{"id":731,"date":"2021-08-05T09:46:10","date_gmt":"2021-08-05T13:46:11","guid":{"rendered":"https:\/\/www.adelphi.edu\/social-work\/continuing-education-professional-development\/certificate-programs\/addictions-certificate-program-application-2\/"},"modified":"2025-04-17T09:56:16","modified_gmt":"2025-04-17T13:56:16","slug":"social-work-fellows-program-enrollment","status":"publish","type":"page","link":"https:\/\/www.adelphi.edu\/social-work\/continuing-education\/certificate-programs\/social-work-fellows-program-enrollment\/","title":{"rendered":"Social Work Fellows Program Enrollment"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_86' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><p>Please complete all questions. You will be contacted once a decision on your acceptance is made. You register and pay after acceptance.<\/p>\r\n \r\n<h2>Eligibility<\/h2>\r\n<p>The participants selected for the program must be MSW-level social workers who are supervising social service workers from diverse settings.  Supervisees can include any number of MSWs, BSWs, or other social service staff, in any combination.  <\/p><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_86'  action='\/social-work\/wp-json\/wp\/v2\/pages\/731' data-formid='86' novalidate><input type=\"hidden\" name=\"adelphi_gf_data\" value=\"1:local-0ab292c336c463c47d6eed6792f5994c:1781082001\"><input type=\"hidden\" name=\"adelphi_gf_hmac\" value=\"9398d239451f1b5d91f0d6b99f9ee47a1a18b546c903bdc640f9ad2d89c0d664\">\n                        <div class='gform-body gform_body'><div id='gform_fields_86' class='gform_fields top_label form_sublabel_above description_below validation_above'><fieldset id=\"field_86_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label 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         <input type='text' name='input_2.1' id='input_86_2_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_86_2_2_container' >\n                                        <label for='input_86_2_2' id='input_86_2_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_2.2' id='input_86_2_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_86_2_3_container' >\n                                    <label for='input_86_2_3' id='input_86_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_2.3' id='input_86_2_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_86_2_4_container' >\n                                        <label for='input_86_2_4' id='input_86_2_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_2.4' id='input_86_2_4' value=''      aria-required='true'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_86_2_5_container' >\n                                    <label for='input_86_2_5' id='input_86_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_2.5' id='input_86_2_5' value=''    aria-required='true'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_86_2_6_container' >\n                                        <label for='input_86_2_6' id='input_86_2_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_2.6' id='input_86_2_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_86_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_4'>Work 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_4' id='input_86_4' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_3\" class=\"gfield gfield--type-phone gfield--input-type-phone field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_3'>Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_86_3' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_5'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_86_5' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_86_20\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_20'>Cell Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_86_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_86_41\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you have an MSW degree?<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_86_41'>\n\t\t\t<div class='gchoice gchoice_86_41_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='Yes'  id='choice_86_41_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_41_0' id='label_86_41_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_41_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_41' type='radio' value='No (you are not eligible)'  id='choice_86_41_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_41_1' id='label_86_41_1' class='gform-field-label gform-field-label--type-inline'>No (you are not eligible)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_86_47\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Current Licensure Status<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_86_47'>\n\t\t\t<div class='gchoice gchoice_86_47_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='LMSW'  id='choice_86_47_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_47_0' id='label_86_47_0' class='gform-field-label gform-field-label--type-inline'>LMSW<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_47_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='LCSW'  id='choice_86_47_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_47_1' id='label_86_47_1' class='gform-field-label gform-field-label--type-inline'>LCSW<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_47_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='LCSW-R'  id='choice_86_47_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_47_2' id='label_86_47_2' class='gform-field-label gform-field-label--type-inline'>LCSW-R<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_47_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_47' type='radio' value='Not currently licensed'  id='choice_86_47_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_47_3' id='label_86_47_3' class='gform-field-label gform-field-label--type-inline'>Not currently licensed<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_86_44\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you currently working as a supervisor?<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_86_44'>\n\t\t\t<div class='gchoice gchoice_86_44_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='Yes'  id='choice_86_44_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_44_0' id='label_86_44_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_44_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_44' type='radio' value='No (you are not eligible)'  id='choice_86_44_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_44_1' id='label_86_44_1' class='gform-field-label gform-field-label--type-inline'>No (you are not eligible)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_86_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you agreeing to attend all 6 SWPF workshops?<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_86_43'>\n\t\t\t<div class='gchoice gchoice_86_43_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='Yes'  id='choice_86_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_43_0' id='label_86_43_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_43_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_43' type='radio' value='No'  id='choice_86_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_43_1' id='label_86_43_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_86_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you agreeing to complete both pre- and post-program self-assessments of supervisory practices?<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_86_42'>\n\t\t\t<div class='gchoice gchoice_86_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='Yes'  id='choice_86_42_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_86_42\"   \/>\n\t\t\t\t\t<label for='choice_86_42_0' id='label_86_42_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='No'  id='choice_86_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_42_1' id='label_86_42_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_86_42'>All survey data will be de-identified and reported only in aggregate. Your name will not be linked in any way with your responses to this survey.<\/div><\/fieldset><fieldset id=\"field_86_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Type of settings you currently work in as a supervisor<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_86_46'><div class='gchoice gchoice_86_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='Addictions services setting'  id='choice_86_46_1'   aria-describedby=\"gfield_description_86_46\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_1' id='label_86_46_1' class='gform-field-label gform-field-label--type-inline'>Addictions services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.2' type='checkbox'  value='Aging services setting'  id='choice_86_46_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_2' id='label_86_46_2' class='gform-field-label gform-field-label--type-inline'>Aging services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.3' type='checkbox'  value='Children and family services setting'  id='choice_86_46_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_3' id='label_86_46_3' class='gform-field-label gform-field-label--type-inline'>Children and family services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.4' type='checkbox'  value='Criminal justice services setting'  id='choice_86_46_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_4' id='label_86_46_4' class='gform-field-label gform-field-label--type-inline'>Criminal justice services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.5' type='checkbox'  value='Disability services setting'  id='choice_86_46_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_5' id='label_86_46_5' class='gform-field-label gform-field-label--type-inline'>Disability services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.6' type='checkbox'  value='Health care services setting'  id='choice_86_46_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_6' id='label_86_46_6' class='gform-field-label gform-field-label--type-inline'>Health care services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.7' type='checkbox'  value='Housing or homelessness services setting'  id='choice_86_46_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_7' id='label_86_46_7' class='gform-field-label gform-field-label--type-inline'>Housing or homelessness services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.8' type='checkbox'  value='Mental health care services setting'  id='choice_86_46_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_8' id='label_86_46_8' class='gform-field-label gform-field-label--type-inline'>Mental health care services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.9' type='checkbox'  value='Veterans services setting'  id='choice_86_46_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_9' id='label_86_46_9' class='gform-field-label gform-field-label--type-inline'>Veterans services setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_86_46_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.11' type='checkbox'  value='Other services settings'  id='choice_86_46_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_86_46_11' id='label_86_46_11' class='gform-field-label gform-field-label--type-inline'>Other services settings<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_86_46'>Select all that apply.<\/div><\/fieldset><div id=\"field_86_31\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_31'>If you selected &quot;other service settings&quot; above, please specify:<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_86_31' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_32'>Total Number of Clients<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_32' id='input_86_32' type='text' value='' class='medium'  aria-describedby=\"gfield_description_86_32\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_86_32'>Please provide a single number to represent your best estimate of the annual total number of clients collectively served by you and the people you supervise (your team). Answer with a specific estimate number (i.e. 250), not a range of numbers.<\/div><\/div><div id=\"field_86_48\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><h2>Supervision<\/h2><p>Please answer the items below about supervision and supervises<\/p><\/div><div id=\"field_86_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_33'>Number of years working at your current organization<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_33' id='input_86_33' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_35'>Number of years serving in a supervisory role at your current organization<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_35' id='input_86_35' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_36'>Current number of social work supervisees<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_36' id='input_86_36' type='text' value='' class='medium'  aria-describedby=\"gfield_description_86_36\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_86_36'>(MSWs, LMSWs, LCSWs, and\/or LCSW-Rs)<\/div><\/div><div id=\"field_86_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_37'>Current number of BSW supervisees<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_37' id='input_86_37' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_38'>Current number of other staff you supervise<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_38' id='input_86_38' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_39'>How many years of supervisory experience do you have?<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_39' id='input_86_39' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_86_50\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><h2>Payment<\/h2><\/div><fieldset id=\"field_86_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_above gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >How will you be paying if you are selected for this program?<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_86_40'>\n\t\t\t<div class='gchoice gchoice_86_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Out-of-pocket without agency reimbursement'  id='choice_86_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_40_0' id='label_86_40_0' class='gform-field-label gform-field-label--type-inline'>Out-of-pocket without agency reimbursement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Out-of-pocket with full agency reimbursement'  id='choice_86_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_40_1' id='label_86_40_1' class='gform-field-label gform-field-label--type-inline'>Out-of-pocket with full agency reimbursement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_40_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Out-of-pocket with partial agency reimbursement'  id='choice_86_40_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_40_2' id='label_86_40_2' class='gform-field-label gform-field-label--type-inline'>Out-of-pocket with partial agency reimbursement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_40_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='My agency will pay directly'  id='choice_86_40_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_40_3' id='label_86_40_3' class='gform-field-label gform-field-label--type-inline'>My agency will pay directly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_40_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='The cost of the course will be covered by the Geriatric Mental Health Initiative at 91勛圖厙 School of Social Work'  id='choice_86_40_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_86_40_4' id='label_86_40_4' class='gform-field-label gform-field-label--type-inline'>The cost of the course will be covered by the Geriatric Mental Health Initiative at 91勛圖厙 School of Social Work<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_86_40_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='I work or live in the Hudson Valley and am interested in learning more about the grant funding available'  id='choice_86_40_5' onchange='gformToggleRadioOther( this 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