{"id":1453,"date":"2021-08-25T05:21:23","date_gmt":"2021-08-25T09:21:23","guid":{"rendered":"https:\/\/wwwcp.umes.edu\/counselingservices\/?page_id=1453"},"modified":"2022-12-21T13:59:24","modified_gmt":"2022-12-21T17:59:24","slug":"workshop-outreach-request-form","status":"publish","type":"page","link":"https:\/\/wwwcp.umes.edu\/counselingservices\/workshop-outreach-request-form\/","title":{"rendered":"Workshop\/Outreach Request Form"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Counselors are available to conduct support groups and workshops and provide information on various topics that are important to students. Whether a group starts or not depends on how many students express interest in it, so please contact us if you are interested in a group, workshop or outreach event. Please call 410-651-6449 or visit Counseling Services at the Student Development Center (SDC) second floor Suite 2260.<\/p>\n\n\n\n<div class=\"forminator-guttenberg\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1452 forminator-design--default forminator-enclosed forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1452\" data-uid=\"6a57bbc7595a2\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-1452\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1452 forminator-design--default forminator-enclosed forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"1452\"\r\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"enclosed\" style=\"display: none;\"\r\n\t\t\t\tdata-uid=\"6a57bbc7595a2\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a57bbc7595a2\" id=\"forminator-field-date-1-picker_6a57bbc7595a2-label\" class=\"forminator-label\">Date of Request<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-1-picker_6a57bbc7595a2\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a57bbc7595a2\" id=\"forminator-field-text-1_6a57bbc7595a2-label\" class=\"forminator-label\">Group Class\/Organization<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a57bbc7595a2\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a57bbc7595a2\" id=\"forminator-field-text-2_6a57bbc7595a2-label\" class=\"forminator-label\">Program Topic<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a57bbc7595a2\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><p><strong>Date(s) of Program:<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a57bbc7595a2\" id=\"forminator-field-date-2-picker_6a57bbc7595a2-label\" class=\"forminator-label\">Date 1<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-2-picker_6a57bbc7595a2\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_6a57bbc7595a2\" id=\"forminator-field-date-3-picker_6a57bbc7595a2-label\" class=\"forminator-label\">Date 2<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-3-picker_6a57bbc7595a2\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"date-4\" class=\"forminator-field-date forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-4-picker_6a57bbc7595a2\" id=\"forminator-field-date-4-picker_6a57bbc7595a2-label\" class=\"forminator-label\">Date 3<\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-4\" value=\"\" placeholder=\"Choose Date\" id=\"forminator-field-date-4-picker_6a57bbc7595a2\" class=\"forminator-input forminator-datepicker\" data-required=\"\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a57bbc7595a2\" id=\"forminator-field-text-3_6a57bbc7595a2-label\" class=\"forminator-label\">Time and Length of Program<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a57bbc7595a2\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a57bbc7595a2\" id=\"forminator-field-text-4_6a57bbc7595a2-label\" class=\"forminator-label\">Location of Program<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a57bbc7595a2\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p><strong>Contact Person<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a57bbc7595a2\" id=\"forminator-field-name-1_6a57bbc7595a2-label\" class=\"forminator-label\">Name<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John Doe\" id=\"forminator-field-name-1_6a57bbc7595a2\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a57bbc7595a2\" id=\"forminator-field-email-1_6a57bbc7595a2-label\" class=\"forminator-label\">Email Address<\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_6a57bbc7595a2\" class=\"forminator-input forminator-email--field\" data-required=\"\" aria-required=\"false\" autocomplete=\"email\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a57bbc7595a2\" id=\"forminator-field-phone-1_6a57bbc7595a2-label\" class=\"forminator-label\">Phone<\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +1 300 400 5000\" id=\"forminator-field-phone-1_6a57bbc7595a2\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a57bbc7595a2-label\"><span id=\"forminator-radiogroup-radio-1-6a57bbc7595a2-label\" class=\"forminator-label\">Types of Program:<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a57bbc7595a2\" class=\"forminator-radio\" title=\"Workshop\/Training\"><input type=\"radio\" name=\"radio-1\" value=\"workshop\/training\" id=\"forminator-field-radio-1-1-6a57bbc7595a2\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Workshop\/Training<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a57bbc7595a2\" class=\"forminator-radio\" title=\"Psychoeducational Presentation\"><input type=\"radio\" name=\"radio-1\" value=\"psychoeducational-presentation\" id=\"forminator-field-radio-1-2-6a57bbc7595a2\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Psychoeducational Presentation<\/span><\/label><label id=\"forminator-field-radio-1-label-3\" for=\"forminator-field-radio-1-3-6a57bbc7595a2\" class=\"forminator-radio\" title=\"Tabling Event\"><input type=\"radio\" name=\"radio-1\" value=\"tabling-event\" id=\"forminator-field-radio-1-3-6a57bbc7595a2\" aria-labelledby=\"forminator-field-radio-1-label-3\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Tabling Event<\/span><\/label><label id=\"forminator-field-radio-1-label-4\" for=\"forminator-field-radio-1-4-6a57bbc7595a2\" class=\"forminator-radio\" title=\"Other\"><input type=\"radio\" name=\"radio-1\" value=\"other\" id=\"forminator-field-radio-1-4-6a57bbc7595a2\" aria-labelledby=\"forminator-field-radio-1-label-4\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Other<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a57bbc7595a2\" id=\"forminator-field-textarea-1_6a57bbc7595a2-label\" class=\"forminator-label\">If you selected \u201cother for the previous question, please provide a description of the program<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a57bbc7595a2\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a57bbc7595a2\" id=\"forminator-field-number-1_6a57bbc7595a2-label\" class=\"forminator-label\">Estimated Audience Size<\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6a57bbc7595a2\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a57bbc7595a2-label\"><span id=\"forminator-radiogroup-radio-2-6a57bbc7595a2-label\" class=\"forminator-label\">Audio\/Visual Equipment Provided:<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a57bbc7595a2\" class=\"forminator-radio\" title=\"Yes\"><input type=\"radio\" name=\"radio-2\" value=\"yes\" id=\"forminator-field-radio-2-1-6a57bbc7595a2\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Yes<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a57bbc7595a2\" class=\"forminator-radio\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"no\" id=\"forminator-field-radio-2-2-6a57bbc7595a2\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a57bbc7595a2\" id=\"forminator-field-textarea-2_6a57bbc7595a2-label\" class=\"forminator-label\">Special Characteristics\/Needs of Audience<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a57bbc7595a2\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-3\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-3_6a57bbc7595a2\" id=\"forminator-field-textarea-3_6a57bbc7595a2-label\" class=\"forminator-label\">Special Requests for Program (i.e., facilitator background and\/or demographics)<\/label><textarea name=\"textarea-3\" placeholder=\"\" id=\"forminator-field-textarea-3_6a57bbc7595a2\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"inline\" data-sitekey=\"6LcCCBQdAAAAAP73y91aYkTmlJsRh0SvZzWKMuhk\" data-size=\"invisible\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Send Message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"8508ba3692\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/counselingservices\/wp-json\/wp\/v2\/pages\/1453\" \/><input type=\"hidden\" name=\"form_id\" value=\"1452\"><input type=\"hidden\" name=\"page_id\" value=\"1453\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/wwwcp.umes.edu\/counselingservices\/workshop-outreach-request-form\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Counselors are available to conduct support groups and workshops and provide information on various topics that are important to students. Whether a group starts or not depends on how many students express interest in it, so please contact us if you are interested in a group, workshop or outreach event. Please call 410-651-6449 or visit&#8230;<span class=\"cpschool-read-more-link-holder\"><a class=\"btn btn-basic cpschool-read-more-link\" href=\"https:\/\/wwwcp.umes.edu\/counselingservices\/workshop-outreach-request-form\/\">Read more <span class=\"sr-only\">Workshop\/Outreach Request Form<\/span><\/a><\/span><\/p>\n","protected":false},"author":21,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","footnotes":""},"folder":[],"class_list":["post-1453","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/pages\/1453","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/users\/21"}],"replies":[{"embeddable":true,"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/comments?post=1453"}],"version-history":[{"count":0,"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/pages\/1453\/revisions"}],"wp:attachment":[{"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/media?parent=1453"}],"wp:term":[{"taxonomy":"folder","embeddable":true,"href":"https:\/\/wwwcp.umes.edu\/counselingservices\/wp-json\/wp\/v2\/folder?post=1453"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}