_33' id='input_19_33' type='email' value='internships@gcc.mass.edu' class='large' tabindex='1063'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_34\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_34'>VP Academic Affairs<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_34' id='input_19_34' type='email' value='' class='large' tabindex='1064'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_49\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_49'>Melanie<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_49' id='input_19_49' type='email' value='zamojskim@gcc.mass.edu' class='large' tabindex='1065'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_48\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_48'>Dawn<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_48' id='input_19_48' type='email' value='josefski@gcc.mass.edu' class='large' tabindex='1066'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_50\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_50'>VP\/Dean<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_50' id='input_19_50' type='email' value='ruscittibl@gcc.mass.edu' class='large' tabindex='1067'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_37\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_37'>Grouping Admin 1<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_37' id='input_19_37' type='email' value='wroblewskia@gcc.mass.edu' class='large' tabindex='1068'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_38\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_38'>Grouping Admin 2<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_38' id='input_19_38' type='email' value='wroblewskia@gcc.mass.edu' class='large' tabindex='1069'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_39\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_19_39'>Grouping Admin 3<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_39' id='input_19_39' type='email' value='davism@gcc.mass.edu' class='large' tabindex='1070'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_19_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><div class=\"alert alert-danger\"><strong>Heads up!<\/strong> Once you submit this form, you will be redirected to electronically sign our Acknowledgement of Risk & Consent. <strong>Your application will not be complete without this signature!<\/strong><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous' tabindex='1071' \/> <input type='submit' id='gform_submit_button_19' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit' tabindex='1072' \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' 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