if (window.location.protocol != "https:" && window.location.href.indexOf("formulate") == -1 && "False" === "True") {
    window.location.href = "https:" + window.location.href.substring(window.location.protocol.length);
}

var fbScriptTag = document.getElementsByClassName("d270e57c-4db9-4028-abb5-82f88795500b"),
    fbBodyTag = document.body,
    fbHeadTag = document.head,
    fbIsTestResponse = 'False',
    fbEnableInstaMedScript = 'False',
    fbRenderContainer = document.createElement("div"),
    fbRenderedCssContainer = document.createElement("div"),
    fbConfigScript = document.createElement("script"),
    fbRequireJSScript = document.createElement("script"),
    fbInstaMedJSScript = document.createElement("script"),
    fbGeoCaptchaCallback = document.createElement("script"),
    fbGeoReCaptchaCallback = document.createElement("script"),
    fbFormulateRenderer = document.createElement("script"),
    fbRenderedIntegrations = document.createElement("script"),
    fbRenderedScripts = document.createElement("script"),
    fbAutoPopulateFromQueryString = document.createElement("script"),
    fbEmbeddedCss = "",
    renderedScripts = '';

if(fbScriptTag.length === 0) {
    fbScriptTag = document.querySelector("script[src*='d270e57c-4db9-4028-abb5-82f88795500b']");
} else {
    fbScriptTag = fbScriptTag[0];
}

fbRenderContainer.id = "formRenderContainer";
fbRenderContainer.className = " fbRenderContainer fbRenderContainer_d270e57c-4db9-4028-abb5-82f88795500b";
fbRenderedCssContainer.id = "fbRenderedCssContainer";

fbConfigScript.type = "text/javascript";
fbRequireJSScript.type = "text/javascript";
fbInstaMedJSScript.type = "text/javascript";
fbGeoCaptchaCallback.type = "text/javascript";
fbGeoReCaptchaCallback.type = "text/javascript";
fbFormulateRenderer.type = "text/javascript";
fbRenderedIntegrations.type = "text/javascript";
fbRenderedScripts.type = "text/javascript";
fbAutoPopulateFromQueryString.type = "text/javascript";

fbRequireJSScript.src = "https://formulate.geonetric.com/Scripts/require.min.js";
fbInstaMedJSScript.src = "https://formulate.geonetric.com/Scripts/vendor/instamed/token.js";
fbInstaMedJSScript.id = "instamed-sdk";
fbGeoCaptchaCallback.src = "https://formulate.geonetric.com/Scripts/geo-captcha-callback.js";
fbGeoReCaptchaCallback.src = "https://www.google.com/recaptcha/api.js?onload=geoFbCaptchaCallback&render=6LdxkTEpAAAAAMKbkhz8-INpQis_mvSaIXnoyC2V";
fbFormulateRenderer.src = "https://formulate.geonetric.com/Scripts/require/formulate-renderer.js?embeddedCssType=0&isTestResponse=False&hasGoogleAnalytics=False";
fbFormulateRenderer.id = "formulateRendererScript";
fbAutoPopulateFromQueryString.src = "https://formulate.geonetric.com/Scripts/auto-populate-from-query-string.js";

if (fbEnableInstaMedScript === 'True') {
    fbInstaMedJSScript.setAttribute("data-displaymode", "embedded");
    fbInstaMedJSScript.setAttribute("data-environment", "UAT");
    fbInstaMedJSScript.setAttribute("data-mobiledisplaymode", "embedded");
}

fbGeoCaptchaCallback.onload = function() {
    if(document.querySelectorAll('.geo-fb-recaptcha').length > 0)
    {
        fbBodyTag.appendChild(fbGeoReCaptchaCallback);
    }
}

fbRequireJSScript.addEventListener("load", function() {
    fbBodyTag.appendChild(fbFormulateRenderer);
    fbBodyTag.appendChild(fbAutoPopulateFromQueryString);
});

fbFormulateRenderer.addEventListener("load", function () {
    initFormBuilderForm();
});

var embeddedCssType = 0
switch (embeddedCssType) {
    case 1:
        fbEmbeddedCss = '<link href=\"https://formulate.geonetric.com/Content/bootstrap.min.css\" rel=\"stylesheet\"><link href=\"https://formulate.geonetric.com/Content/embedded/font-awesome/css/font-awesome.min.css\" rel=\"stylesheet\"><link href=\"https://formulate.geonetric.com/Content/embedded/embedded.css\" rel=\"stylesheet\">';
        break;
    case 2:
        fbEmbeddedCss = '';
        break;
    default:
        fbEmbeddedCss = '<link href=\"https://formulate.geonetric.com/Content/embedded/font-awesome/css/font-awesome.min.css\" rel=\"stylesheet\"><link href=\"https://formulate.geonetric.com/Content/embedded/embedded.css\" rel=\"stylesheet\">';
}

if (fbIsTestResponse === 'True') {
    fbRenderContainer.setAttribute('data-test-mode', 'true');
} else {
    fbRenderContainer.setAttribute('data-test-mode', 'false');
}

fbRenderContainer.innerHTML = "<div id=\'formContainer_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'fbFormContainer fbFormContainer_d270e57c-4db9-4028-abb5-82f88795500b BlockLabels hidden\'>\
<p>Required fields are marked with <span class=\'fb-required\'>*</span></p>\
<input type=\'hidden\' name=\'formId\' id=\'formId\' value=\'d270e57c-4db9-4028-abb5-82f88795500b\' />\
<input type=\'hidden\' name=\'formName\' id=\'formName\' value=\'Medical Laboratory Science Program Recommendation\' />\
<input type=\'hidden\' name=\'formVersion\' value=\'6\' id=\'formVersion\' />\
<input type=\'hidden\' name=\'organizationId\' id=\'organizationId\' value=\'829fb7a6-25c3-472c-8e7a-81d80575bc24\' />\
<input type=\'hidden\' name=\'responseId\' id=\'responseId\' value=\'eaa419cf-ac20-4a47-a9d0-ca1e292e3921\' />\
<input type=\'hidden\' name=\'formBaseUrl\' id=\'formBaseUrl\' value=\'https://formulate.geonetric.com\' />\
\
\
<p>You have been asked to submit a recommendation for a student applying to the North Mississippi Medical Center Medical Laboratory Science Program. Your personal appraisal of this applicant is of great importance to us. Please give your frank opinion as to the student&rsquo;s qualifications by checking the appropriate boxes and completing the blanks.</p><p>If you have questions or need more information, please contact:</p><p>Cynthia Holman, MLS Program Director</p><p>(662) 377-3080<br>cholman@nmhs.net</p>\
                        <fieldset class=\'fb-fieldset \'>\
                            <legend class=\'fb-legend \'>Name of applicant</legend>\
                            \
                            <div class=\'row\'>\
                                <div class=\'col-sm-6\'>\
                                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label  \' for=\'FormField28_d270e57c-4db9-4028-abb5-82f88795500bFirst\'>First Name<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'fb-name-field form-control input-medium\' id=\'FormField28_d270e57c-4db9-4028-abb5-82f88795500bFirst\' name=\'FormField28_d270e57c-4db9-4028-abb5-82f88795500bFirst\' type=\'text\' data-export-label=\'Name_of_applicant_First_Name\'  integration-export-label=\'\' placeholder=\'\' required data-msg-required=\'First Name is required.\' />\
                        \
                    </div>\
                </div>\
                                </div>\
                                <div class=\'col-sm-6\'>\
                                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label  \' for=\'FormField28_d270e57c-4db9-4028-abb5-82f88795500bLast\'>Last Name<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'fb-name-field form-control input-medium\' id=\'FormField28_d270e57c-4db9-4028-abb5-82f88795500bLast\' name=\'FormField28_d270e57c-4db9-4028-abb5-82f88795500bLast\' type=\'text\' data-export-label=\'Name_of_applicant_Last_Name\'  integration-export-label=\'\' placeholder=\'\' required data-msg-required=\'Last Name is required.\' />\
                        \
                    </div>\
                </div>\
                                </div>\
                            </div>\
                        </fieldset><div class=\'fb-section\'><p>Please rate the applicant&apos;s skill or aptitude for each of these traits.</p><div class=\'form-group\'><label  class=\'control-label  \'>MOTIVATION: desire to increase their contribution to the organization and to society in general<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'MOTIVATION: desire to increase their contribution to the organization and to society in general is required.\' name=\'checkbox3\' id=\'FormField3_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Motivation\' ><label for=\'FormField3_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'MOTIVATION: desire to increase their contribution to the organization and to society in general is required.\' name=\'checkbox3\' id=\'FormField3_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Motivation\' ><label for=\'FormField3_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'MOTIVATION: desire to increase their contribution to the organization and to society in general is required.\' name=\'checkbox3\' id=\'FormField3_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Motivation\' ><label for=\'FormField3_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>INITIATIVE: capability as reflected by work; self-starting<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'INITIATIVE: capability as reflected by work; self-starting is required.\' name=\'checkbox4\' id=\'FormField4_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Initiative\' ><label for=\'FormField4_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'INITIATIVE: capability as reflected by work; self-starting is required.\' name=\'checkbox4\' id=\'FormField4_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Initiative\' ><label for=\'FormField4_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'INITIATIVE: capability as reflected by work; self-starting is required.\' name=\'checkbox4\' id=\'FormField4_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Initiative\' ><label for=\'FormField4_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>LEADERSHIP: ability to plan and work with others and effectively direct activities<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'LEADERSHIP: ability to plan and work with others and effectively direct activities is required.\' name=\'checkbox5\' id=\'FormField5_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Leadership\' ><label for=\'FormField5_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'LEADERSHIP: ability to plan and work with others and effectively direct activities is required.\' name=\'checkbox5\' id=\'FormField5_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Leadership\' ><label for=\'FormField5_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'LEADERSHIP: ability to plan and work with others and effectively direct activities is required.\' name=\'checkbox5\' id=\'FormField5_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Leadership\' ><label for=\'FormField5_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>CONCERN FOR OTHERS: consideration of others’ feelings and ability to view all parameters of circumstances<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'CONCERN FOR OTHERS: consideration of others’ feelings and ability to view all parameters of circumstances is required.\' name=\'checkbox6\' id=\'FormField6_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Concern_for_others\' ><label for=\'FormField6_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'CONCERN FOR OTHERS: consideration of others’ feelings and ability to view all parameters of circumstances is required.\' name=\'checkbox6\' id=\'FormField6_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Concern_for_others\' ><label for=\'FormField6_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'CONCERN FOR OTHERS: consideration of others’ feelings and ability to view all parameters of circumstances is required.\' name=\'checkbox6\' id=\'FormField6_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Concern_for_others\' ><label for=\'FormField6_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>RESPONSIBILITY: ability to assume accountability for inherent burdens of work and society<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'RESPONSIBILITY: ability to assume accountability for inherent burdens of work and society is required.\' name=\'checkbox7\' id=\'FormField7_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Responsibility\' ><label for=\'FormField7_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'RESPONSIBILITY: ability to assume accountability for inherent burdens of work and society is required.\' name=\'checkbox7\' id=\'FormField7_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Responsibility\' ><label for=\'FormField7_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'RESPONSIBILITY: ability to assume accountability for inherent burdens of work and society is required.\' name=\'checkbox7\' id=\'FormField7_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Responsibility\' ><label for=\'FormField7_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>INTEGRITY: adherence to honesty in dealings with others<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'INTEGRITY: adherence to honesty in dealings with others is required.\' name=\'checkbox8\' id=\'FormField8_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Integrity\' ><label for=\'FormField8_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'INTEGRITY: adherence to honesty in dealings with others is required.\' name=\'checkbox8\' id=\'FormField8_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Integrity\' ><label for=\'FormField8_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'INTEGRITY: adherence to honesty in dealings with others is required.\' name=\'checkbox8\' id=\'FormField8_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Integrity\' ><label for=\'FormField8_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>EMOTIONAL STABILITY: ability to react under stress in a mature and dependable manner<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'EMOTIONAL STABILITY: ability to react under stress in a mature and dependable manner is required.\' name=\'checkbox9\' id=\'FormField9_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Emotional_stability\' ><label for=\'FormField9_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'EMOTIONAL STABILITY: ability to react under stress in a mature and dependable manner is required.\' name=\'checkbox9\' id=\'FormField9_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Emotional_stability\' ><label for=\'FormField9_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'EMOTIONAL STABILITY: ability to react under stress in a mature and dependable manner is required.\' name=\'checkbox9\' id=\'FormField9_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Emotional_stability\' ><label for=\'FormField9_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>ADAPTABILITY: ability to work with and under directions of others<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'ADAPTABILITY: ability to work with and under directions of others is required.\' name=\'checkbox10\' id=\'FormField10_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Adaptability\' ><label for=\'FormField10_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'ADAPTABILITY: ability to work with and under directions of others is required.\' name=\'checkbox10\' id=\'FormField10_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Adaptability\' ><label for=\'FormField10_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'ADAPTABILITY: ability to work with and under directions of others is required.\' name=\'checkbox10\' id=\'FormField10_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Adaptability\' ><label for=\'FormField10_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>APPEARANCE: neatness in person and dress<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'APPEARANCE: neatness in person and dress is required.\' name=\'checkbox11\' id=\'FormField11_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Appearance\' ><label for=\'FormField11_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'APPEARANCE: neatness in person and dress is required.\' name=\'checkbox11\' id=\'FormField11_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Appearance\' ><label for=\'FormField11_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'APPEARANCE: neatness in person and dress is required.\' name=\'checkbox11\' id=\'FormField11_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Appearance\' ><label for=\'FormField11_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>APPLICATION OF ACQUIRED SKILLS: ability to learn and perform tasks<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'APPLICATION OF ACQUIRED SKILLS: ability to learn and perform tasks is required.\' name=\'checkbox12\' id=\'FormField12_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Application_of_skills\' ><label for=\'FormField12_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'APPLICATION OF ACQUIRED SKILLS: ability to learn and perform tasks is required.\' name=\'checkbox12\' id=\'FormField12_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Application_of_skills\' ><label for=\'FormField12_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'APPLICATION OF ACQUIRED SKILLS: ability to learn and perform tasks is required.\' name=\'checkbox12\' id=\'FormField12_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Application_of_skills\' ><label for=\'FormField12_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>ATTENDANCE: reliability to be at designated functions and to be on time<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'ATTENDANCE: reliability to be at designated functions and to be on time is required.\' name=\'checkbox13\' id=\'FormField13_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Attendance\' ><label for=\'FormField13_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'ATTENDANCE: reliability to be at designated functions and to be on time is required.\' name=\'checkbox13\' id=\'FormField13_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Attendance\' ><label for=\'FormField13_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'ATTENDANCE: reliability to be at designated functions and to be on time is required.\' name=\'checkbox13\' id=\'FormField13_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Attendance\' ><label for=\'FormField13_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>INTERPERSONAL RELATIONSHIPS: ability to establish and maintain effective relationships with others<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'Low\' required data-msg-required=\'INTERPERSONAL RELATIONSHIPS: ability to establish and maintain effective relationships with others is required.\' name=\'checkbox14\' id=\'FormField14_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Interpersonal_relationships\' ><label for=\'FormField14_d270e57c-4db9-4028-abb5-82f88795500b_1\'>Low</label></div><div class=\'separate\'><input type=\'radio\' value=\'Average\' required data-msg-required=\'INTERPERSONAL RELATIONSHIPS: ability to establish and maintain effective relationships with others is required.\' name=\'checkbox14\' id=\'FormField14_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Interpersonal_relationships\' ><label for=\'FormField14_d270e57c-4db9-4028-abb5-82f88795500b_2\'>Average</label></div><div class=\'separate\'><input type=\'radio\' value=\'High\' required data-msg-required=\'INTERPERSONAL RELATIONSHIPS: ability to establish and maintain effective relationships with others is required.\' name=\'checkbox14\' id=\'FormField14_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Interpersonal_relationships\' ><label for=\'FormField14_d270e57c-4db9-4028-abb5-82f88795500b_3\'>High</label></div></fieldset></div></div></div></div><div class=\'fb-section\'><p>Please rate the student on each of the following statements using a scale of 1-4 with 4 representing excellent.</p><div class=\'form-group\'><label  class=\'control-label  \'>Uses logical thought processes<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'1\' required data-msg-required=\'Uses logical thought processes is required.\' name=\'checkbox17\' id=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Uses_logical_thought_processes\' ><label for=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_1\'>1</label></div><div class=\'flow\'><input type=\'radio\' value=\'2\' required data-msg-required=\'Uses logical thought processes is required.\' name=\'checkbox17\' id=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Uses_logical_thought_processes\' ><label for=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_2\'>2</label></div><div class=\'flow\'><input type=\'radio\' value=\'3\' required data-msg-required=\'Uses logical thought processes is required.\' name=\'checkbox17\' id=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Uses_logical_thought_processes\' ><label for=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_3\'>3</label></div><div class=\'flow\'><input type=\'radio\' value=\'4\' required data-msg-required=\'Uses logical thought processes is required.\' name=\'checkbox17\' id=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_4\' class=\'right\' data-export-label=\'Uses_logical_thought_processes\' ><label for=\'FormField17_d270e57c-4db9-4028-abb5-82f88795500b_4\'>4</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Able to transfer information<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'1\' required data-msg-required=\'Able to transfer information is required.\' name=\'checkbox19\' id=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Able_to_transfer_information\' ><label for=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_1\'>1</label></div><div class=\'flow\'><input type=\'radio\' value=\'2\' required data-msg-required=\'Able to transfer information is required.\' name=\'checkbox19\' id=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Able_to_transfer_information\' ><label for=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_2\'>2</label></div><div class=\'flow\'><input type=\'radio\' value=\'3\' required data-msg-required=\'Able to transfer information is required.\' name=\'checkbox19\' id=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Able_to_transfer_information\' ><label for=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_3\'>3</label></div><div class=\'flow\'><input type=\'radio\' value=\'4\' required data-msg-required=\'Able to transfer information is required.\' name=\'checkbox19\' id=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_4\' class=\'right\' data-export-label=\'Able_to_transfer_information\' ><label for=\'FormField19_d270e57c-4db9-4028-abb5-82f88795500b_4\'>4</label></div></fieldset></div></div></div><div class=\'form-group\'><label  class=\'control-label  \'>Learns from mistakes<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'flow\'><input type=\'radio\' value=\'1\' required data-msg-required=\'Learns from mistakes is required.\' name=\'checkbox20\' id=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Learns_from_mistakes\' ><label for=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_1\'>1</label></div><div class=\'flow\'><input type=\'radio\' value=\'2\' required data-msg-required=\'Learns from mistakes is required.\' name=\'checkbox20\' id=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Learns_from_mistakes\' ><label for=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_2\'>2</label></div><div class=\'flow\'><input type=\'radio\' value=\'3\' required data-msg-required=\'Learns from mistakes is required.\' name=\'checkbox20\' id=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Learns_from_mistakes\' ><label for=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_3\'>3</label></div><div class=\'flow\'><input type=\'radio\' value=\'4\' required data-msg-required=\'Learns from mistakes is required.\' name=\'checkbox20\' id=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_4\' class=\'right\' data-export-label=\'Learns_from_mistakes\' ><label for=\'FormField20_d270e57c-4db9-4028-abb5-82f88795500b_4\'>4</label></div></fieldset></div></div></div></div><div class=\'form-group\'><label for=\'FormField21_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'control-label  \'>Please give any additional information you feel might be helpful in evaluation of this applicant</label><div>\
<textarea rows=\'10\' name=\'FormField21_d270e57c-4db9-4028-abb5-82f88795500b\' id=\'FormField21_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'form-control textarea-medium\'   data-export-label=\'Additional_information\'  placeholder=\'\'></textarea>\
</div></div><div class=\'form-group\'><label  class=\'control-label  \'>Summary recommendation<span class=\'fb-required\'>*</span></label><div class=\'Chkbx\'><div><fieldset class=\'RadioGroup\'><div class=\'separate\'><input type=\'radio\' value=\'I would NOT recommend this applicant for admission.\' required data-msg-required=\'Summary recommendation is required.\' name=\'checkbox22\' id=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_1\' class=\'right\' data-export-label=\'Summary_recommendation\' ><label for=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_1\'>I would NOT recommend this applicant for admission.</label></div><div class=\'separate\'><input type=\'radio\' value=\'I recommend this applicant but with some reservation.\' required data-msg-required=\'Summary recommendation is required.\' name=\'checkbox22\' id=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_2\' class=\'right\' data-export-label=\'Summary_recommendation\' ><label for=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_2\'>I recommend this applicant but with some reservation.</label></div><div class=\'separate\'><input type=\'radio\' value=\'I feel this candidate is qualified and competent for admission.\' required data-msg-required=\'Summary recommendation is required.\' name=\'checkbox22\' id=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_3\' class=\'right\' data-export-label=\'Summary_recommendation\' ><label for=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_3\'>I feel this candidate is qualified and competent for admission.</label></div><div class=\'separate\'><input type=\'radio\' value=\'I would highly recommend this applicant for admission.\' required data-msg-required=\'Summary recommendation is required.\' name=\'checkbox22\' id=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_4\' class=\'right\' data-export-label=\'Summary_recommendation\' ><label for=\'FormField22_d270e57c-4db9-4028-abb5-82f88795500b_4\'>I would highly recommend this applicant for admission.</label></div></fieldset></div></div></div><div class=\'fb-section\'><p>Please answer the following questions about yourself and your relationship to the applicant.</p><div class=\'form-group\'><label for=\'FormField24_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'control-label  \'>How many years have you known this applicant?<span class=\'fb-required\'>*</span></label><div>\
<input type=\'text\' name=\'FormField24_d270e57c-4db9-4028-abb5-82f88795500b\' id=\'FormField24_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'form-control input-medium \' value=\'\'  required data-msg-required=\'How many years have you known this applicant? is required.\' data-export-label=\'How_many_years_know\'  placeholder=\'\'  />\
</div></div><div class=\'form-group\'><label for=\'FormField25_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'control-label  \'>What is your relationship to the applicant?<span class=\'fb-required\'>*</span></label><div>\
<input type=\'text\' name=\'FormField25_d270e57c-4db9-4028-abb5-82f88795500b\' id=\'FormField25_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'form-control input-medium \' value=\'\'  required data-msg-required=\'What is your relationship to the applicant? is required.\' data-export-label=\'Relationship_to_applicant\'  placeholder=\'\'  />\
</div></div><div class=\'form-group\'><label for=\'FormField26_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'control-label  \'>What is your occupation?<span class=\'fb-required\'>*</span></label><div>\
<input type=\'text\' name=\'FormField26_d270e57c-4db9-4028-abb5-82f88795500b\' id=\'FormField26_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'form-control input-medium \' value=\'\'  required data-msg-required=\'What is your occupation? is required.\' data-export-label=\'What_is_your_occupation\'  placeholder=\'\'  />\
</div></div>\
                        <fieldset class=\'fb-fieldset \'>\
                            <legend class=\'fb-legend \'>Name of recommender</legend>\
                            \
                            <div class=\'row\'>\
                                <div class=\'col-sm-6\'>\
                                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label  \' for=\'FormField27_d270e57c-4db9-4028-abb5-82f88795500bFirst\'>First Name<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'fb-name-field form-control input-medium\' id=\'FormField27_d270e57c-4db9-4028-abb5-82f88795500bFirst\' name=\'FormField27_d270e57c-4db9-4028-abb5-82f88795500bFirst\' type=\'text\' data-export-label=\'Name_of_recommender_First_Name\'  integration-export-label=\'\' placeholder=\'\' required data-msg-required=\'First Name is required.\' />\
                        \
                    </div>\
                </div>\
                                </div>\
                                <div class=\'col-sm-6\'>\
                                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label  \' for=\'FormField27_d270e57c-4db9-4028-abb5-82f88795500bLast\'>Last Name<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'fb-name-field form-control input-medium\' id=\'FormField27_d270e57c-4db9-4028-abb5-82f88795500bLast\' name=\'FormField27_d270e57c-4db9-4028-abb5-82f88795500bLast\' type=\'text\' data-export-label=\'Name_of_recommender_Last_Name\'  integration-export-label=\'\' placeholder=\'\' required data-msg-required=\'Last Name is required.\' />\
                        \
                    </div>\
                </div>\
                                </div>\
                            </div>\
                        </fieldset><div class=\'form-group\'><label for=\'FormField29_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'control-label  \'>Title</label><div>\
<input type=\'text\' name=\'FormField29_d270e57c-4db9-4028-abb5-82f88795500b\' id=\'FormField29_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'form-control input-medium \' value=\'\'   data-export-label=\'Title\'  placeholder=\'\'  />\
</div></div>\
                <fieldset class=\'fb-fieldset \'>\
                    <legend class=\'fb-legend \'>Address</legend>\
                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label \' for=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Line1\'>Line 1<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'form-control\' id=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Line1\' name=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Line1\' type=\'text\' data-export-label=\'Address_Line1_30\'  required data-msg-required=\'Address Line 1 is required.\' autocomplete=\'street-address\'  />\
                    </div>\
                </div>\
                    \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label \' for=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Line2\'>Line 2</label>\
                    <div >\
                        <input class=\'form-control\' id=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Line2\' name=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Line2\' type=\'text\' data-export-label=\'Address_Line2_30\'     />\
                    </div>\
                </div>\
                    <div class=\'row\'>\
                        <div class=\'col-sm-4\'>\
                            \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label \' for=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_City\'>City<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'form-control\' id=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_City\' name=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_City\' type=\'text\' data-export-label=\'Address_City_30\'  required data-msg-required=\'Address City is required.\' autocomplete=\'locality\'  />\
                    </div>\
                </div>\
                        </div>\
                        <div class=\'col-sm-4\'>\
                            \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label \' for=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_State\'>State<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <select class=\'form-control\' name=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_State\' id=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_State\' autocomplete=\'region\' required=\'required\' data-msg-required=\'Address State is required.\' data-export-label=\'Address_State_30\' >\
                            <option value=\'\'>( Please Select )</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>\
                    </div>\
                </div>\
                \
                        </div>\
                        <div class=\'col-sm-4\'>\
                            \
                <div class=\'form-group fb-form-group\'>\
                    <label class=\'control-label \' for=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Zip\'>Zip<span class=\'fb-required\'>*</span></label>\
                    <div >\
                        <input class=\'form-control\' id=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Zip\' name=\'FormField30_d270e57c-4db9-4028-abb5-82f88795500b_Zip\' type=\'text\' data-export-label=\'Address_Zip_30\'  required data-msg-required=\'Address Zip is required.\' autocomplete=\'postal-code\' data-rule-zipCode=\'true\' />\
                    </div>\
                </div>\
                        </div>\
                    </div>\
                </fieldset><div class=\'form-group\'><label for=\'FormField31_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'control-label  \'>Email<span class=\'fb-required\'>*</span></label><div><input type=\'email\' name=\'FormField31_d270e57c-4db9-4028-abb5-82f88795500b\' id=\'FormField31_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'form-control input-medium \' value=\'\' required data-msg-required=\'Email is required.\' data-export-label=\'Email\'  data-msg-email=\'Please specify a valid email.\' />\
</div></div><div class=\'form-group\'><label for=\'FormField32_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'control-label  \'>Phone number<span class=\'fb-required\'>*</span></label><div><input type=\'text\' name=\'FormField32_d270e57c-4db9-4028-abb5-82f88795500b\' id=\'FormField32_d270e57c-4db9-4028-abb5-82f88795500b\' class=\'form-control input-medium \' value=\'\' required data-msg-required=\'Phone number is required.\' data-export-label=\'Phone_number\'  data-rule-phoneUS=\'true\' data-msg-phoneUS=\'Please specify a valid phone number.\' />\
</div></div></div>\
\
<div id=\'form-errors\' class=\'alert alert-danger fade in\' role=\'alert\' style=\'display:none\'></div>\
<div class=\'form-group ignore\'><div class=\'form-group ButtonHolder\'><div class=\'col-sm-4 col-sm-offset-2\'><button id=\'fb-submitButton\' type=\'button\' class=\'btn btn-primary Button\' value=\'Submit\'>Submit</button></div></div></div>\
</div>";

fbConfigScript.innerHTML = "window.formHost = 'https://formulate.geonetric.com'; window.submissionHost = 'https://formulate.geonetric.com/';";
fbRenderedScripts.innerHTML = renderedScripts.replace(/<script>/ig, '\n').replace(/<\/script>/ig, '').replace(/\s{4}/ig, "");
fbRenderedIntegrations.innerHTML = "";
fbRenderedCssContainer.innerHTML = '';

fbScriptTag.parentNode.insertBefore(fbRenderContainer, fbScriptTag.nextSibling);

fbBodyTag.appendChild(fbConfigScript);
fbBodyTag.appendChild(fbRequireJSScript);
if (fbEnableInstaMedScript === 'True')
    fbHeadTag.appendChild(fbInstaMedJSScript);
fbBodyTag.insertAdjacentHTML('beforeend', fbEmbeddedCss);
fbBodyTag.appendChild(fbGeoCaptchaCallback);
fbBodyTag.appendChild(fbRenderedIntegrations);
fbBodyTag.appendChild(fbRenderedCssContainer);
fbBodyTag.appendChild(fbRenderedScripts);


fbScriptTag.parentNode.removeChild(fbScriptTag);