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<CustomForm Name="GPP Request Information Form" Locale="" XPowerPath="/Content Store/Form Components/GPP Forms/GPP Request Information Form" ID="x4908">
	<name type="string" label="Form Name" readonly="false" hidden="false" required="false" ID="1"/><Method type="enumeration" values="post get" label="Method" readonly="false" hidden="false" required="false" ID="2">post</Method><actionURL type="string" label="Action Url" readonly="false" hidden="false" required="false" ID="3">x4931</actionURL><IntroCopy type="dhtml" label="Intro Copy" readonly="false" hidden="false" required="false" ID="4"><![CDATA[<p>Thank you for your interest in Emmanuel College's Graduate &amp; Professional Programs. We will mail you an information packet pertaining to the program(s) you expressed interest in.</p>]]></IntroCopy><FormCode type="dhtml" label="Form Code" readonly="false" hidden="false" required="false" ID="5"><![CDATA[<form><fieldset><label><strong>First Name: </strong><input type="text" size="30" value="" name="firstname" /></label><label><strong>Last Name: </strong><input type="text" size="30" value="" name="lastname" /></label><label><strong>E-mail:</strong><input type="text" size="30" value="" name="e-mail" /></label><label><strong>Phone:</strong><input type="text" size="30" value="" name="phone" /></label><label><strong>Employer:</strong><input type="text" size="30" value="" name="employer" /></label><label><strong>Work Phone:</strong><input type="text" size="30" value="" name="workphone" /></label><label><strong>Address:</strong><input type="text" size="30" value="" name="address" /></label><label><strong>City/Town:</strong><input type="text" size="30" value="" name="city" /></label><label><strong>State/Province:</strong><select size="1" name="stateprovince"><option value="" selected>Select State/Province</option><option value="AL">AL - Alabama</option><option value="AK">AK - Alaska</option><option value="AB">AB - Alberta</option><option value="AS">AS - American Samoa</option><option value="AZ">AZ - Arizona</option><option value="AR">AR - Arkansas</option><option value="BC">BC - British Columbia</option><option value="CA">CA - California</option><option value="CO">CO - Colorado</option><option value="CT">CT - Connecticut</option><option value="DC">DC - Washington D.C.</option><option value="DE">DE - Delaware</option><option value="FL">FL - Florida</option><option value="FM">FM - Fed States of Micronesia</option><option value="GA">GA - Georgia</option><option value="GU">GU - Guam</option><option value="HI">HI - Hawaii</option><option value="ID">ID - Idaho</option><option value="IL">IL - Illinois</option><option value="IN">IN - Indiana</option><option value="IA">IA - Iowa</option><option value="KS">KS - Kansas</option><option value="KY">KY - Kentucky</option><option value="LA">LA - Louisiana</option><option value="MB">MB - Manitoba</option><option value="ME">ME - Maine</option><option value="MP">MP - Marianas Pacific</option><option value="MH">MH - Marshall Islands</option><option value="MD">MD - Maryland</option><option value="MA">MA - Massachusetts</option><option value="MI">MI - Michigan</option><option value="MN">MN - Minnesota</option><option value="MS">MS - Mississippi</option><option value="MO">MO - Missouri</option><option value="MT">MT - Montana</option><option value="NE">NE - Nebraska</option><option value="NV">NV - Nevada</option><option value="NB">NB - New Brunswick</option><option value="NF">NF - Newfoundland</option><option value="NH">NH - New Hampshire</option><option value="NJ">NJ - New Jersey</option><option value="NM">NM - New Mexico</option><option value="NY">NY - New York</option><option value="NC">NC - North Carolina</option><option value="ND">ND - North Dakota</option><option value="NT">NT - Northwest Territories</option><option value="NS">NS - Nova Scotia</option><option value="OH">OH - Ohio</option><option value="OK">OK - Oklahoma</option><option value="ON">ON - Ontario</option><option value="OR">OR - Oregon</option><option value="PA">PA - Pennsylvania</option><option value="PE">PE - Prince Edward Island</option><option value="PR">PR - Puerto Rico</option><option value="PW">PW - Palau</option><option value="PQ">PQ - Quebec</option><option value="RI">RI - Rhode Island</option><option value="SK">SK - Saskatchewan</option><option value="SC">SC - South Carolina</option><option value="SD">SD - South Dakota</option><option value="TN">TN - Tennessee</option><option value="TX">TX - Texas</option><option value="UT">UT - Utah</option><option value="VT">VT - Vermont</option><option value="VA">VA - Virginia</option><option value="VI">VI - Virgin Islands (U.S.)</option><option value="WA">WA - Washington</option><option value="WV">WV - West Virginia</option><option value="WI">WI - Wisconsin</option><option value="WY">WY - Wyoming</option><option value="YT">YT - Yukon Territory</option><option value="">None Applicable</option></select></label><label><strong>Zip/Postal Code:</strong><input type="text" value="" name="zip" /></label><label class="clear"><strong>Country</strong><em>(if not in U.S.)</em><strong>:</strong><input type="text" size="30" value="" name="Country" /></label></fieldset><br class="clear" /><fieldset><div class="radio"><strong>About which program(s) </strong><strong>would you like to receive information?</strong></div><div class="radio"><label><input class="checkbox" type="checkbox" value="ecap/bsba" name="program" /> ECAP/BSBA - Emmanuel College Advancement Program/Bachelor of Science in Business Administration</label><br class="clear" /><label><input class="checkbox" type="checkbox" value="BSN" name="program" /> BSN - Bachelor of Science in Nursing <em>(You must be an RN to apply to this program.)</em></label><br class="clear" /><label><input class="checkbox" type="checkbox" value="MAT" name="program" /> MAT - Master of Arts in Teaching</label><br class="clear" /><label><input class="checkbox" type="checkbox" value="MED" name="program" /> MED - Master of Education in School Administration</label><br class="clear" /><label><input class="checkbox" type="checkbox" value="CAGS" name="program" /> CAGS - Certificate of Advanced Graduate Study in Educational Leadership</label><br class="clear" /><label><input class="checkbox" type="checkbox" value="MSM" name="program" /> MSM - Master of Science in Management</label><br class="clear" /><label><input class="checkbox" type="checkbox" value="HRM" name="program" /> HRM - Master of Science in Human Resource Management</label><br class="clear" /><label><input class="checkbox" type="checkbox" value="HRC" name="program" /> HRC - Graduate Certificate in Human Resource Management</label><br class="clear" /><label><input class="checkbox" type="checkbox" value="MLC" name="program" /> MLC - Graduate Certificate in Management &amp; Leadership</label></div></fieldset><fieldset><label><strong>How did you hear about us?</strong><select size="1" name="source"><option value="" selected>Select Source</option><option value="Boston_dot_com">Boston.com</option><option value="Boston_Herald">Boston Herald</option><option value="Boston_Metro">Boston Metro</option><option value="Boston_Now">Boston Now</option><option value="Eagle_Tribune">Eagle Tribune</option><option value="Mix_985">Mix 98.5</option><option value="General_Radio">General Radio</option><option value="Patriot_Ledger">Patriot Ledger</option><option value="Sun_Chronicle">Sun Chronicle</option><option value="General_Newspaper">General Newspaper</option><option value="Workplace_Poster">Poster in Workplace</option><option value="Direct_Mail">Received Mail</option><option value="Search_Engine">Search Engine</option><option value="Hospital_Visit">Hospital Visit/Fair</option><option value="College_Fair">College Fair</option><option value="School_Guide">School Guide</option><option value="MBTA">MBTA Advertisement</option><option value="EC_Alum">Emmanuel College Alum</option><option value="EC_Student">Emmanuel College Student</option><option value="Other">Other (please fill in below)</option></select></label><br class="clear" /><label><strong>If other, please let us know where: </strong><input type="text" size="30" value="" name="other_response" /></label></fieldset><input type="hidden" value="firstname,lastname,address,city,stateprovince,zip,e-mail,program,source" name="req" /><input class="button" onclick="return testResults(this.form)" type="submit" value="Submit" name="cmdsubmit" /></form>]]></FormCode><FooterCopy type="dhtml" label="Footer Copy" readonly="false" hidden="false" required="false" ID="6"><![CDATA[]]></FooterCopy></CustomForm>

