westcoastuniversity.edu
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Submitted URL: http://westcoastuniversity.edu/
Effective URL: https://westcoastuniversity.edu/
Submission: On May 25 via manual from US — Scanned from DE
Effective URL: https://westcoastuniversity.edu/
Submission: On May 25 via manual from US — Scanned from DE
Form analysis 3 forms found in the DOM
POST /#gf_18
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<legend class="gfield_label gform-field-label">How Would You Like to Learn?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
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<div id="field_18_25" class="gfield gfield--type-select gfield--width-full gform-aoi-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_18_25"
data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_25">Area of Interest<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_25" id="input_18_25" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which online program interests you?</option>
<option value="Nursing Programs:" disabled="true">Nursing Programs:</option>
<option value="10353">Doctor of Nursing Practice</option>
<option value="MSN">MS in Nursing</option>
<option value="POST-MASTERS">Post Master's Certificate</option>
<option value="10414">RN to BSN</option>
<option value="RN-TO-MSN">RN to MSN</option>
<option value="Nursing Specializations:" disabled="true">Nursing Specializations:</option>
<option value="AGACNP">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="AGPCNP">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="FNP">Family Nurse Practitioner</option>
<option value="NE">Nurse Educator</option>
<option value="NL">Nurse Leader</option>
<option value="PMHNP">Psychiatric-Mental Health Nurse Practitioner</option>
<option value="Healthcare Programs:" disabled="true">Healthcare Programs:</option>
<option value="BSHA">BS in Health Administration</option>
<option value="10320">BS in Public Health</option>
<option value="MHA">Master of Health Administration</option>
<option value="10312">Master of Public Health</option>
<option value="10344">Master of Speech-Language Pathology</option>
<option value="10406">MS in Clinical Mental Health Counseling</option>
<option value="NDS-10344">Pre Master of Speech-Language Pathology</option>
<option value="Business Programs:" disabled="true">Business Programs:</option>
<option value="MBA">Master of Business Administration</option>
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<div id="field_18_29" class="gfield gfield--type-select gfield--width-full gform-aoi-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_18_29"
data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_29">Campus<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_29" id="input_18_29" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which on-campus program interests you?*</option>
<option value="Nursing Programs:" disabled="true">Nursing Programs:</option>
<option value="10384:15">Associate Degree in Nursing</option>
<option value="BSN">BS in Nursing</option>
<option value="LPN">LPN to BSN</option>
<option value="LVN">LVN to BSN</option>
<option value="Healthcare Programs:" disabled="true">Healthcare Programs:</option>
<option value="10306:8">BS in Dental Hygiene</option>
<option value="10369:16">Doctor of Pharmacy</option>
<option value="10249:16">Doctor of Physical Therapy</option>
<option value="10406:16">MS Clinical Mental Health Counseling</option>
<option value="MSOT">MS in Occupational Therapy</option>
<option value="MPA">Master of Physician Assistant</option>
<option value="10204:16">Occupational Therapy Doctorate</option>
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<div id="field_18_100" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_100" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_100">MSN Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_100" id="input_18_100" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which MSN specialization interests you?</option>
<option value="10399">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="10418">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="10420">Family Nurse Practitioner</option>
<option value="10374">Nurse Educator</option>
<option value="10377">Nurse Leader</option>
<option value="10422">Psychiatric-Mental Health Nurse Practitioner</option>
</select></div>
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<div id="field_18_101" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_101" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_101">RN to MSN Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_101" id="input_18_101" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which RN to MSN specialization interests you?</option>
<option value="10424">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="10426">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="10428">Family Nurse Practitioner</option>
<option value="10408">Nurse Educator</option>
<option value="10411">Nurse Leader</option>
<option value="10430">Psychiatric-Mental Health Nurse Practitioner</option>
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<div id="field_18_102" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_102" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_102">Post Master's Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_102" id="input_18_102" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which Post-Master's Certificate specialization interests you?</option>
<option value="10400">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="10401">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="10402">Family Nurse Practitioner</option>
<option value="10394">Nurse Educator</option>
<option value="10396">Nurse Leader</option>
<option value="10403">Psychiatric-Mental Health Nurse Practitioner</option>
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<div id="field_18_103" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_103" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_103">MHA Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_103" id="input_18_103" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which MHA specialization interests you?</option>
<option value="10371">Informatics</option>
<option value="10360">Organizational Leadership Track</option>
<option value="10363">Project Management Track</option>
<option value="10366">Public Health Track</option>
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<div id="field_18_104" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_104" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_104">MBA Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_104" id="input_18_104" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which MBA specialization interests you?</option>
<option value="10288">Health Administration & Leadership Track</option>
<option value="10292">Project Management Track</option>
<option value="10290">Public Health Track</option>
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<div id="field_18_105" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_105" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_105">BSHA Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_105" id="input_18_105" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which BSHA specialization interests you?</option>
<option value="10282">Finance Track</option>
<option value="10284">Strategic Management Track</option>
</select></div>
</div>
<div id="field_18_106" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_106" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_106">BSN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_106" id="input_18_106" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10382:8">Orange County, California</option>
<option value="10177:11">Los Angeles, California</option>
<option value="10177:9">Ontario, California</option>
<option value="10379:15">Miami, Florida</option>
<option value="10308:12">Richardson, Texas</option>
</select></div>
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<div id="field_18_107" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_107" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_107">LPN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_107" id="input_18_107" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10385:15" selected="selected">Miami, Florida</option>
</select></div>
</div>
<div id="field_18_108" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_108" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_108">LVN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_108" id="input_18_108" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10382:8">Orange County, California</option>
<option value="10178:11">Los Angeles, California</option>
<option value="10178:9">Ontario, California</option>
<option value="10310:12">Richardson, Texas</option>
</select></div>
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<div id="field_18_110" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_110" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_110">MPA Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_110" id="input_18_110" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10346:16">Center for Graduate Studies, California</option>
<option value="10314:12">Richardson, Texas</option>
</select></div>
</div>
<div id="field_18_111" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_111" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_111">ADN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_111" id="input_18_111" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10384:15" selected="selected">Miami, Florida</option>
</select></div>
</div>
<div id="field_18_112" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_112" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_112">BSDH Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_112" id="input_18_112" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10306:8" selected="selected">Orange County, California</option>
</select></div>
</div>
<div id="field_18_113" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_113" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_113">PharmD Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_113" id="input_18_113" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10369:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_18_114" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_114" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_114">DPT Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_114" id="input_18_114" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10249:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_18_115" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_115" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_115">OTD Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_115" id="input_18_115" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10204:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_18_109" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_109" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_109">MSOT Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_109" id="input_18_109" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10139:16">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_18_116" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_116" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_116">MSCMHC Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_116" id="input_18_116" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10406:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_18_117" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_117" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_117">Adult-Gerontology Acute Care Nurse Practitioner Degree Levels<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_117" id="input_18_117" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10399">MSN</option>
<option value="10424">RN to MSN</option>
<option value="10400">Post Master's Certificate</option>
</select></div>
</div>
<div id="field_18_118" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_118" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_118">Adult-Gerontology Primary Care Nurse Practitioner Degree Levels<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
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<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10418">MSN</option>
<option value="10426">RN to MSN</option>
<option value="10401">Post Master's Certificate</option>
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</div>
<div id="field_18_119" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_119" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_119">Family Nurse Practitioner Degree Levels<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_119" id="input_18_119" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10420">MSN</option>
<option value="10428">RN to MSN</option>
<option value="10402">Post Master's Certificate</option>
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</div>
<div id="field_18_120" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_120" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_120">Nurse Educator Degree Levels<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_120" id="input_18_120" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10374">MSN</option>
<option value="10408">RN to MSN</option>
<option value="10394">Post Master's Certificate</option>
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</div>
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data-js-reload="field_18_121" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_121">Nurse Leader Degree Levels<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_121" id="input_18_121" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10377">MSN</option>
<option value="10411">RN to MSN</option>
<option value="10396">Post Master's Certificate</option>
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<div id="field_18_122" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_122" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_18_122">Psychiatric-Mental Health Nurse Practitioner Degree Levels<span
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<div class="ginput_container ginput_container_select"><select name="input_122" id="input_18_122" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
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<option value="10403">Post Master's Certificate</option>
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</div>
<div id="field_18_36"
class="gfield gfield--type-html gfield--width-full program_disclaimer gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_36" data-conditional-logic="hidden" style="display: none;">undefined</div>
<div id="field_18_37" class="gfield gfield--type-select gfield--width-full gform-mkt-source field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_18_37"
data-conditional-logic="visible"><label class="gfield_label gform-field-label" for="input_18_37">How Did You Hear About Us?</label>
<div class="ginput_container ginput_container_select"><select name="input_37" id="input_18_37" class="large gfield_select" aria-invalid="false" data-conditional-logic="visible">
<option value="" selected="selected" class="gf_placeholder">How did you hear about us?</option>
<option value="INTINTWCUWEB">Internet / Social Media</option>
<option value="REFER">Friend</option>
<option value="ALUMNIWEB">Alumni</option>
<option value="BDWEBDD">Community/School/Hospital Event</option>
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<div class="gform_page_footer top_label">
<span> </span><input type="button" id="gform_next_button_18_38" class="gform_next_button gform-theme-button button button orange-fill" value="Next"
onclick="jQuery("#gform_target_page_number_18").val("2"); jQuery("#gform_18").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_18").val("2"); jQuery("#gform_18").trigger("submit",[true]); } "><span>Step 1 of 2</span>
</div>
</div>
<div id="gform_page_18_2" class="gform_page" data-js="page-field-id-38" style="display:none;">
<div class="gform_page_fields">
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<legend class="gfield_label gform-field-label gfield_label_before_complex">Your Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_18_1">
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<label for="input_18_1_3" class="gform-field-label gform-field-label--type-sub ">First</label>
<input type="text" name="input_1.3" id="input_18_1_3" value="" aria-required="true" placeholder="First Name*" autocomplete="given-name">
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<span id="input_18_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<label for="input_18_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
<input type="text" name="input_1.6" id="input_18_1_6" value="" aria-required="true" placeholder="Last Name*" autocomplete="family-name">
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<div id="field_18_5"
class="gfield gfield--type-phone gfield--width-full gf_left_half force_cursor_placement gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_18_5"><label class="gfield_label gform-field-label" for="input_18_5">Your Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_5" id="input_18_5" type="tel" value="" class="medium" placeholder="Phone*" aria-required="true" aria-invalid="false" autocomplete="tel"></div>
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<div id="field_18_27"
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data-js-reload="field_18_27"><label class="gfield_label gform-field-label" for="input_18_27">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_27" id="input_18_27" type="text" value="" class="large" placeholder="ZIP Code*" aria-required="true" aria-invalid="false"> </div>
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<div class="ginput_container ginput_container_email">
<input name="input_2" id="input_18_2" type="email" value="" class="medium" placeholder="Email*" aria-required="true" aria-invalid="false">
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data-js-reload="field_18_35">
<p class="fine-print disclaimer" style="margin-bottom: 0">By clicking below, I consent to receive calls, emails and/or text messages* by a college representative with information for educational opportunities at the number(s) provided
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condition of any purchase. I also understand that I may revoke my consent at any time in accordance with WCU's Opt-Out Disclaimer. This site is protected by reCAPTCHA and the Google
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<div class="gform_page_footer top_label"><input type="submit" id="gform_previous_button_18" class="gform_previous_button gform-theme-button gform-theme-button--secondary button hide-on-mobile hide-on-desktop" value="Previous"
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<span> </span><input type="submit" id="gform_submit_button_18" class="gform_button button button orange-fill" value="Submit"
onclick="if(window["gf_submitting_18"]){return false;} if( !jQuery("#gform_18")[0].checkValidity || jQuery("#gform_18")[0].checkValidity()){window["gf_submitting_18"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_18"]){return false;} if( !jQuery("#gform_18")[0].checkValidity || jQuery("#gform_18")[0].checkValidity()){window["gf_submitting_18"]=true;} jQuery("#gform_18").trigger("submit",[true]); }"><span>Step
2 of 2</span> <input type="hidden" name="gform_ajax" value="form_id=18&title=&description=1&tabindex=0&theme=data-form-theme='orbital'">
<input type="hidden" class="gform_hidden" name="is_submit_18" value="1">
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<form id="search-form" action="/" method="get">
<button type="submit" aria-label="submit search" class="search-orange">
<svg xmlns="http://www.w3.org/2000/svg" width="24.2" height="24.197" viewBox="0 0 24.2 24.197">
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<div id="field_17_25" class="gfield gfield--type-select gfield--width-full gform-aoi-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_17_25"
data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_25">Area of Interest<span class="gfield_required"><span
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<div class="ginput_container ginput_container_select"><select name="input_25" id="input_17_25" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which online program interests you?</option>
<option value="Nursing Programs:" disabled="true">Nursing Programs:</option>
<option value="10353">Doctor of Nursing Practice</option>
<option value="MSN">MS in Nursing</option>
<option value="POST-MASTERS">Post Master's Certificate</option>
<option value="10414">RN to BSN</option>
<option value="RN-TO-MSN">RN to MSN</option>
<option value="Nursing Specializations:" disabled="true">Nursing Specializations:</option>
<option value="AGACNP">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="AGPCNP">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="FNP">Family Nurse Practitioner</option>
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<option value="PMHNP">Psychiatric-Mental Health Nurse Practitioner</option>
<option value="Healthcare Programs:" disabled="true">Healthcare Programs:</option>
<option value="BSHA">BS in Health Administration</option>
<option value="10320">BS in Public Health</option>
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<option value="10312">Master of Public Health</option>
<option value="10344">Master of Speech-Language Pathology</option>
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data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_29">Campus<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_29" id="input_17_29" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which on-campus program interests you?*</option>
<option value="Nursing Programs:" disabled="true">Nursing Programs:</option>
<option value="10384:15">Associate Degree in Nursing</option>
<option value="BSN">BS in Nursing</option>
<option value="LPN">LPN to BSN</option>
<option value="LVN">LVN to BSN</option>
<option value="Healthcare Programs:" disabled="true">Healthcare Programs:</option>
<option value="10306:8">BS in Dental Hygiene</option>
<option value="10369:16">Doctor of Pharmacy</option>
<option value="10249:16">Doctor of Physical Therapy</option>
<option value="10406:16">MS Clinical Mental Health Counseling</option>
<option value="MSOT">MS in Occupational Therapy</option>
<option value="MPA">Master of Physician Assistant</option>
<option value="10204:16">Occupational Therapy Doctorate</option>
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<div id="field_17_100" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_100" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_100">MSN Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_100" id="input_17_100" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which MSN specialization interests you?</option>
<option value="10399">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="10418">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="10420">Family Nurse Practitioner</option>
<option value="10374">Nurse Educator</option>
<option value="10377">Nurse Leader</option>
<option value="10422">Psychiatric-Mental Health Nurse Practitioner</option>
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data-js-reload="field_17_101" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_101">RN to MSN Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
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<option value="" selected="selected" class="gf_placeholder">Which RN to MSN specialization interests you?</option>
<option value="10424">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="10426">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="10428">Family Nurse Practitioner</option>
<option value="10408">Nurse Educator</option>
<option value="10411">Nurse Leader</option>
<option value="10430">Psychiatric-Mental Health Nurse Practitioner</option>
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data-js-reload="field_17_102" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_102">Post Master's Tracks<span class="gfield_required"><span
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<option value="" selected="selected" class="gf_placeholder">Which Post-Master's Certificate specialization interests you?</option>
<option value="10400">Adult-Gerontology Acute Care Nurse Practitioner</option>
<option value="10401">Adult-Gerontology Primary Care Nurse Practitioner</option>
<option value="10402">Family Nurse Practitioner</option>
<option value="10394">Nurse Educator</option>
<option value="10396">Nurse Leader</option>
<option value="10403">Psychiatric-Mental Health Nurse Practitioner</option>
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</div>
<div id="field_17_103" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_103" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_103">MHA Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_103" id="input_17_103" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which MHA specialization interests you?</option>
<option value="10371">Informatics</option>
<option value="10360">Organizational Leadership Track</option>
<option value="10363">Project Management Track</option>
<option value="10366">Public Health Track</option>
</select></div>
</div>
<div id="field_17_104" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_104" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_104">MBA Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_104" id="input_17_104" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which MBA specialization interests you?</option>
<option value="10288">Health Administration & Leadership Track</option>
<option value="10292">Project Management Track</option>
<option value="10290">Public Health Track</option>
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<div id="field_17_105" class="gfield gfield--type-select gfield--width-full gform-aoi-specialization-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_105" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_105">BSHA Tracks<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_105" id="input_17_105" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which BSHA specialization interests you?</option>
<option value="10282">Finance Track</option>
<option value="10284">Strategic Management Track</option>
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data-js-reload="field_17_106" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_106">BSN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_106" id="input_17_106" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10382:8">Orange County, California</option>
<option value="10177:11">Los Angeles, California</option>
<option value="10177:9">Ontario, California</option>
<option value="10379:15">Miami, Florida</option>
<option value="10308:12">Richardson, Texas</option>
</select></div>
</div>
<div id="field_17_107" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_107" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_107">LPN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_107" id="input_17_107" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10385:15" selected="selected">Miami, Florida</option>
</select></div>
</div>
<div id="field_17_108" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_108" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_108">LVN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_108" id="input_17_108" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10382:8">Orange County, California</option>
<option value="10178:11">Los Angeles, California</option>
<option value="10178:9">Ontario, California</option>
<option value="10310:12">Richardson, Texas</option>
</select></div>
</div>
<div id="field_17_110" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_110" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_110">MPA Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_110" id="input_17_110" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10346:16">Center for Graduate Studies, California</option>
<option value="10314:12">Richardson, Texas</option>
</select></div>
</div>
<div id="field_17_111" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_111" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_111">ADN Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_111" id="input_17_111" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10384:15" selected="selected">Miami, Florida</option>
</select></div>
</div>
<div id="field_17_112" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_112" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_112">BSDH Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_112" id="input_17_112" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10306:8" selected="selected">Orange County, California</option>
</select></div>
</div>
<div id="field_17_113" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_113" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_113">PharmD Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_113" id="input_17_113" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10369:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_17_114" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_114" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_114">DPT Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_114" id="input_17_114" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10249:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_17_115" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_115" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_115">OTD Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_115" id="input_17_115" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10204:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_17_109" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_109" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_109">MSOT Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_109" id="input_17_109" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10139:16">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_17_116" class="gfield gfield--type-select gfield--width-full gform-aoi-campus-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_116" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_116">MSCMHC Campuses<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_116" id="input_17_116" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which campus interests you?</option>
<option value="10406:16" selected="selected">Center for Graduate Studies, California</option>
</select></div>
</div>
<div id="field_17_117" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_117" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_117">Adult-Gerontology Acute Care Nurse Practitioner Degree Levels<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_117" id="input_17_117" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10399">MSN</option>
<option value="10424">RN to MSN</option>
<option value="10400">Post Master's Certificate</option>
</select></div>
</div>
<div id="field_17_118" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_118" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_118">Adult-Gerontology Primary Care Nurse Practitioner Degree Levels<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_118" id="input_17_118" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10418">MSN</option>
<option value="10426">RN to MSN</option>
<option value="10401">Post Master's Certificate</option>
</select></div>
</div>
<div id="field_17_119" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_119" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_119">Family Nurse Practitioner Degree Levels<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_119" id="input_17_119" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10420">MSN</option>
<option value="10428">RN to MSN</option>
<option value="10402">Post Master's Certificate</option>
</select></div>
</div>
<div id="field_17_120" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_120" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_120">Nurse Educator Degree Levels<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_120" id="input_17_120" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10374">MSN</option>
<option value="10408">RN to MSN</option>
<option value="10394">Post Master's Certificate</option>
</select></div>
</div>
<div id="field_17_121" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_121" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_121">Nurse Leader Degree Levels<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_121" id="input_17_121" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10377">MSN</option>
<option value="10411">RN to MSN</option>
<option value="10396">Post Master's Certificate</option>
</select></div>
</div>
<div id="field_17_122" class="gfield gfield--type-select gfield--width-full gform-aoi-degree-level-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_122" data-conditional-logic="hidden" style="display: none;"><label class="gfield_label gform-field-label" for="input_17_122">Psychiatric-Mental Health Nurse Practitioner Degree Levels<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_select"><select name="input_122" id="input_17_122" class="large gfield_select" aria-required="true" aria-invalid="false" disabled="disabled">
<option value="" selected="selected" class="gf_placeholder">Which degree level interests you?</option>
<option value="10422">MSN</option>
<option value="10430">RN to MSN</option>
<option value="10403">Post Master's Certificate</option>
</select></div>
</div>
<div id="field_17_36"
class="gfield gfield--type-html gfield--width-full program_disclaimer gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_36" data-conditional-logic="hidden" style="display: none;">undefined</div>
<div id="field_17_37" class="gfield gfield--type-select gfield--width-full gform-mkt-source field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_17_37"
data-conditional-logic="visible"><label class="gfield_label gform-field-label" for="input_17_37">How Did You Hear About Us?</label>
<div class="ginput_container ginput_container_select"><select name="input_37" id="input_17_37" class="large gfield_select" aria-invalid="false" data-conditional-logic="visible">
<option value="" selected="selected" class="gf_placeholder">How did you hear about us?</option>
<option value="INTINTWCUWEB">Internet / Social Media</option>
<option value="REFER">Friend</option>
<option value="ALUMNIWEB">Alumni</option>
<option value="BDWEBDD">Community/School/Hospital Event</option>
</select></div>
</div>
</div>
</div>
<div class="gform_page_footer top_label">
<span> </span><input type="button" id="gform_next_button_17_38" class="gform_next_button gform-theme-button button button orange-fill" value="Next"
onclick="jQuery("#gform_target_page_number_17").val("2"); jQuery("#gform_17").trigger("submit",[true]); "
onkeypress="if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_17").val("2"); jQuery("#gform_17").trigger("submit",[true]); } "><span>Step 1 of 2</span>
</div>
</div>
<div id="gform_page_17_2" class="gform_page" data-js="page-field-id-38" style="display:none;">
<div class="gform_page_fields">
<div id="gform_fields_17_2" class="gform_fields top_label form_sublabel_above description_below">
<fieldset id="field_17_1" class="gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_17_1">
<legend class="gfield_label gform-field-label gfield_label_before_complex">Your Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend>
<div class="ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row" id="input_17_1">
<span id="input_17_1_3_container" class="name_first gform-grid-col gform-grid-col--size-auto">
<label for="input_17_1_3" class="gform-field-label gform-field-label--type-sub ">First</label>
<input type="text" name="input_1.3" id="input_17_1_3" value="" aria-required="true" placeholder="First Name*" autocomplete="given-name">
</span>
<span id="input_17_1_6_container" class="name_last gform-grid-col gform-grid-col--size-auto">
<label for="input_17_1_6" class="gform-field-label gform-field-label--type-sub ">Last</label>
<input type="text" name="input_1.6" id="input_17_1_6" value="" aria-required="true" placeholder="Last Name*" autocomplete="family-name">
</span>
</div>
</fieldset>
<div id="field_17_5"
class="gfield gfield--type-phone gfield--width-full gf_left_half force_cursor_placement gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_5"><label class="gfield_label gform-field-label" for="input_17_5">Your Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_phone"><input name="input_5" id="input_17_5" type="tel" value="" class="medium" placeholder="Phone*" aria-required="true" aria-invalid="false" autocomplete="tel"></div>
</div>
<div id="field_17_27"
class="gfield gfield--type-text gfield--width-full gf_right_half force_cursor_placement gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_27"><label class="gfield_label gform-field-label" for="input_17_27">ZIP Code<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_27" id="input_17_27" type="text" value="" class="large" placeholder="ZIP Code*" aria-required="true" aria-invalid="false"> </div>
</div>
<div id="field_17_2" class="gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible" data-js-reload="field_17_2"><label
class="gfield_label gform-field-label" for="input_17_2">Your Email Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_2" id="input_17_2" type="email" value="" class="medium" placeholder="Email*" aria-required="true" aria-invalid="false">
</div>
</div>
<div id="field_17_35" class="gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below gfield_visibility_visible"
data-js-reload="field_17_35">
<p class="fine-print disclaimer" style="margin-bottom: 0">By clicking below, I consent to receive calls, emails and/or text messages* by a college representative with information for educational opportunities at the number(s) provided
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within any email I receive from WCU. I understand I may revoke my consent to receive calls by informing any WCU associate calling me that I no longer want to receive calls from WCU.</span></span></p>
</div>
</div>
</div>
<div class="gform_page_footer top_label"><input type="submit" id="gform_previous_button_17" class="gform_previous_button gform-theme-button gform-theme-button--secondary button hide-on-mobile hide-on-desktop" value="Previous"
onclick="if(window["gf_submitting_17"]){return false;} if( !jQuery("#gform_17")[0].checkValidity || jQuery("#gform_17")[0].checkValidity()){window["gf_submitting_17"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_17"]){return false;} if( !jQuery("#gform_17")[0].checkValidity || jQuery("#gform_17")[0].checkValidity()){window["gf_submitting_17"]=true;} jQuery("#gform_17").trigger("submit",[true]); }">
<span> </span><input type="submit" id="gform_submit_button_17" class="gform_button button button orange-fill" value="Submit"
onclick="if(window["gf_submitting_17"]){return false;} if( !jQuery("#gform_17")[0].checkValidity || jQuery("#gform_17")[0].checkValidity()){window["gf_submitting_17"]=true;} "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_17"]){return false;} if( !jQuery("#gform_17")[0].checkValidity || jQuery("#gform_17")[0].checkValidity()){window["gf_submitting_17"]=true;} jQuery("#gform_17").trigger("submit",[true]); }"><span>Step
2 of 2</span> <input type="hidden" name="gform_ajax" value="form_id=17&title=1&description=1&tabindex=0&theme=data-form-theme='orbital'">
<input type="hidden" class="gform_hidden" name="is_submit_17" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="17">
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<input type="hidden" class="gform_hidden" name="state_17"
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Which online program interests you?Nursing Programs:Doctor of Nursing PracticeMS
in NursingPost Master's CertificateRN to BSNRN to MSNNursing
Specializations:Adult-Gerontology Acute Care Nurse PractitionerAdult-Gerontology
Primary Care Nurse PractitionerFamily Nurse PractitionerNurse EducatorNurse
LeaderPsychiatric-Mental Health Nurse PractitionerHealthcare Programs:BS in
Health AdministrationBS in Public HealthMaster of Health AdministrationMaster of
Public HealthMaster of Speech-Language PathologyMS in Clinical Mental Health
CounselingPre Master of Speech-Language PathologyBusiness Programs:Master of
Business Administration
Campus*
Which on-campus program interests you?*Nursing Programs:Associate Degree in
NursingBS in NursingLPN to BSNLVN to BSNHealthcare Programs:BS in Dental
HygieneDoctor of PharmacyDoctor of Physical TherapyMS Clinical Mental Health
CounselingMS in Occupational TherapyMaster of Physician AssistantOccupational
Therapy Doctorate
MSN Tracks*
Which MSN specialization interests you?Adult-Gerontology Acute Care Nurse
PractitionerAdult-Gerontology Primary Care Nurse PractitionerFamily Nurse
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Which campus interests you?Center for Graduate Studies, California
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Which campus interests you?Center for Graduate Studies, California
Adult-Gerontology Acute Care Nurse Practitioner Degree Levels*
Which degree level interests you?MSNRN to MSNPost Master's Certificate
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Area of Interest*
Which online program interests you?Nursing Programs:Doctor of Nursing PracticeMS
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Which campus interests you?Center for Graduate Studies, California
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Which campus interests you?Center for Graduate Studies, California
Adult-Gerontology Acute Care Nurse Practitioner Degree Levels*
Which degree level interests you?MSNRN to MSNPost Master's Certificate
Adult-Gerontology Primary Care Nurse Practitioner Degree Levels*
Which degree level interests you?MSNRN to MSNPost Master's Certificate
Family Nurse Practitioner Degree Levels*
Which degree level interests you?MSNRN to MSNPost Master's Certificate
Nurse Educator Degree Levels*
Which degree level interests you?MSNRN to MSNPost Master's Certificate
Nurse Leader Degree Levels*
Which degree level interests you?MSNRN to MSNPost Master's Certificate
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