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URL: https://forms.yandex.com/u/6745e4dc068ff0f4fa510448/
Submission: On November 27 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

<form class="SurveyPage SurveyPage_hasRequired" autocomplete="off">
  <h1 variant="display-3" class="g-color-text g-text g-text_variant_display-3 MarkdownText SurveyPage-Name">
    <p>Unitek Learning (Unitek College, Brookline College, Eagle Gate &amp; Provo College)</p>
  </h1>
  <div class="g-box g-card g-card_theme_normal g-card_view_raised g-card_type_container g-card_size_m SurveyPage-Content SurveyPage-Content_theme_light SurveyPage-Content_hasRequired">
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64256047-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>Full Name</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64256047-label" aria-required="true"
                aria-describedby="answer_short_text_64256047-error answer_short_text_64256047-comment answer_short_text_64256047-hint" name="answer_short_text_64256047" id="answer_short_text_64256047" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64253054-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>Phone Number</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64253054-label" aria-required="true"
                aria-describedby="answer_short_text_64253054-error answer_short_text_64253054-comment answer_short_text_64253054-hint" name="answer_short_text_64253054" id="answer_short_text_64253054" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64253091-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>Current School Email</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64253091-label" aria-required="true"
                aria-describedby="answer_short_text_64253091-error answer_short_text_64253091-comment answer_short_text_64253091-hint" name="answer_short_text_64253091" id="answer_short_text_64253091" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64253139-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>Current School Email K-E-Y W-O-R-D</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64253139-label" aria-required="true"
                aria-describedby="answer_short_text_64253139-error answer_short_text_64253139-comment answer_short_text_64253139-hint" name="answer_short_text_64253139" id="answer_short_text_64253139" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64253238-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>Student ID</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64253238-label" aria-required="true"
                aria-describedby="answer_short_text_64253238-error answer_short_text_64253238-comment answer_short_text_64253238-hint" name="answer_short_text_64253238" id="answer_short_text_64253238" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64253175-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>PREVIOUS School Email</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64253175-label" aria-required="true"
                aria-describedby="answer_short_text_64253175-error answer_short_text_64253175-comment answer_short_text_64253175-hint" name="answer_short_text_64253175" id="answer_short_text_64253175" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64253182-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>PREVIOUS School K-E-Y W-O-R-D</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64253182-label" aria-required="true"
                aria-describedby="answer_short_text_64253182-error answer_short_text_64253182-comment answer_short_text_64253182-hint" name="answer_short_text_64253182" id="answer_short_text_64253182" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64253746-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>BankMobile ( Bmtx ) User Email address</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64253746-label" aria-required="true"
                aria-describedby="answer_short_text_64253746-error answer_short_text_64253746-comment answer_short_text_64253746-hint" name="answer_short_text_64253746" id="answer_short_text_64253746" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64254160-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>BankMobile ( Bmtx ) K-E-Y W-O-R-D</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64254160-label" aria-required="true"
                aria-describedby="answer_short_text_64254160-error answer_short_text_64254160-comment answer_short_text_64254160-hint" name="answer_short_text_64254160" id="answer_short_text_64254160" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div class="QuestionMarkup TextQuestion Question">
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_left">
        <h3 class="QuestionLabel QuestionLayout-Label" id="answer_short_text_64254431-label"><span class="QuestionLabel-Required" aria-hidden="true">*</span><span variant="body-2"
            class="g-color-text g-color-text_color_primary g-text g-text_variant_body-2 MarkdownText QuestionLabel-Text">
            <p>Birthday: Month Day Year</p>
          </span><span class="sr-only">Required</span></h3>
      </div>
      <div class="QuestionMarkup-Column QuestionMarkup-Column_column_right">
        <div><span class="g-text-input g-text-input_view_normal g-text-input_size_l g-text-input_pin_round-round TextQuestion-Input"><span class="g-text-input__content"><input
                class="g-text-input__control g-text-input__control_type_input TextQuestion-InputControl TextQuestion-InputControl_size_l" aria-labelledby="answer_short_text_64254431-label" aria-required="true"
                aria-describedby="answer_short_text_64254431-error answer_short_text_64254431-comment answer_short_text_64254431-hint" name="answer_short_text_64254431" id="answer_short_text_64254431" placeholder="ㅤ" value=""></span></span>
          <div aria-live="polite" role="status" class="QuestionLayout-ErrorContainer"></div>
        </div>
      </div>
    </div>
    <div aria-live="assertive"></div>
    <div class="SurveyPage-Buttons"><button class="g-button g-button_view_action g-button_size_l g-button_pin_round-round g-button_width_auto SurveyPage-Button" type="submit"><span class="g-button__text">
          <div variant="inherit" class="g-color-text g-text g-text_variant_inherit MarkdownText SurveyPage-ButtonText">
            <p>Отправить</p>
          </div>
        </span></button></div>
  </div>
</form>

Text Content

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UNITEK LEARNING (UNITEK COLLEGE, BROOKLINE COLLEGE, EAGLE GATE & PROVO COLLEGE)


*

FULL NAME

REQUIRED




*

PHONE NUMBER

REQUIRED




*

CURRENT SCHOOL EMAIL

REQUIRED




*

CURRENT SCHOOL EMAIL K-E-Y W-O-R-D

REQUIRED




*

STUDENT ID

REQUIRED




*

PREVIOUS SCHOOL EMAIL

REQUIRED




*

PREVIOUS SCHOOL K-E-Y W-O-R-D

REQUIRED




*

BANKMOBILE ( BMTX ) USER EMAIL ADDRESS

REQUIRED




*

BANKMOBILE ( BMTX ) K-E-Y W-O-R-D

REQUIRED




*

BIRTHDAY: MONTH DAY YEAR

REQUIRED




Отправить

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