{"id":120002,"date":"2023-05-31T08:51:00","date_gmt":"2023-05-31T12:51:00","guid":{"rendered":"https:\/\/www.rochester.edu\/human-resources\/?page_id=120002"},"modified":"2023-09-26T15:03:15","modified_gmt":"2023-09-26T19:03:15","slug":"cpr-training-form","status":"publish","type":"page","link":"https:\/\/www.rochester.edu\/human-resources\/professional-success\/staff-training\/cpr-training-form\/","title":{"rendered":"American Heart Association CPR Training Request Form"},"content":{"rendered":"<p>Thank you for your interest in the training opportunities provided by\u00a0the University\u2019s Learning &amp; Development team. Please complete the questions below and select at least one training option that you\u2019re interested in. Once we have received your training request, we will follow up with you based upon your specific interest.<\/p>\n<p>Please, note it may take up to 10 business days for our team to respond to you.<\/p>\n<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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n<div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_282' style='display:none'>\n<div class='gform_heading'>\n<p class='gform_description'>\n<\/p><\/div>\n<form method='post' enctype='multipart\/form-data'  id='gform_282'  novalidate action='\/human-resources\/wp-json\/wp\/v2\/pages\/120002' data-formid='282' novalidate>\n<div class='gform-body gform_body'>\n<div id='gform_fields_282' class='gform_fields top_label form_sublabel_below description_below validation_below'>\n<div id=\"field_282_1\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-email form-control-icon\"  data-field-class=\"gf-email form-control-icon\" ><label class='gfield_label gform-field-label' for='input_282_1'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_email'>\n                            <input name='input_1' id='input_282_1' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div>\n<\/div>\n<div id=\"field_282_2\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-phone form-control-icon\"  data-field-class=\"gf-phone form-control-icon\" ><label class='gfield_label gform-field-label' for='input_282_2'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_phone'><input name='input_2' id='input_282_2' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div>\n<\/div>\n<fieldset id=\"field_282_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" >\n<legend class='gfield_label gform-field-label' >Are you requesting as:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_282_3'>\n<div class='gchoice gchoice_282_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='a University affiliated person'  id='choice_282_3_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_3_0' id='label_282_3_0' class='gform-field-label gform-field-label--type-inline'>a University affiliated person<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_282_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='a University affiliated department\/entity'  id='choice_282_3_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_3_1' id='label_282_3_1' class='gform-field-label gform-field-label--type-inline'>a University affiliated department\/entity<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_282_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='NOT a University affiliated person'  id='choice_282_3_2' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_3_2' id='label_282_3_2' class='gform-field-label gform-field-label--type-inline'>NOT a University affiliated person<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_282_3_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='NOT a University affiliated entity'  id='choice_282_3_3' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_3_3' id='label_282_3_3' class='gform-field-label gform-field-label--type-inline'>NOT a University affiliated entity<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<\/fieldset>\n<fieldset id=\"field_282_4\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-name form-control-icon-complex\"  data-field-class=\"gf-name form-control-icon-complex\" >\n<legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>\n<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_282_4'>\n<p>                            <span id='input_282_4_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' ><br \/>\n                                                    <input type='text' name='input_4.3' id='input_282_4_3' value=''   aria-required='true'     \/><br \/>\n                                                    <label for='input_282_4_3' class='gform-field-label gform-field-label--type-sub '>First<\/label><br \/>\n                                                <\/span><\/p>\n<p>                            <span id='input_282_4_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' ><br \/>\n                                                    <input type='text' name='input_4.6' id='input_282_4_6' value=''   aria-required='true'     \/><br \/>\n                                                    <label for='input_282_4_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label><br \/>\n                                                <\/span><\/p><\/div>\n<\/fieldset>\n<\/fieldset>\n<div id=\"field_282_5\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_282_5'>Department\/entity name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_5' id='input_282_5' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div>\n<\/div>\n<div id=\"field_282_13\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_282_13'>Entity name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_13' id='input_282_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div>\n<\/div>\n<div id=\"field_282_6\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_282_6'>How many people need to be trained?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_number'><input name='input_6' id='input_282_6' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div>\n<\/div>\n<div id=\"field_282_7\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf-date gf-date-layout-datepicker form-control-icon\"  data-field-class=\"gf-date gf-date-layout-datepicker form-control-icon\" ><label class='gfield_label gform-field-label' for='input_282_7'>Preferred timeline for training delivery<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_date'>\n                            <input aria-describedby='field_282_7_dmessage' name='input_7' id='input_282_7' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_282_7_date_format gfield_description_282_7\" aria-invalid=\"false\" aria-required=\"true\"\/><br \/>\n                            <span id='input_282_7_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n<p>                        <input type='hidden' id='gforms_calendar_icon_input_282_7' class='gform_hidden' value='https:\/\/www.rochester.edu\/human-resources\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/p>\n<div class='gfield_description' id='gfield_description_282_7'>Minimum of 60 days advance notice is needed to accommodate group requests of three or more.<\/div>\n<\/div>\n<fieldset id=\"field_282_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" >\n<legend class='gfield_label gform-field-label' >Is there a regulatory requirement for the training requested?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_282_8'>\n<div class='gchoice gchoice_282_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Yes'  id='choice_282_8_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_8_0' id='label_282_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_282_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='No'  id='choice_282_8_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_8_1' id='label_282_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<\/fieldset>\n<fieldset id=\"field_282_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" >\n<legend class='gfield_label gform-field-label' >Is this a voluntary training?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_282_9'>\n<div class='gchoice gchoice_282_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Yes'  id='choice_282_9_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_9_0' id='label_282_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_282_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No'  id='choice_282_9_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_9_1' id='label_282_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<\/fieldset>\n<fieldset id=\"field_282_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gf-radio\"  data-field-class=\"gf-radio\" >\n<legend class='gfield_label gform-field-label' >Would you prefer a certification card?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_282_10'>\n<div class='gchoice gchoice_282_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Yes'  id='choice_282_10_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_10_0' id='label_282_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_282_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No'  id='choice_282_10_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_282_10_1' id='label_282_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<\/fieldset>\n<fieldset id=\"field_282_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gf-checkbox\"  data-field-class=\"gf-checkbox\" >\n<legend class='gfield_label gform-field-label gfield_label_before_complex' >Additional training options requested:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>\n<div class='ginput_container ginput_container_checkbox'>\n<div class='gfield_checkbox ' id='input_282_14'>\n<div class='gchoice gchoice_282_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='Basic CPR: This course includes cardio-pulmonary resuscitation (CPR) and automated external defibrillator (AED) training for adult, child and infant victims. It includes additional content on topics opioid overdose and choking. It provides a 2-year certification card.'  id='choice_282_14_1'   aria-describedby=\"gfield_description_282_14\"\/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_282_14_1' id='label_282_14_1' class='gform-field-label gform-field-label--type-inline'>Basic CPR: This course includes cardio-pulmonary resuscitation (CPR) and automated external defibrillator (AED) training for adult, child and infant victims. It includes additional content on topics opioid overdose and choking. It provides a 2-year certification card.<\/label>\n\t\t\t\t\t\t\t<\/div>\n<div class='gchoice gchoice_282_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='Stop the Bleed: Victims can die within 5-10 minutes from uncontrolled bleeding. Similar to how the general public learns and performs CPR, the public should also learn proper bleeding control techniques. This training provides that information including how to use hands, dressing and tourniquets to Stop the Bleed.'  id='choice_282_14_2'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_282_14_2' id='label_282_14_2' class='gform-field-label gform-field-label--type-inline'>Stop the Bleed: Victims can die within 5-10 minutes from uncontrolled bleeding. Similar to how the general public learns and performs CPR, the public should also learn proper bleeding control techniques. This training provides that information including how to use hands, dressing and tourniquets to Stop the Bleed.<\/label>\n\t\t\t\t\t\t\t<\/div>\n<div class='gchoice gchoice_282_14_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.3' type='checkbox'  value='Narcan\u00ae Training: Opioid overdoses occur everyday and have been increasing across our community. Narcan training will provide the participant with training on how to administer naloxone\/Narcan\u00ae to help prevent overdose deaths.'  id='choice_282_14_3'   \/><br \/>\n\t\t\t\t\t\t\t\t<label for='choice_282_14_3' id='label_282_14_3' class='gform-field-label gform-field-label--type-inline'>Narcan\u00ae Training: Opioid overdoses occur everyday and have been increasing across our community. Narcan training will provide the participant with training on how to administer naloxone\/Narcan\u00ae to help prevent overdose deaths.<\/label>\n\t\t\t\t\t\t\t<\/div>\n<div class='gchoice gchoice_282_14_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.4' type='checkbox'  value='Mobile Hands-Only Kiosk: The kiosk is only for use in large, publicly-accessible venues (ie: libraries, museums, festivals). The kiosk training focuses on hands-only CPR through the use of interactive technology. 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