{"id":18828,"date":"2024-10-31T11:30:00","date_gmt":"2024-10-31T16:30:00","guid":{"rendered":"https:\/\/wp.stolaf.edu\/hr\/?page_id=18828"},"modified":"2024-10-30T15:45:45","modified_gmt":"2024-10-30T20:45:45","slug":"18828-2","status":"publish","type":"page","link":"https:\/\/wp.stolaf.edu\/hr\/18828-2\/","title":{"rendered":"Tuition Benefit Form"},"content":{"rendered":"<div data-modular-content-collection><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_34' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Tuition Benefit Form<\/h2>\n                            <p class='gform_description'>Employees must complete the tuition benefit application Annually by MAY 1 if applying for undergrad tuition benefit.<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_34'  action='\/hr\/wp-json\/wp\/v2\/pages\/18828' data-formid='34' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_34' class='gform_fields top_label form_sublabel_above description_above validation_below'><fieldset id=\"field_34_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-name\"  data-field-class=\"gf-name\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >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_34_1'>\n                            \n                            <span id='input_34_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_34_1_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_1.3' id='input_34_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_34_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_34_1_6' class='gform-field-label gform-field-label--type-sub '>Last Name<\/label>\n                                                            <input type='text' name='input_1.6' id='input_34_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_34_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-email\"  data-field-class=\"gf-email\" ><label class='gfield_label gform-field-label' for='input_34_2'>St. Olaf Email ONLY<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_34_2' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_34_9\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-name\"  data-field-class=\"gf-name\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Student 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 has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_34_9'>\n                            \n                            <span id='input_34_9_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_34_9_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_9.3' id='input_34_9_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            <span id='input_34_9_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_34_9_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                    <input type='text' name='input_9.4' id='input_34_9_4' value=''   aria-required='false'    autocomplete=\"additional-name\" \/>\n                                                <\/span>\n                            <span id='input_34_9_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_34_9_6' class='gform-field-label gform-field-label--type-sub '>Last Name<\/label>\n                                                            <input type='text' name='input_9.6' id='input_34_9_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_34_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_34_10'>Student Date of Birth (00\/00\/0000)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_34_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_34_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" ><legend class='gfield_label gform-field-label' >Have you previously used the tuition benefit for this dependent?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_34_12'>\n\t\t\t<div class='gchoice gchoice_34_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Yes'  id='choice_34_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_34_12_0' id='label_34_12_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_34_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='No'  id='choice_34_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_34_12_1' id='label_34_12_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_34_25\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Which programs are you applying for? (Select all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_34_25'><div class='gchoice gchoice_34_25_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.1' type='checkbox'  value='ACM'  id='choice_34_25_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_25_1' id='label_34_25_1' class='gform-field-label gform-field-label--type-inline'>ACM<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_25_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.2' type='checkbox'  value='ELCA'  id='choice_34_25_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_25_2' id='label_34_25_2' class='gform-field-label gform-field-label--type-inline'>ELCA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_25_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.3' type='checkbox'  value='GLCA'  id='choice_34_25_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_25_3' id='label_34_25_3' class='gform-field-label gform-field-label--type-inline'>GLCA<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_25_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_25.4' type='checkbox'  value='St. Olaf College'  id='choice_34_25_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_25_4' id='label_34_25_4' class='gform-field-label gform-field-label--type-inline'>St. Olaf College<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_34_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >ACM Colleges\/Universities Being Considered<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_34_7'><div class='gchoice gchoice_34_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Beloit College'  id='choice_34_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_1' id='label_34_7_1' class='gform-field-label gform-field-label--type-inline'>Beloit College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Carleton College'  id='choice_34_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_2' id='label_34_7_2' class='gform-field-label gform-field-label--type-inline'>Carleton College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Coe College'  id='choice_34_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_3' id='label_34_7_3' class='gform-field-label gform-field-label--type-inline'>Coe College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='Colorado College'  id='choice_34_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_4' id='label_34_7_4' class='gform-field-label gform-field-label--type-inline'>Colorado College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.5' type='checkbox'  value='Cornell College'  id='choice_34_7_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_5' id='label_34_7_5' class='gform-field-label gform-field-label--type-inline'>Cornell College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.6' type='checkbox'  value='Grinnell College'  id='choice_34_7_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_6' id='label_34_7_6' class='gform-field-label gform-field-label--type-inline'>Grinnell College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.7' type='checkbox'  value='Knox College'  id='choice_34_7_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_7' id='label_34_7_7' class='gform-field-label gform-field-label--type-inline'>Knox College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.8' type='checkbox'  value='Lake Forest College'  id='choice_34_7_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_8' id='label_34_7_8' class='gform-field-label gform-field-label--type-inline'>Lake Forest College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.9' type='checkbox'  value='Lawrence University'  id='choice_34_7_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_9' id='label_34_7_9' class='gform-field-label gform-field-label--type-inline'>Lawrence University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.11' type='checkbox'  value='Luther College'  id='choice_34_7_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_11' id='label_34_7_11' class='gform-field-label gform-field-label--type-inline'>Luther College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.12' type='checkbox'  value='Macalester College'  id='choice_34_7_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_12' id='label_34_7_12' class='gform-field-label gform-field-label--type-inline'>Macalester College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.13' type='checkbox'  value='Monmouth College'  id='choice_34_7_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_13' id='label_34_7_13' class='gform-field-label gform-field-label--type-inline'>Monmouth College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_7_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.14' type='checkbox'  value='Ripon College'  id='choice_34_7_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_7_14' id='label_34_7_14' class='gform-field-label gform-field-label--type-inline'>Ripon College<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_34_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >ELCA Colleges\/Universities Being Considered<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_34_13'><div class='gchoice gchoice_34_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Augsburg College'  id='choice_34_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_1' id='label_34_13_1' class='gform-field-label gform-field-label--type-inline'>Augsburg College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='Augustana College'  id='choice_34_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_2' id='label_34_13_2' class='gform-field-label gform-field-label--type-inline'>Augustana College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Augustana University'  id='choice_34_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_3' id='label_34_13_3' class='gform-field-label gform-field-label--type-inline'>Augustana University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='California Lutheran University'  id='choice_34_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_4' id='label_34_13_4' class='gform-field-label gform-field-label--type-inline'>California Lutheran University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.5' type='checkbox'  value='Capital University'  id='choice_34_13_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_5' id='label_34_13_5' class='gform-field-label gform-field-label--type-inline'>Capital University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.6' type='checkbox'  value='Carthage College'  id='choice_34_13_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_6' id='label_34_13_6' class='gform-field-label gform-field-label--type-inline'>Carthage College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.7' type='checkbox'  value='Concordia College'  id='choice_34_13_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_7' id='label_34_13_7' class='gform-field-label gform-field-label--type-inline'>Concordia College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.8' type='checkbox'  value='Grand View University'  id='choice_34_13_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_8' id='label_34_13_8' class='gform-field-label gform-field-label--type-inline'>Grand View University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.9' type='checkbox'  value='Gustavus Adolphus College'  id='choice_34_13_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_9' id='label_34_13_9' class='gform-field-label gform-field-label--type-inline'>Gustavus Adolphus College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.11' type='checkbox'  value='Lenoir-Rhyne University'  id='choice_34_13_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_11' id='label_34_13_11' class='gform-field-label gform-field-label--type-inline'>Lenoir-Rhyne University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.12' type='checkbox'  value='Midland University'  id='choice_34_13_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_12' id='label_34_13_12' class='gform-field-label gform-field-label--type-inline'>Midland University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.13' type='checkbox'  value='Pacific Lutheran University'  id='choice_34_13_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_13' id='label_34_13_13' class='gform-field-label gform-field-label--type-inline'>Pacific Lutheran University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.14' type='checkbox'  value='Roanoke College'  id='choice_34_13_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_14' id='label_34_13_14' class='gform-field-label gform-field-label--type-inline'>Roanoke College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.15' type='checkbox'  value='St. Olaf College'  id='choice_34_13_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_15' id='label_34_13_15' class='gform-field-label gform-field-label--type-inline'>St. Olaf College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.16' type='checkbox'  value='Susquehanna University'  id='choice_34_13_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_16' id='label_34_13_16' class='gform-field-label gform-field-label--type-inline'>Susquehanna University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.17' type='checkbox'  value='Texas Lutheran University'  id='choice_34_13_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_17' id='label_34_13_17' class='gform-field-label gform-field-label--type-inline'>Texas Lutheran University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.18' type='checkbox'  value='Theil College'  id='choice_34_13_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_18' id='label_34_13_18' class='gform-field-label gform-field-label--type-inline'>Theil College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.19' type='checkbox'  value='Wagner College'  id='choice_34_13_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_19' id='label_34_13_19' class='gform-field-label gform-field-label--type-inline'>Wagner College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.21' type='checkbox'  value='Wartburg College'  id='choice_34_13_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_21' id='label_34_13_21' class='gform-field-label gform-field-label--type-inline'>Wartburg College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_13_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.22' type='checkbox'  value='Wittenberg University'  id='choice_34_13_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_13_22' id='label_34_13_22' class='gform-field-label gform-field-label--type-inline'>Wittenberg University<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_34_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >GLCA Colleges\/University Being Considered<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_34_14'><div class='gchoice gchoice_34_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='Allegheny College'  id='choice_34_14_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_1' id='label_34_14_1' class='gform-field-label gform-field-label--type-inline'>Allegheny College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='Antioch College'  id='choice_34_14_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_2' id='label_34_14_2' class='gform-field-label gform-field-label--type-inline'>Antioch College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.3' type='checkbox'  value='Beloit College'  id='choice_34_14_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_3' id='label_34_14_3' class='gform-field-label gform-field-label--type-inline'>Beloit College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.4' type='checkbox'  value='Denison University'  id='choice_34_14_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_4' id='label_34_14_4' class='gform-field-label gform-field-label--type-inline'>Denison University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.5' type='checkbox'  value='Depauw University'  id='choice_34_14_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_5' id='label_34_14_5' class='gform-field-label gform-field-label--type-inline'>Depauw University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.6' type='checkbox'  value='Earlham College'  id='choice_34_14_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_6' id='label_34_14_6' class='gform-field-label gform-field-label--type-inline'>Earlham College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.7' type='checkbox'  value='Hope College'  id='choice_34_14_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_7' id='label_34_14_7' class='gform-field-label gform-field-label--type-inline'>Hope College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.8' type='checkbox'  value='Kalamazoo College'  id='choice_34_14_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_8' id='label_34_14_8' class='gform-field-label gform-field-label--type-inline'>Kalamazoo College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.9' type='checkbox'  value='Kenyon College'  id='choice_34_14_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_9' id='label_34_14_9' class='gform-field-label gform-field-label--type-inline'>Kenyon College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.11' type='checkbox'  value='Lake Forest College'  id='choice_34_14_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_11' id='label_34_14_11' class='gform-field-label gform-field-label--type-inline'>Lake Forest College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.12' type='checkbox'  value='Oberlin College'  id='choice_34_14_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_12' id='label_34_14_12' class='gform-field-label gform-field-label--type-inline'>Oberlin College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.13' type='checkbox'  value='Ohio Wesleyan University'  id='choice_34_14_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_13' id='label_34_14_13' class='gform-field-label gform-field-label--type-inline'>Ohio Wesleyan University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.14' type='checkbox'  value='Wabash College'  id='choice_34_14_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_14' id='label_34_14_14' class='gform-field-label gform-field-label--type-inline'>Wabash College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.15' type='checkbox'  value='Washington &amp; Lee University'  id='choice_34_14_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_15' id='label_34_14_15' class='gform-field-label gform-field-label--type-inline'>Washington &amp; Lee University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.16' type='checkbox'  value='Willamette University'  id='choice_34_14_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_16' id='label_34_14_16' class='gform-field-label gform-field-label--type-inline'>Willamette University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.17' type='checkbox'  value='Wittenberg University'  id='choice_34_14_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_17' id='label_34_14_17' class='gform-field-label gform-field-label--type-inline'>Wittenberg University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_34_14_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.18' type='checkbox'  value='The College of Wooster'  id='choice_34_14_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_34_14_18' id='label_34_14_18' class='gform-field-label gform-field-label--type-inline'>The College of Wooster<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_34_27\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Employee Authorizations<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_27.1' id='input_34_27_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_34_27_1' >By checking this box, I hereby apply for tuition remission benefits for the dependent listed within the provisions of the Tuition Benefit Policy. By typing my name below, I consent to electronic processing of this form to include use of my electronic signature.<\/label><input type='hidden' name='input_27.2' value='By checking this box, I hereby apply for tuition remission benefits for the dependent listed within the provisions of the Tuition Benefit Policy. By typing my name below, I consent to electronic processing of this form to include use of my electronic signature.' class='gform_hidden' \/><input type='hidden' name='input_27.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_34_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_34_28'>Type Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_34_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_34' class='gform_button button' 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