{"id":1720,"date":"2024-01-29T10:49:50","date_gmt":"2024-01-29T18:49:50","guid":{"rendered":"https:\/\/ct-prod-wp.taftcollege.edu\/forms\/?page_id=1720"},"modified":"2024-03-06T12:27:45","modified_gmt":"2024-03-06T20:27:45","slug":"full-time-faculty-committee-assignment-request-form","status":"publish","type":"page","link":"https:\/\/ct-prod-wp.taftcollege.edu\/forms\/faculty-staff\/full-time-faculty-committee-assignment-request-form\/","title":{"rendered":"Full Time Faculty Committee Assignment Request Form"},"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 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class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_4b7e8370775760431b91266063bdaaf1\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_99' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_99_4\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">General Information<\/h3><\/div><div id=\"field_99_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_99_19'>Select your email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_99_19' class='large gfield_select'  aria-describedby=\"gfield_description_99_19\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='aabbott@taftcollege.edu' >Abbott Amar<\/option><option value='cadriano@taftcollege.edu' >Adriano Christi<\/option><option value='jaltenhofel@taftcollege.edu' >Altenhofel Jennifer<\/option><option value='kbandy@taftcollege.edu' >Bandy Kanoe<\/option><option value='mbeasley@taftcollege.edu' >Beasley Michelle<\/option><option value='wberry@taftcollege.edu' >Berry Wendy<\/option><option value='pblake@taftcollege.edu' >Blake Paul<\/option><option value='abledsoe@taftcollege.edu' >Bledsoe Adam<\/option><option value='dbogle@taftcollege.edu' >Bogle Darcy<\/option><option value='ncahoon@taftcollege.edu' >Cahoon Nathan<\/option><option value='kcarlson@taftcollege.edu' >Carlson Kamala<\/option><option value='jchaidez@taftcollege.edu' >Chaidez Joell<\/option><option value='dchampion@taftcollege.edu' >Champion Diane<\/option><option value='cchung@taftcollege.edu' >Chung-Wee Christopher<\/option><option value='aclark@taftcollege.edu' >Clark Amanda<\/option><option value='asalazar@taftcollege.edu' >Cotto Apolonia<\/option><option value='pdaley@taftcollege.edu' >Daley Pearl<\/option><option value='bdevine@taftcollege.edu' >Devine Bill<\/option><option value='cduron@taftcollege.edu' >Duron Candace<\/option><option value='gdyer@taftcollege.edu' >Dyer Geoffrey<\/option><option value='jeigenauer@taftcollege.edu' >Eigenauer John<\/option><option value='seveland@taftcollege.edu' >Eveland Sharyn<\/option><option value='cflachmann@taftcollege.edu' >Flachmann Christopher<\/option><option value='GGardner@taftcollege.edu' >Gardner Gina<\/option><option value='sgetty@taftcollege.edu' >Getty Shelley<\/option><option value='ggolling@taftcollege.edu' >Golling Greg<\/option><option value='lgonzalez@taftcollege.edu' >Gonzalez Lourdes<\/option><option value='ehershkowitz@taftcollege.edu' >Hershkowitz Eric<\/option><option value='vjacobi@taftcollege.edu' >Jacobi Vicki<\/option><option value='ajarrahian@taftcollege.edu' >Jarrahian Abbas<\/option><option value='sjm@taftcollege.edu' >Jimenez Murguia Salvador<\/option><option value='dkerr@taftcollege.edu' >Kerr Danielle<\/option><option value='kkulzer@taftcollege.edu' >Kulzer Kelly<\/option><option value='slytle@taftcollege.edu' >Lytle Steve<\/option><option value='vmaiocco@taftcollege.edu' >Maiocco Vince<\/option><option value='jmartinez@taftcollege.edu' >Martinez Julian<\/option><option value='mmartinez@taftcollege.edu' >Martinez Mariza<\/option><option value='jmay@taftcollege.edu' >May James<\/option><option value='mmayfield@taftcollege.edu' >Mayfield Mike<\/option><option value='jmendenhall@taftcollege.edu' >Mendenhall Janis<\/option><option value='tmendoza@taftcollege.edu' >Mendoza Tina<\/option><option value='dmitchell@taftcollege.edu' >Mitchell David<\/option><option value='wnishiyama@taftcollege.edu' >Nishiyama Wesley<\/option><option value='moja@taftcollege.edu' >Oja Michelle<\/option><option value='jover@taftcollege.edu' >Over Jonathan<\/option><option value='jpage@taftcollege.edu' >Page Jason<\/option><option value='rpayne@taftcollege.edu' >Payne Ruby<\/option><option value='rpolski@taftcollege.edu' >Polski Robin<\/option><option value='traber@taftcollege.edu' >Raber Tabitha<\/option><option value='jescobedo@taftcollege.edu' >Rangel-Escobedo Juana<\/option><option value='dreynolds@taftcollege.edu' >Reynolds David S.<\/option><option value='jreynolds@taftcollege.edu' >Reynolds Joy<\/option><option value='krichards@taftcollege.edu' >Richards Kristi<\/option><option value='drodenhauser@taftcollege.edu' >Rodenhauser Debora<\/option><option value='mrossi@taftcollege.edu' >Rossi Mallori<\/option><option value='broth@taftcollege.edu' >Roth Becky<\/option><option value='ksmith@taftcollege.edu' >Smith Kenneth<\/option><option value='tsmith@taftcollege.edu' >Smith Terri<\/option><option value='ctaylor@taftcollege.edu' >Taylor Christopher<\/option><option value='ltravis@taftcollege.edu' >Travis Lori<\/option><option value='kwebster@taftcollege.edu' >Webster Kyle<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_99_19'>Find your name in this dropdown.<\/div><\/div><div id=\"field_99_5\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Assignment<\/h3><\/div><fieldset id=\"field_99_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Committee Detail Selection.<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_99_7'>\n\t\t\t<div class='gchoice gchoice_99_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='I will serve on two committees. My committee preferences are indicated below.'  id='choice_99_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_99_7_0' id='label_99_7_0' class='gform-field-label gform-field-label--type-inline'>I will serve on two committees. My committee preferences are indicated below.<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_99_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='I will serve on one committee and am requesting Alternative Committee Service. [Select the Alternative Assignment box and at least one preferred committee; complete the alternative assignment request]'  id='choice_99_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_99_7_1' id='label_99_7_1' class='gform-field-label gform-field-label--type-inline'>I will serve on one committee and am requesting Alternative Committee Service. [Select the Alternative Assignment box and at least one preferred committee; complete the alternative assignment request]<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_99_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='I serve as a Dental Hygiene faculty member'  id='choice_99_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_99_7_2' id='label_99_7_2' class='gform-field-label gform-field-label--type-inline'>I serve as a Dental Hygiene faculty member<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_99_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='I will serve as a Chair or Co-chair on one committee. [Select the Chaired preferred committee]'  id='choice_99_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_99_7_3' id='label_99_7_3' class='gform-field-label gform-field-label--type-inline'>I will serve as a Chair or Co-chair on one committee. [Select the Chaired preferred committee]<span class=\"radio-button\" role=\"none\">\n\t\t\t\t\t<span class=\"radio-button__center\"><\/span>\n\t\t\t\t<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_99_9\" class=\"gfield gfield--type-form gfield--input-type-form gform-theme__no-reset--children gfield--width-full expando field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_99_9'>Select Committee<\/label><div class=\"gpnf-nested-entries-container ginput_container\">\n\n\t<table class=\"gpnf-nested-entries\">\n\n\t\t<thead>\n\t\t<tr>\n\t\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-field-1\">\n\t\t\t\t\tPreferred\/Required\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-field-6\">\n\t\t\t\t\tSelect a Committee\t\t\t\t<\/th>\n\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-row-actions\"><span class=\"screen-reader-text\">Actions<\/span><\/th>\n\t\t<\/tr>\n\t\t<\/thead>\n\n\t\t<tbody data-bind=\"visible: entries().length, foreach: entries\">\n\t\t<tr data-bind=\"attr: { 'data-entryid': id }\">\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f1.label, attr: { 'data-value': f1.label }\"\n\t\t\t\t\tdata-heading=\"Preferred\/Required\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f6.label, attr: { 'data-value': f6.label }\"\n\t\t\t\t\tdata-heading=\"Select a Committee\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t<td class=\"gpnf-row-actions\" style=\"display: none;\" data-bind=\"visible: true\">\n\t\t\t\t<ul>\n\t\t\t\t\t<li class=\"edit\"><button type=\"button\" class=\"edit-button gform-theme-button--secondary\" data-bind=\"click: $parent.editEntry, attr: { 'aria-label': 'Edit Entry {0} where Preferred\/Required is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Edit<\/button><\/li>\n\t\t\t\t\t\t\t\t\t\t<li class=\"delete\"><button type=\"button\" class=\"delete-button gform-theme-button--simple gform-theme-button--size-md\" data-bind=\"click: $parent.deleteEntry, attr: { 'aria-label': 'Delete Entry {0} where Preferred\/Required is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Delete<\/button><\/li>\n\t\t\t\t<\/ul>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t\t<tbody data-bind=\"visible: entries().length <= 0\">\n\t\t<tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\" style=\"display: none;\">\n\t\t\t<td colspan=\"3\">\n\t\t\t\tThere are no <span>Entries.<\/span>\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t<\/table>\n\n\t<button type=\"button\" class=\"gpnf-add-entry\"\n\t\t        data-formid=\"99\"\n\t\t        data-nestedformid=\"100\"\n\t\t\t\tdata-bind=\"attr: { disabled: isMaxed }, css: { 'gf-default-disabled': isMaxed }\"\n\t\t\t\t>\n\t\t\t\tAdd Entry\n\t\t\t<\/button>\t\n\t\t\t<p class=\"gpnf-add-entry-max\" data-bind=\"visible: isMaxed\" style=\"display: none;\">\n\t\t\t\tMaximum number of entries reached.\n\t\t\t<\/p>\n<\/div>\n<input type=\"hidden\"\n                name=\"input_9\"\n                id=\"input_99_9\"\n                data-bind=\"value: entryIds\"\n                value=\"\" \/><div class='gfield_description' id='gfield_description_99_9'>Add as many committees as indicated by your selection above.<\/div><\/div><div id=\"field_99_11\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Alternative Committee Service<\/h3><\/div><div id=\"field_99_12\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>\n    Describe the nature of the alternative service for which you are requesting approval. Enter the information in the area below and\/or attach document(s). Provide enough information so that your request may be evaluated for approval by the supervising Vice-President.\n<\/p>\n<p>\n    If your request for Alternative Committee Service is approved by the supervising Vice-President, a copy of this form will be returned to you. (<strong>Note<\/strong>: <i>A minimum of ten (10) hours of Alternative Committee Service is needed to fulfill one committee assignment. Alternative Committee Service must be completed by the end of the current academic year.<\/i>)\n<\/p>\n<p>\n    Possible examples of Alternative Committee Service include but are not limited to the following: Service on an institution workgroup such as DEIAA, Curriculum Tech Review,\u00a0multiple campus committees that meet more than 10 hours a year, service on accreditation committees, new program development, a Faculty Peer Mentor, and special projects.<\/p>\n<p>\n    <strong>Description of Alternative Committee Service<\/strong>: (<i>include the number of hours necessary to complete the alternative service; add attachments as needed<\/i>)\n<\/p><\/div><fieldset id=\"field_99_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Alternative Committee Service<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_99_10'><div class='gchoice gchoice_99_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Alternative Service'  id='choice_99_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_10_1' id='label_99_10_1' class='gform-field-label gform-field-label--type-inline'>Alternative Service<span class=\"checkbox\" role=\"none\">\n\t\t\t<!--<svg class=\"brei-icon brei-icon-check\" focusable=\"false\">\n\t\t\t\t<use xlink:href=\"#brei-icon-check\"><\/use>\n\t\t\t<\/svg>-->\n\t\t<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_99_15\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_99_15'>Number of hours<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_15' id='input_99_15' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_99_15\" \/><\/div><div class='gfield_description' id='gfield_description_99_15'>number of hours necessary to complete the alternative service<\/div><\/div><div id=\"field_99_13\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_99_13'>Describe the nature of the alternative service for which you are requesting approval<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><div id=\"wp-input_99_13-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><link rel='stylesheet' id='dashicons-css' href='https:\/\/ct-prod-wp.taftcollege.edu\/forms\/wp-includes\/css\/dashicons.min.css?ver=6.9.4' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='editor-buttons-css' href='https:\/\/ct-prod-wp.taftcollege.edu\/forms\/wp-includes\/css\/editor.min.css?ver=6.9.4' type='text\/css' media='all' \/>\n<div id=\"wp-input_99_13-editor-container\" class=\"wp-editor-container\"><textarea class=\"large wp-editor-area\" style=\"height: 280px\" autocomplete=\"off\" cols=\"40\" name=\"input_13\" id=\"input_99_13\"><\/textarea><\/div>\n<\/div>\n\n<\/div><\/div><div id=\"field_99_14\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_99_14'>Attach documents related to your alternative service request.<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_99_14' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_99_14&quot;,&quot;container&quot;:&quot;gform_multifile_upload_99_14&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_99_14&quot;,&quot;filelist&quot;:&quot;gform_preview_99_14&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/ct-prod-wp.taftcollege.edu\\\/forms\\\/?gf_page=46c9246ddf994a9&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/ct-prod-wp.taftcollege.edu\\\/forms\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/ct-prod-wp.taftcollege.edu\\\/forms\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;pdf,doc,docx,xls,xslx,gif,jpg,jpeg,png,txt,ppt,pptx,rtf&quot;}],&quot;max_file_size&quot;:&quot;83886080b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:99,&quot;field_id&quot;:14,&quot;_gform_file_upload_nonce_99_14&quot;:&quot;1eb1f0a103&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_99_14&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_99_14' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_99_14' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_99_14\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_99_14'>Accepted file types: pdf, doc, docx, xls, xslx, gif, jpg, jpeg, png, txt, ppt, pptx, rtf, Max. file size: 80 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_99_14'><\/ul> <div id='gform_preview_99_14' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_99_16\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Signature<\/h3><\/div><div id=\"field_99_17\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_99_17'>Signature<\/label><input type='hidden' value='' name='input_17' id='input_99_17_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_99_17_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_99_17' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/ct-prod-wp.taftcollege.edu\/forms\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), 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src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_99_17_data' name='input_99_17_data' value=''><\/div><\/div><fieldset id=\"field_99_18\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<\/legend><div id='input_99_18' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_99_18_1_container'>\n                                            <input readonly='readonly' type='number' maxlength='2' name='input_18[]' id='input_99_18_1' value='04'   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_99_18_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_99_18_2_container'>\n                                            <input readonly='readonly' type='number' maxlength='2' name='input_18[]' id='input_99_18_2' value='05'   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_99_18_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_99_18_3_container'>\n                                            <input readonly='readonly' type='number' maxlength='4' name='input_18[]' id='input_99_18_3' value='2026'   aria-required='false'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_99_18_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <input type=\"hidden\" id=\"gwro_hidden_capture_99_18_1\" name=\"gwro_hidden_capture_99_18_1\" value=\"04\" class=\"gf-default-disabled\" \/><input type=\"hidden\" id=\"gwro_hidden_capture_99_18_2\" name=\"gwro_hidden_capture_99_18_2\" value=\"05\" class=\"gf-default-disabled\" \/><input type=\"hidden\" id=\"gwro_hidden_capture_99_18_3\" name=\"gwro_hidden_capture_99_18_3\" value=\"2026\" class=\"gf-default-disabled\" \/><\/div><div class='gfield_description' id='gfield_description_99_18'>This field is populated dynamically.<\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_99' 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