{"id":1290,"date":"2024-05-30T11:19:23","date_gmt":"2024-05-30T15:19:23","guid":{"rendered":"https:\/\/www.krdhd.org\/site\/?page_id=1290"},"modified":"2024-06-06T11:06:48","modified_gmt":"2024-06-06T15:06:48","slug":"student-request","status":"publish","type":"page","link":"https:\/\/www.krdhd.org\/site\/student-request\/","title":{"rendered":"Student Practicum Application"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1 style=\"text-align: center;\"><strong>KRDHD Student Practicum Application<\/strong><\/h1>\n<p><strong><\/strong><\/p>\n<p>We appreciate your interest in doing a practicum at the Kentucky River District Health Department. To help us understand your practicum needs we request you complete the following student application. We will review your application and be in contact with a determination regarding availability and opportunities.<\/p>\n<p><strong><\/strong><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.24.3&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<div class=\"forminator-ui forminator-custom-form forminator-custom-form-1289 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1289\" data-uid=\"6a4fc51fe9723\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1289\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1289 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1289\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a4fc51fe9723\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a4fc51fe9723\" id=\"forminator-field-name-1_6a4fc51fe9723-label\" class=\"forminator-label\">1) Full Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a4fc51fe9723\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a4fc51fe9723\" id=\"forminator-field-text-1_6a4fc51fe9723-label\" class=\"forminator-label\">2) Home county\/state <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a4fc51fe9723\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a4fc51fe9723\" id=\"forminator-field-email-1_6a4fc51fe9723-label\" class=\"forminator-label\">3) Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a4fc51fe9723\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a4fc51fe9723\" id=\"forminator-field-text-7_6a4fc51fe9723-label\" class=\"forminator-label\">4) University\/College <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a4fc51fe9723\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a4fc51fe9723\" id=\"forminator-field-text-2_6a4fc51fe9723-label\" class=\"forminator-label\">5) College\/Department <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a4fc51fe9723\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a4fc51fe9723-label\"><span id=\"forminator-radiogroup-radio-1-6a4fc51fe9723-label\" class=\"forminator-label\">6) Semester Practicum Begins <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a4fc51fe9723\" class=\"forminator-radio\" title=\"Fall (Aug-Dec)\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a4fc51fe9723\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Fall (Aug-Dec)<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a4fc51fe9723\" class=\"forminator-radio\" title=\"Spring (Jan-May)\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a4fc51fe9723\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Spring (Jan-May)<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6a4fc51fe9723\" class=\"forminator-radio\" title=\"Summer (May-July)\"><input type=\"radio\" name=\"radio-1\" value=\"Summer-(May-July)\" id=\"forminator-field-radio-1-3-6a4fc51fe9723\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Summer (May-July)<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-6a4fc51fe9723\" class=\"forminator-radio\" title=\"Other\"><input type=\"radio\" name=\"radio-1\" value=\"Other\" id=\"forminator-field-radio-1-4-6a4fc51fe9723\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a4fc51fe9723\" id=\"forminator-field-text-6_6a4fc51fe9723-label\" class=\"forminator-label\">If Other, please write in:<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a4fc51fe9723\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a4fc51fe9723-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a4fc51fe9723-label\" class=\"forminator-label\">7) Area of Interest (check all that apply) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-1-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"Administrative\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Administrative\" id=\"forminator-field-checkbox-1-1-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-1-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Administrative<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-2-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"Risk Reduction\/Substance Use Disorder\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Risk Reduction\/Substance Use Disorder\" id=\"forminator-field-checkbox-1-2-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-2-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Risk Reduction\/Substance Use Disorder<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-3-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"Health Promotion\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Health Promotion\" id=\"forminator-field-checkbox-1-3-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-3-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Health Promotion<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-4-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"HANDS\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"HANDS\" id=\"forminator-field-checkbox-1-4-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-4-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">HANDS<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-5-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"Breastfeeding Program\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Breastfeeding-Program\" id=\"forminator-field-checkbox-1-5-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-5-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breastfeeding Program<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-6-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"Environmental\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Environmental\" id=\"forminator-field-checkbox-1-6-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-6-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Environmental<\/span><\/label><label id=\"forminator-field-checkbox-1-7-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-7-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"Family Planning\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Family-Planning\" id=\"forminator-field-checkbox-1-7-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-7-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Family Planning<\/span><\/label><label id=\"forminator-field-checkbox-1-8-6a4fc51fe9723-label\" for=\"forminator-field-checkbox-1-8-6a4fc51fe9723\" class=\"forminator-checkbox\" title=\"Other - Write In (Required):\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Other---Write-In-(Required):\" id=\"forminator-field-checkbox-1-8-6a4fc51fe9723\" aria-labelledby=\"forminator-field-checkbox-1-8-6a4fc51fe9723-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other - Write In (Required):<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a4fc51fe9723\" id=\"forminator-field-textarea-1_6a4fc51fe9723-label\" class=\"forminator-label\">8) Days of the week and hours\u00a0student\u00a0would have available to complete practicum\u00a0hours?\u00a0* <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-1_6a4fc51fe9723\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6a4fc51fe9723\" id=\"forminator-field-number-2_6a4fc51fe9723-label\" class=\"forminator-label\">9) Total Number of Hours Required* <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_6a4fc51fe9723\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"9999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a4fc51fe9723\" id=\"forminator-field-textarea-3_6a4fc51fe9723-label\" class=\"forminator-label\">10) Is there an academic assignment required with your placement (i.e. research project, capstone project) that requires access to specific agency material or client interaction? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-3_6a4fc51fe9723\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a4fc51fe9723\" id=\"forminator-field-textarea-2_6a4fc51fe9723-label\" class=\"forminator-label\">11) If assignment is required, provide details about what is required. <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-2_6a4fc51fe9723\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a4fc51fe9723\" id=\"forminator-field-textarea-4_6a4fc51fe9723-label\" class=\"forminator-label\">12) What skills. knowledge or program competencies do you hope to gain by completing a practicum with the KRDHD? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-4_6a4fc51fe9723\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a4fc51fe9723\" id=\"forminator-field-textarea-5_6a4fc51fe9723-label\" class=\"forminator-label\">13) What skills would you bring to the practicum site? (i.e. Word, Excel, PowerPoint, Canva, organizational skills, data collection and analysis)\u00a0 <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-5\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-5_6a4fc51fe9723\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6a4fc51fe9723\" id=\"forminator-field-textarea-6_6a4fc51fe9723-label\" class=\"forminator-label\">14) Requirements of practicum supervisor (education\/experience).\u00a0 <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-6\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-6_6a4fc51fe9723\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a4fc51fe9723-label\"><span id=\"forminator-radiogroup-radio-2-6a4fc51fe9723-label\" class=\"forminator-label\">15) Is there a current MOU or Affiliation agreement between your university\/college and the KRDHD? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a4fc51fe9723\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a4fc51fe9723\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a4fc51fe9723\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a4fc51fe9723\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-6a4fc51fe9723\" class=\"forminator-radio\" title=\"Unsure, but will check status\"><input type=\"radio\" name=\"radio-2\" value=\"Summer-(May-July)\" id=\"forminator-field-radio-2-3-6a4fc51fe9723\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Unsure, but will check status<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_6a4fc51fe9723\" id=\"forminator-field-textarea-7_6a4fc51fe9723-label\" class=\"forminator-label\">16) Other information you would like us to consider in your request. <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-7\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-7_6a4fc51fe9723\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Send Message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"5690f04454\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/site\/wp-json\/wp\/v2\/pages\/1290\" \/><input type=\"hidden\" name=\"form_id\" value=\"1289\"><input type=\"hidden\" name=\"page_id\" value=\"1290\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.krdhd.org\/site\/student-request\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>KRDHD Student Practicum Application We appreciate your interest in doing a practicum at the Kentucky River District Health Department. To help us understand your practicum needs we request you complete the following student application. We will review your application and be in contact with a determination regarding availability and opportunities. <div class=\"forminator-ui forminator-custom-form forminator-custom-form-1289 forminator-design--default  forminator_ajax\" data-forminator-render=\"1\" data-form=\"forminator-module-1289\" data-uid=\"6a4fc520135b9\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1289\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1289 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"1\"\n\t\t\t\tdata-form-id=\"1289\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a4fc520135b9\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a4fc520135b9\" id=\"forminator-field-name-1_6a4fc520135b9-label\" class=\"forminator-label\">1) Full Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a4fc520135b9\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a4fc520135b9\" id=\"forminator-field-text-1_6a4fc520135b9-label\" class=\"forminator-label\">2) Home county\/state <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a4fc520135b9\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a4fc520135b9\" id=\"forminator-field-email-1_6a4fc520135b9-label\" class=\"forminator-label\">3) Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a4fc520135b9\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a4fc520135b9\" id=\"forminator-field-text-7_6a4fc520135b9-label\" class=\"forminator-label\">4) University\/College <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a4fc520135b9\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a4fc520135b9\" id=\"forminator-field-text-2_6a4fc520135b9-label\" class=\"forminator-label\">5) College\/Department <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a4fc520135b9\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a4fc520135b9-label\"><span id=\"forminator-radiogroup-radio-1-6a4fc520135b9-label\" class=\"forminator-label\">6) Semester Practicum Begins <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a4fc520135b9\" class=\"forminator-radio\" title=\"Fall (Aug-Dec)\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a4fc520135b9\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Fall (Aug-Dec)<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a4fc520135b9\" class=\"forminator-radio\" title=\"Spring (Jan-May)\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a4fc520135b9\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Spring (Jan-May)<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6a4fc520135b9\" class=\"forminator-radio\" title=\"Summer (May-July)\"><input type=\"radio\" name=\"radio-1\" value=\"Summer-(May-July)\" id=\"forminator-field-radio-1-3-6a4fc520135b9\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Summer (May-July)<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-6a4fc520135b9\" class=\"forminator-radio\" title=\"Other\"><input type=\"radio\" name=\"radio-1\" value=\"Other\" id=\"forminator-field-radio-1-4-6a4fc520135b9\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a4fc520135b9\" id=\"forminator-field-text-6_6a4fc520135b9-label\" class=\"forminator-label\">If Other, please write in:<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a4fc520135b9\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a4fc520135b9-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a4fc520135b9-label\" class=\"forminator-label\">7) Area of Interest (check all that apply) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-1-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"Administrative\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Administrative\" id=\"forminator-field-checkbox-1-1-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-1-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Administrative<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-2-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"Risk Reduction\/Substance Use Disorder\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Risk Reduction\/Substance Use Disorder\" id=\"forminator-field-checkbox-1-2-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-2-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Risk Reduction\/Substance Use Disorder<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-3-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"Health Promotion\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Health Promotion\" id=\"forminator-field-checkbox-1-3-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-3-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Health Promotion<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-4-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"HANDS\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"HANDS\" id=\"forminator-field-checkbox-1-4-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-4-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">HANDS<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-5-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"Breastfeeding Program\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Breastfeeding-Program\" id=\"forminator-field-checkbox-1-5-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-5-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Breastfeeding Program<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-6-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"Environmental\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Environmental\" id=\"forminator-field-checkbox-1-6-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-6-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Environmental<\/span><\/label><label id=\"forminator-field-checkbox-1-7-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-7-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"Family Planning\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Family-Planning\" id=\"forminator-field-checkbox-1-7-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-7-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Family Planning<\/span><\/label><label id=\"forminator-field-checkbox-1-8-6a4fc520135b9-label\" for=\"forminator-field-checkbox-1-8-6a4fc520135b9\" class=\"forminator-checkbox\" title=\"Other - Write In (Required):\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Other---Write-In-(Required):\" id=\"forminator-field-checkbox-1-8-6a4fc520135b9\" aria-labelledby=\"forminator-field-checkbox-1-8-6a4fc520135b9-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Other - Write In (Required):<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a4fc520135b9\" id=\"forminator-field-textarea-1_6a4fc520135b9-label\" class=\"forminator-label\">8) Days of the week and hours\u00a0student\u00a0would have available to complete practicum\u00a0hours?\u00a0* <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-1_6a4fc520135b9\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-2\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-2_6a4fc520135b9\" id=\"forminator-field-number-2_6a4fc520135b9-label\" class=\"forminator-label\">9) Total Number of Hours Required* <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-2\" value=\"\" placeholder=\"\" id=\"forminator-field-number-2_6a4fc520135b9\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"9999\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a4fc520135b9\" id=\"forminator-field-textarea-3_6a4fc520135b9-label\" class=\"forminator-label\">10) Is there an academic assignment required with your placement (i.e. research project, capstone project) that requires access to specific agency material or client interaction? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-3\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-3_6a4fc520135b9\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a4fc520135b9\" id=\"forminator-field-textarea-2_6a4fc520135b9-label\" class=\"forminator-label\">11) If assignment is required, provide details about what is required. <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-2_6a4fc520135b9\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-4\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-4_6a4fc520135b9\" id=\"forminator-field-textarea-4_6a4fc520135b9-label\" class=\"forminator-label\">12) What skills. knowledge or program competencies do you hope to gain by completing a practicum with the KRDHD? <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-4\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-4_6a4fc520135b9\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-5\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-5_6a4fc520135b9\" id=\"forminator-field-textarea-5_6a4fc520135b9-label\" class=\"forminator-label\">13) What skills would you bring to the practicum site? (i.e. Word, Excel, PowerPoint, Canva, organizational skills, data collection and analysis)\u00a0 <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-5\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-5_6a4fc520135b9\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-6\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-6_6a4fc520135b9\" id=\"forminator-field-textarea-6_6a4fc520135b9-label\" class=\"forminator-label\">14) Requirements of practicum supervisor (education\/experience).\u00a0 <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-6\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-6_6a4fc520135b9\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a4fc520135b9-label\"><span id=\"forminator-radiogroup-radio-2-6a4fc520135b9-label\" class=\"forminator-label\">15) Is there a current MOU or Affiliation agreement between your university\/college and the KRDHD? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a4fc520135b9\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a4fc520135b9\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a4fc520135b9\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a4fc520135b9\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-6a4fc520135b9\" class=\"forminator-radio\" title=\"Unsure, but will check status\"><input type=\"radio\" name=\"radio-2\" value=\"Summer-(May-July)\" id=\"forminator-field-radio-2-3-6a4fc520135b9\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Unsure, but will check status<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-7\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-7_6a4fc520135b9\" id=\"forminator-field-textarea-7_6a4fc520135b9-label\" class=\"forminator-label\">16) Other information you would like us to consider in your request. <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-7\" placeholder=\"E.g. text placeholder\nYou can add new line\" id=\"forminator-field-textarea-7_6a4fc520135b9\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Send Message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"5690f04454\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/site\/wp-json\/wp\/v2\/pages\/1290\" \/><input type=\"hidden\" name=\"form_id\" value=\"1289\"><input type=\"hidden\" name=\"page_id\" value=\"1290\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.krdhd.org\/site\/student-request\/\"><input type=\"hidden\" name=\"render_id\" value=\"1\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-1290","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/pages\/1290","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/comments?post=1290"}],"version-history":[{"count":5,"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/pages\/1290\/revisions"}],"predecessor-version":[{"id":1303,"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/pages\/1290\/revisions\/1303"}],"wp:attachment":[{"href":"https:\/\/www.krdhd.org\/site\/wp-json\/wp\/v2\/media?parent=1290"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}