{"id":6251,"date":"2023-11-13T20:12:34","date_gmt":"2023-11-13T20:12:34","guid":{"rendered":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/?page_id=6251"},"modified":"2023-11-13T20:32:03","modified_gmt":"2023-11-13T20:32:03","slug":"scholarship-conf-application","status":"publish","type":"page","link":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/scholarship-conf-application\/","title":{"rendered":"Scholarship Registration"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row][vc_column]<div class=\"wpforms-container wpforms-container-full vc_btn3-containervc_btn3-inline\" id=\"wpforms-5797\"><form id=\"wpforms-form-5797\" class=\"wpforms-validate wpforms-form\" data-formid=\"5797\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/yuma\/wp-json\/wp\/v2\/pages\/6251\" data-token=\"7e9b0660cc1443a8855acf15311887c9\" data-token-time=\"1776980071\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-5797-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5797-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-5797-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5797-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-5797-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-5797-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-5797-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5797-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-5797-field_2-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-5797-field_2\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-5797-field_2\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][2]\" aria-label=\"Phone\" required><\/div><div id=\"wpforms-5797-field_3-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Address<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5797-field_3\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][3][address1]\" ><label for=\"wpforms-5797-field_3\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5797-field_3-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][3][address2]\" ><label for=\"wpforms-5797-field_3-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5797-field_3-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][3][city]\" ><label for=\"wpforms-5797-field_3-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-5797-field_3-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][3][state]\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-5797-field_3-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5797-field_3-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][3][postal]\" ><label for=\"wpforms-5797-field_3-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-5797-field_9-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"9\"><h3 id=\"wpforms-5797-field_9\">Session Selection<\/h3><\/div><div id=\"wpforms-5797-field_7-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-5797-field_7\">Select 1st Session Speaker <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5797-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required=\"required\"><option value=\"Maria Swearingin - (Suicidio)\"  class=\"choice-1 depth-1\"  >Maria Swearingin - (Suicidio)<\/option><option value=\"Donna Rico - (Rejection)\"  class=\"choice-2 depth-1\"  >Donna Rico - (Rejection)<\/option><option value=\"LeAnn White - (Worthlessness)\"  class=\"choice-3 depth-1\"  >LeAnn White - (Worthlessness)<\/option><\/select><div class=\"wpforms-field-description\">Please select at least one speaker from the list.<\/div><\/div><div id=\"wpforms-5797-field_8-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-5797-field_8\">Select 2nd Session Speaker <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5797-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" required=\"required\"><option value=\"Joanna Lluberes - (Bombardeada por Fe)\"  class=\"choice-1 depth-1\"  >Joanna Lluberes - (Bombardeada por Fe)<\/option><option value=\"Estalee Williams - (Family, Blending, and Healing)\"  class=\"choice-2 depth-1\"  >Estalee Williams - (Family, Blending, and Healing)<\/option><option value=\"Claudia Jauregui - (Emotional and Psychological Abuse)\"  class=\"choice-3 depth-1\"  >Claudia Jauregui - (Emotional and Psychological Abuse)<\/option><\/select><div class=\"wpforms-field-description\">Please select at least one speaker from the list.<\/div><\/div><div id=\"wpforms-5797-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-5797-field_12\">Role <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5797-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>please select role<\/option><option value=\"Board Member\"  class=\"choice-1 depth-1\"  >Board Member<\/option><option value=\"Speaker\"  class=\"choice-2 depth-1\"  >Speaker<\/option><option value=\"Prayer Partner\"  class=\"choice-3 depth-1\"  >Prayer Partner<\/option><option value=\"Volunteer\"  class=\"choice-4 depth-1\"  >Volunteer<\/option><option value=\"Scholarship\"  class=\"choice-5 depth-1\"  >Scholarship<\/option><\/select><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-5797-field-hp\" class=\"wpforms-field-label\">Name<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-5797-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"5797\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/pages\/6251\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-5797\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"REGISTER\" aria-live=\"assertive\" value=\"wpforms-submit\">REGISTER<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->[\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"nf_dc_page":"","jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-6251","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/PbtH0k-1CP","_links":{"self":[{"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/pages\/6251","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/comments?post=6251"}],"version-history":[{"count":4,"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/pages\/6251\/revisions"}],"predecessor-version":[{"id":6259,"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/pages\/6251\/revisions\/6259"}],"wp:attachment":[{"href":"https:\/\/yuma.heartsbeinghealed.org\/yuma\/wp-json\/wp\/v2\/media?parent=6251"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}