{"id":1224,"date":"2019-10-07T20:52:54","date_gmt":"2019-10-07T20:52:54","guid":{"rendered":"https:\/\/www.hps-sc.com\/?page_id=1224"},"modified":"2023-01-24T21:50:56","modified_gmt":"2023-01-25T02:50:56","slug":"form","status":"publish","type":"page","link":"https:\/\/www.hps-sc.com\/pb\/form\/","title":{"rendered":"Consentimento para Tratamento"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_10' style='display:none'><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Consentimento para Tratamento<\/h2>\n                            <span class='gform_description'>Este formul\u00e1rio nos d\u00e1 permiss\u00e3o para tratar seu filho. Os dados s\u00e3o mantidos em sigilo e usados apenas para tratamento e faturamento, de acordo com as leis estaduais e federais. Se as informa\u00e7\u00f5es mudarem antes do tratamento, entre em contato conosco.<\/span>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indica campos obrigat\u00f3rios<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/pb\/wp-json\/wp\/v2\/pages\/1224#gf_10' novalidate><div id='gf_page_steps_10' class='gf_page_steps'><div id='gf_step_10_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Se\u00e7\u00e3o de informa\u00e7\u00f5es do Aluno<\/span><\/div><div id='gf_step_10_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Se\u00e7\u00e3o Medica<\/span><\/div><div id='gf_step_10_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Se\u00e7\u00e3o de Pagamento<\/span><\/div><div id='gf_step_10_4' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Firmar y Consentimiento<\/span><\/div><\/div>\n                        <div class='gform_body gform-body'><div id='gform_page_10_1' class='gform_page' >\n                                    <div class='gform_page_fields'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_10_9\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Informa\u00e7\u00f5es da Escola<\/h3><\/div><div id=\"field_10_46\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_46' >Distrito Escolar<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_10_46' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Abbeville County School District<\/option><option value='2' >Aiken County Public Schools<\/option><option value='3' >Allendale County Schools<\/option><option value='10' >Anderson 1 &amp; 2 AVC<\/option><option value='9' >Anderson Alternative School District<\/option><option value='4' >Anderson School District One<\/option><option value='5' >Anderson School District Two<\/option><option value='6' >Anderson School District Three<\/option><option value='7' >Anderson County School District 4<\/option><option value='8' >Anderson School District Five<\/option><option value='11' >Bamberg School District<\/option><option value='16' >Barnwell County AVC<\/option><option value='15' >Barnwell School District 45<\/option><option value='17' >Beaufort County School District<\/option><option value='18' >Beaufort-Jasper Career Center<\/option><option value='19' >Berkeley County School District<\/option><option value='13' >Blackville-Hilda Public Schools<\/option><option value='20' >Calhoun County Public Schools<\/option><option value='21' >Charleston County School District<\/option><option value='105' >Charter Institute at Erskine<\/option><option value='22' >Cherokee County School District<\/option><option value='23' >Chester County School District<\/option><option value='24' >Chesterfield County School District<\/option><option value='25' >Clarendon County School District One<\/option><option value='26' >Clarendon County School District Two<\/option><option value='27' >Clarendon County School District Three<\/option><option value='29' >Colleton County School District<\/option><option value='72' >Cope Area Career Center<\/option><option value='84' >Daniel Morgan Vocational Center<\/option><option value='30' >Darlington County School District<\/option><option value='33' >Dillon County Applied Tech Center<\/option><option value='31' >Dillon School District Three<\/option><option value='32' >Dillon School District Four<\/option><option value='36' >Dorchester County Career School<\/option><option value='34' >Dorchester County School District Two<\/option><option value='35' >Dorchester County School District Four<\/option><option value='37' >Edgefield County School District<\/option><option value='28' >F E Dubose Vocational Center<\/option><option value='38' >Fairfield County School District<\/option><option value='96' >Felton Laboratory School<\/option><option value='39' >Florence School District One<\/option><option value='40' >Florence School District Two<\/option><option value='41' >Florence School District Three<\/option><option value='42' >Florence School District Four<\/option><option value='43' >Florence School District Five<\/option><option value='93' >Fort Mill School District<\/option><option value='44' >Georgetown County School District<\/option><option value='108' >GLEAMNS Human Resources Commission, Inc.<\/option><option value='102' >Governor&#039;s School for Math and Science<\/option><option value='101' >Governor&#039;s School for the Arts and Humanities<\/option><option value='45' >Greenville County School District<\/option><option value='49' >Greenwood County Career Center<\/option><option value='46' >Greenwood County School District 50<\/option><option value='47' >Greenwood County School District 51<\/option><option value='48' >Greenwood County School District 52<\/option><option value='86' >H B Swofford AVC<\/option><option value='50' >Hampton County School District One<\/option><option value='51' >Hampton County School District Two<\/option><option value='52' >Horry County Schools<\/option><option value='53' >Jasper County School District<\/option><option value='97' >John De La Howe<\/option><option value='99' >Juvenile Justice Schools<\/option><option value='54' >Kershaw County School District<\/option><option value='55' >Lancaster County School District<\/option><option value='56' >Laurens County School District No. 55<\/option><option value='57' >Laurens County School District 56<\/option><option value='58' >Lee County School District<\/option><option value='63' >Lexington and Richland School District Five<\/option><option value='59' >Lexington County School District One<\/option><option value='60' >Lexington County School District Two<\/option><option value='61' >Lexington County School District Three<\/option><option value='62' >Lexington County School District Four<\/option><option value='103' >Marion County School District<\/option><option value='66' >Marlboro County School District<\/option><option value='64' >McCormick County School District<\/option><option value='110' >Movement School<\/option><option value='67' >Newberry County School District<\/option><option value='68' >Oconee County School District<\/option><option value='71' >Orangeburg County School District<\/option><option value='100' >Palmetto Unified<\/option><option value='104' >Pee Dee Head Starts<\/option><option value='73' >Pickens County School District<\/option><option value='85' >R D Anderson Applied Technology Center<\/option><option value='74' >Richland County School District One<\/option><option value='75' >Richland County School District Two<\/option><option value='92' >Rock Hill School District Three of York County<\/option><option value='76' >Saluda County School District One<\/option><option value='94' >SC Public School Charter District<\/option><option value='98' >SC School for the Deaf and Blind<\/option><option value='107' >Share Community Action Partnership<\/option><option value='77' >Spartanburg County School District One<\/option><option value='78' >Spartanburg County School District Two<\/option><option value='79' >Spartanburg County School District Three<\/option><option value='80' >Spartanburg County School District Four<\/option><option value='81' >Spartanburg County School District Five<\/option><option value='82' >Spartanburg County School District Six<\/option><option value='83' >Spartanburg County School District Seven<\/option><option value='87' >Sumter School District<\/option><option value='88' >Union County School District<\/option><option value='89' >Williamsburg County School District<\/option><option value='95' >Williamsburg Tech<\/option><option value='14' >Williston School District 29<\/option><option value='90' >York School District One<\/option><option value='91' >York County School District Two<\/option><\/select><\/div><\/div><div id=\"field_10_51\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_51' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_51'>Abbeville County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_51' id='input_10_51' class='large gfield_select'  aria-describedby=\"gfield_description_10_51\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Abbeville County Career Center<\/option><option value='2' >Abbeville High School<\/option><option value='3' >Cherokee Trail Elementary<\/option><option value='4' >Diamond Hill Elementary<\/option><option value='5' >Dixie High School<\/option><option value='6' >John C. Calhoun Elementary<\/option><option value='7' >Long Cane Primary<\/option><option value='8' >Westwood Elementary<\/option><option value='9' >Wright Middle<\/option><\/select><\/div><\/div><div id=\"field_10_52\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_52' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_52'>Aiken County Public Schools<\/div><div class='ginput_container ginput_container_select'><select name='input_52' id='input_10_52' class='large gfield_select'  aria-describedby=\"gfield_description_10_52\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='10' >Aiken County Career Center<\/option><option value='11' >Aiken High School<\/option><option value='12' >Aiken Middle<\/option><option value='13' >Aiken Performing Arts Academy Charter<\/option><option value='14' >Belvedere Elementary<\/option><option value='15' >Busbee Corbett Elementary Middle<\/option><option value='16' >Byrd Elementary<\/option><option value='17' >Chukker Creek Elementary<\/option><option value='18' >Clearwater Elementary<\/option><option value='19' >East Aiken School of the Arts<\/option><option value='20' >Gloverville Elementary<\/option><option value='21' >Greendale Elementary<\/option><option value='22' >Hammond Hill Elementary<\/option><option value='23' >Horse Creek Academy<\/option><option value='24' >J. D. Lever Elementary<\/option><option value='25' >Jackson Middle<\/option><option value='27' >Langley-Bath-Clearwater Middle<\/option><option value='28' >Leavelle McCampbell Middle<\/option><option value='29' >Lloyd-Kennedy Charter<\/option><option value='30' >M. B. Kennedy Middle<\/option><option value='31' >Midland Valley High School<\/option><option value='32' >Millbrook Elementary<\/option><option value='33' >Mossy Creek Elementary<\/option><option value='34' >New Ellenton Middle<\/option><option value='35' >North Aiken Elementary<\/option><option value='36' >North Augusta Elementary<\/option><option value='37' >North Augusta High School<\/option><option value='38' >North Augusta Middle<\/option><option value='39' >Oakwood-Windsor Elementary<\/option><option value='40' >Paul Knox Middle<\/option><option value='41' >Redcliffe Elementary<\/option><option value='42' >Ridge Spring Monetta Elementary<\/option><option value='43' >Ridge Spring-Monetta Middle High School<\/option><option value='44' >Schofield Middle<\/option><option value='45' >Silver Bluff High School<\/option><option value='46' >South Aiken High School<\/option><option value='47' >Wagener-Salley High School<\/option><option value='48' >Warrenville Elementary<\/option><option value='324' >Jefferson Elementary-Aiken<\/option><\/select><\/div><\/div><div id=\"field_10_53\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_53' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_53'>Allendale County Schools<\/div><div class='ginput_container ginput_container_select'><select name='input_53' id='input_10_53' class='large gfield_select'  aria-describedby=\"gfield_description_10_53\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='49' >Allendale Elementary<\/option><option value='50' >Allendale Fairfax High School<\/option><option value='51' >Allendale-Fairfax Middle<\/option><option value='52' >Fairfax Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_81\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_81' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_81'>Anderson School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_81' id='input_10_81' class='large gfield_select'  aria-describedby=\"gfield_description_10_81\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='53' >Cedar Grove Elementary<\/option><option value='54' >Concrete Primary<\/option><option value='55' >Hunt Meadows Elementary<\/option><option value='56' >Palmetto Elementary<\/option><option value='57' >Palmetto High School<\/option><option value='58' >Palmetto Middle<\/option><option value='59' >Powdersville Elementary<\/option><option value='60' >Powdersville High School<\/option><option value='61' >Powdersville Middle<\/option><option value='62' >Spearman Elementary<\/option><option value='63' >West Pelzer Elementary<\/option><option value='64' >Wren Elementary<\/option><option value='65' >Wren High School<\/option><option value='66' >Wren Middle<\/option><\/select><\/div><\/div><div id=\"field_10_82\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_82' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_82'>Anderson School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_82' id='input_10_82' class='large gfield_select'  aria-describedby=\"gfield_description_10_82\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='67' >Belton Elementary<\/option><option value='68' >Belton Honea Path High School<\/option><option value='69' >Belton Middle<\/option><option value='70' >Honea Path Elementary<\/option><option value='71' >Honea Path Middle<\/option><option value='72' >Marshall Primary<\/option><option value='73' >Wright Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_83\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_83' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_83'>Anderson School District Three<\/div><div class='ginput_container ginput_container_select'><select name='input_83' id='input_10_83' class='large gfield_select'  aria-describedby=\"gfield_description_10_83\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='74' >Crescent High School<\/option><option value='75' >Flat Rock Elementary<\/option><option value='76' >Iva Elementary<\/option><option value='77' >Starr Elementary<\/option><option value='78' >Starr-Iva Middle<\/option><\/select><\/div><\/div><div id=\"field_10_84\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_84' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_84'>Anderson County School District 4<\/div><div class='ginput_container ginput_container_select'><select name='input_84' id='input_10_84' class='large gfield_select'  aria-describedby=\"gfield_description_10_84\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='79' >La France Elementary<\/option><option value='80' >Mt. Lebanon Elementary<\/option><option value='81' >Pendleton Elementary<\/option><option value='82' >Pendleton High School<\/option><option value='83' >Riverside Middle-Anderson<\/option><option value='84' >Townville Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_85\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_85' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_85'>Anderson School District Five<\/div><div class='ginput_container ginput_container_select'><select name='input_85' id='input_10_85' class='large gfield_select'  aria-describedby=\"gfield_description_10_85\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='85' >Anderson  Five Charter School<\/option><option value='86' >Anderson Five Career Campus<\/option><option value='1291' >Anderson Institute of Technology<\/option><option value='87' >Calhoun Academy of the Arts<\/option><option value='88' >Centerville Elementary-Anderson 5<\/option><option value='89' >Concord Elementary<\/option><option value='90' >Glenview Middle<\/option><option value='91' >Homeland Park Primary<\/option><option value='92' >Lakeside Middle<\/option><option value='93' >McCants Middle<\/option><option value='94' >McLees Elementary<\/option><option value='95' >Midway Elementary School of Science and Engineering<\/option><option value='96' >Nevitt Forest Elementary<\/option><option value='97' >New Prospect Elementary<\/option><option value='98' >North Pointe Elementary<\/option><option value='99' >Robert Anderson Middle<\/option><option value='100' >South Fant School of Early Education<\/option><option value='101' >Southwood Academy of the Arts<\/option><option value='102' >T. L. Hanna High School<\/option><option value='103' >Varennes Elementary<\/option><option value='104' >West Market School of Early Education<\/option><option value='105' >Westside High School<\/option><option value='106' >Whitehall Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_86\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_86' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_86'>Anderson 1 & 2 AVC<\/div><div class='ginput_container ginput_container_select'><select name='input_86' id='input_10_86' class='large gfield_select'  aria-describedby=\"gfield_description_10_86\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='108' >Career Tec Ctr Anderson1&amp;2<\/option><\/select><\/div><\/div><div id=\"field_10_187\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_187' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_187'>Renaissance Academy<\/div><div class='ginput_container ginput_container_select'><select name='input_187' id='input_10_187' class='large gfield_select'  aria-describedby=\"gfield_description_10_187\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='107' >Renaissance Academy<\/option><\/select><\/div><\/div><div id=\"field_10_87\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_87' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_87'>Bamberg School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_87' id='input_10_87' class='large gfield_select'  aria-describedby=\"gfield_description_10_87\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='109' >Bamberg-Ehrhardt High School<\/option><option value='110' >Bamberg-Ehrhardt Middle<\/option><option value='112' >Denmark Olar High School<\/option><option value='113' >Denmark-Olar Elementary<\/option><option value='114' >Denmark-Olar Middle<\/option><option value='111' >Richard Carroll Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_88\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_88' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_88'>Bamberg School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_88' id='input_10_88' class='large gfield_select'  aria-describedby=\"gfield_description_10_88\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='112' >Denmark Olar High School<\/option><option value='113' >Denmark-Olar Elementary<\/option><option value='114' >Denmark-Olar Middle<\/option><\/select><\/div><\/div><div id=\"field_10_91\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_91' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_91'>Barnwell School District 45<\/div><div class='ginput_container ginput_container_select'><select name='input_91' id='input_10_91' class='large gfield_select'  aria-describedby=\"gfield_description_10_91\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='121' >Barnwell Elementary<\/option><option value='122' >Barnwell High School<\/option><option value='123' >Barnwell Primary<\/option><option value='124' >Guinyard-Butler Middle<\/option><\/select><\/div><\/div><div id=\"field_10_92\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_92' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_92'>Barnwell County AVC<\/div><div class='ginput_container ginput_container_select'><select name='input_92' id='input_10_92' class='large gfield_select'  aria-describedby=\"gfield_description_10_92\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='125' >Barnwell County Career Centertr<\/option><\/select><\/div><\/div><div id=\"field_10_93\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_93' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_93'>Beaufort County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_93' id='input_10_93' class='large gfield_select'  aria-describedby=\"gfield_description_10_93\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='126' >Battery Creek High School<\/option><option value='127' >Beaufort Elementary<\/option><option value='128' >Beaufort High School<\/option><option value='129' >Beaufort Middle<\/option><option value='130' >Bluffton Elementary<\/option><option value='131' >Bluffton High School<\/option><option value='132' >Bluffton Middle<\/option><option value='133' >Broad River Elementary<\/option><option value='134' >Coosa Elementary<\/option><option value='135' >Daufuskie Elem. ANNEX<\/option><option value='136' >H. E. McCracken Middle<\/option><option value='137' >Hilton Head Island Early Childhood Center<\/option><option value='138' >Hilton Head Island Elementary<\/option><option value='139' >Hilton Head Island Elementary School for the Creative Arts<\/option><option value='140' >Hilton Head Island High School<\/option><option value='141' >Hilton Head Island Middle<\/option><option value='142' >Joseph S. Shanklin Elementary<\/option><option value='143' >Lady&#039;s Island Elementary<\/option><option value='144' >Lady&#039;s Island Middle<\/option><option value='145' >Michael C. Riley Elementary<\/option><option value='146' >Mossy Oaks Elementary<\/option><option value='147' >Okatie Elementary<\/option><option value='148' >Port Royal Elementary<\/option><option value='149' >Pritchardville Elementary<\/option><option value='150' >Red Cedar Elementary<\/option><option value='151' >Right Choice  School<\/option><option value='152' >River Ridge Academy<\/option><option value='153' >Riverview Charter School<\/option><option value='154' >Robert Smalls International Academy<\/option><option value='155' >St. Helena Elementary<\/option><option value='156' >Whale Branch Early College High School<\/option><option value='157' >Whale Branch Elementary<\/option><option value='158' >Whale Branch Middle<\/option><\/select><\/div><\/div><div id=\"field_10_95\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_95' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_95'>Beaufort-Jasper Career Center<\/div><div class='ginput_container ginput_container_select'><select name='input_95' id='input_10_95' class='large gfield_select'  aria-describedby=\"gfield_description_10_95\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='159' >Beaufort-Jasper Academy For Ex<\/option><\/select><\/div><\/div><div id=\"field_10_94\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_94' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_94'>Berkeley County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_94' id='input_10_94' class='large gfield_select'  aria-describedby=\"gfield_description_10_94\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='160' >Berkeley County Middle College High School<\/option><option value='161' >Berkeley Elementary<\/option><option value='162' >Berkeley High School<\/option><option value='163' >Berkeley Intermediate<\/option><option value='164' >Berkeley Middle<\/option><option value='165' >Boulder Bluff Elementary<\/option><option value='1285' >Bowen&#039;s Corner Elementary<\/option><option value='166' >Cainhoy Elementary Middle<\/option><option value='167' >Cane Bay Elementary<\/option><option value='168' >Cane Bay High School<\/option><option value='169' >Cane Bay Middle<\/option><option value='1443' >Carolyn Lewis School<\/option><option value='170' >College Park Elementary<\/option><option value='171' >College Park Middle<\/option><option value='172' >Cross Elementary<\/option><option value='173' >Cross High School<\/option><option value='174' >Daniel Island School<\/option><option value='175' >Devon Forest Elementary<\/option><option value='1286' >Foxbank Elementary<\/option><option value='176' >Goose Creek High School<\/option><option value='177' >Goose Creek Elementary<\/option><option value='178' >Hanahan Elementary<\/option><option value='179' >Hanahan High School<\/option><option value='180' >Hanahan Middle<\/option><option value='181' >Henry E. Bonner Elementary<\/option><option value='182' >Howe Hall AIMS Elementary<\/option><option value='183' >J. K. Gourdin Elementary<\/option><option value='184' >Macedonia Middle<\/option><option value='185' >Marrington Elementary<\/option><option value='186' >Marrington Middle School of the Arts<\/option><option value='191' >Mount Holly Elementary (formerly Sedgefield Intermediate)<\/option><option value='163' >Moncks Corner Elementary<\/option><option value='187' >Nexton Elementary<\/option><option value='1268' >Philip Simmons Elementary<\/option><option value='1269' >Phillip Simmons Middle<\/option><option value='188' >Sangaree Elementary<\/option><option value='189' >Sangaree Intermediate<\/option><option value='190' >Sangaree Middle<\/option><option value='192' >Sedgefield Middle<\/option><option value='193' >St. Stephen Elementary<\/option><option value='194' >St. Stephen Middle<\/option><option value='195' >Stratford High School<\/option><option value='196' >Timberland High  School<\/option><option value='197' >Westview Elementary<\/option><option value='198' >Westview Middle<\/option><option value='199' >Westview Primary<\/option><option value='200' >Whitesville Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_89\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_89' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_89'>Blackville-Hilda Public Schools<\/div><div class='ginput_container ginput_container_select'><select name='input_89' id='input_10_89' class='large gfield_select'  aria-describedby=\"gfield_description_10_89\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='115' >Blackville-Hilda High School<\/option><option value='116' >Blackville-Hilda Junior High<\/option><option value='117' >Macedonia Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_96\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_96' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_96'>Calhoun County Public Schools<\/div><div class='ginput_container ginput_container_select'><select name='input_96' id='input_10_96' class='large gfield_select'  aria-describedby=\"gfield_description_10_96\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='201' >Calhoun County High School<\/option><option value='202' >Sandy Run School<\/option><option value='203' >St. Matthews K-8 School<\/option><\/select><\/div><\/div><div id=\"field_10_97\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_97' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_97'>Charleston County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_97' id='input_10_97' class='large gfield_select'  aria-describedby=\"gfield_description_10_97\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='204' >A. C. Corcoran Elementary<\/option><option value='205' >Academic Magnet High School<\/option><option value='206' >Allegro Charter School of Music<\/option><option value='207' >Angel Oak Elementary<\/option><option value='208' >Ashley River Creative Arts Elementary<\/option><option value='209' >Baptist Hill High School<\/option><option value='210' >Belle Hall Elementary<\/option><option value='211' >Buist Academy<\/option><option value='212' >Burke High School<\/option><option value='213' >C.E. Williams Middle School<\/option><option value='235' >Camp Middle<\/option><option value='1276' >Cape Romain Environmental Charter School<\/option><option value='1278' >Carolina Park Elementary School<\/option><option value='214' >Carolina Voyager Charter<\/option><option value='215' >Charles Pinckney Elementary<\/option><option value='216' >Charleston Charter School for Math and Science<\/option><option value='217' >Charleston Development Academy Public Charter School<\/option><option value='218' >Charleston Progressive Academy<\/option><option value='219' >Charleston School Of The Arts<\/option><option value='220' >Chicora Elementary School<\/option><option value='1272' >Daniel Jenkins Academy<\/option><option value='221' >Drayton Hall Elementary School<\/option><option value='222' >E.B. Ellington Elementary School<\/option><option value='223' >East Cooper Center for Advanced Studies<\/option><option value='224' >Edith L. Frierson Elementary<\/option><option value='225' >Edmund A. Burns Elementary<\/option><option value='226' >Fort Johnson Middle<\/option><option value='227' >Garrett Academy of Technology<\/option><option value='228' >Greg Mathis Charter High School<\/option><option value='229' >Harbor View Elementary<\/option><option value='230' >Haut Gap Middle<\/option><option value='231' >Hunley Park Elementary<\/option><option value='232' >James B. Edwards Elementary<\/option><option value='233' >James Island Charter High School<\/option><option value='234' >James Island Elementary<\/option><option value='236' >James Simons Montessori School<\/option><option value='237' >Jane Edwards Elementary<\/option><option value='238' >Jennie Moore Elementary<\/option><option value='239' >Jerry Zucker Middle School of Science<\/option><option value='240' >Ladson Elementary<\/option><option value='241' >Laing Middle School of Science and Technology<\/option><option value='242' >Lambs Elementary School<\/option><option value='243' >Laurel Hill Primary<\/option><option value='1267' >Liberty Hill Academy<\/option><option value='244' >Lincoln High School<\/option><option value='245' >Malcolm C. Hursey Elementary<\/option><option value='246' >Mamie Whitesides Elementary<\/option><option value='247' >Mary Ford Early Learning &amp; Family Center<\/option><option value='248' >Matilda Dunston Elementary<\/option><option value='1270' >Meeting Street Academy<\/option><option value='249' >Meeting Street Elementary at Brentwood<\/option><option value='250' >Memminger School of Global Studies<\/option><option value='251' >Midland Park Primary<\/option><option value='252' >Military Magnet Academy<\/option><option value='253' >Minnie Hughes Elementary<\/option><option value='254' >Mitchell Elementary<\/option><option value='255' >Montessori Community School<\/option><option value='256' >Morningside Middle<\/option><option value='257' >Morningside Middle ANNEX<\/option><option value='258' >Moultrie Middle<\/option><option value='259' >Mt. Pleasant Academy<\/option><option value='260' >Mt. Zion Elementary<\/option><option value='261' >Murray LaSaine Elementary<\/option><option value='262' >North Charleston Creative Arts Elementary<\/option><option value='263' >North Charleston Elementary<\/option><option value='264' >North Charleston High School<\/option><option value='265' >Northwoods Middle<\/option><option value='1037' >Oakland Elementary-Charleston<\/option><option value='267' >Orange Grove Elementary Charter<\/option><option value='268' >Pattison&#039;s Academy for Comprehensive Education<\/option><option value='269' >Pepperhill Elementary<\/option><option value='270' >Pinehurst Elementary<\/option><option value='271' >R. B. Stall High School<\/option><option value='272' >Sanders-Clyde Elementary<\/option><option value='1261' >Septima Clarke Alternative<\/option><option value='273' >Simmons Pinckney Middle<\/option><option value='274' >Springfield Elementary<\/option><option value='275' >St. Andrew&#039;s School of Math and Science<\/option><option value='276' >St. James Santee Elementary<\/option><option value='277' >St. John&#039;s High School<\/option><option value='278' >Stiles Point Elementary<\/option><option value='279' >Stono Park Elementary<\/option><option value='280' >Sullivan&#039;s Island Elementary<\/option><option value='281' >Thomas C. Cario Middle<\/option><option value='282' >W. B. Goodwin Elementary<\/option><option value='283' >Wando High School<\/option><option value='284' >West Ashley High School<\/option><option value='285' >West Ashley Middle<\/option><option value='1271' >West Ashley Advanced Study Magnet<\/option><\/select><\/div><\/div><div id=\"field_10_151\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_151' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_151'>Charter Institute at Erskine<\/div><div class='ginput_container ginput_container_select'><select name='input_151' id='input_10_151' class='large gfield_select'  aria-describedby=\"gfield_description_10_151\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1299' >Belton Preparatory Academy<\/option><option value='1300' >Berkeley Preparatory Academy<\/option><option value='1301' >Brashier Middle College Charter School<\/option><option value='1302' >Calhoun Falls Charter School<\/option><option value='1303' >Cherokee Charter Academy<\/option><option value='1304' >Clear Dot Charter School<\/option><option value='1305' >Coastal Leadership Academy<\/option><option value='1306' >Cyber Academy of SC<\/option><option value='1307' >Gates School<\/option><option value='1308' >Gray Collegiate Academy<\/option><option value='1309' >Horse Creek Academy<\/option><option value='1310' >Legion Collegiate Academy<\/option><option value='1311' >Lowcountry Leadership Charter School<\/option><option value='1312' >Lowcountry Connections Academy<\/option><option value='1313' >Mevers School of Excellence<\/option><option value='1218' >Midlands STEM Institute<\/option><option value='1316' >Oceanside Collegiate Academy<\/option><option value='1317' >Odyssey Online Learning<\/option><option value='1318' >Royal Live Oaks Academy<\/option><option value='1319' >South Carolina Connections Academy<\/option><option value='1320' >SC Preparatory Academy<\/option><option value='1321' >South Carolina Virtual Charter School<\/option><option value='1322' >Summit Classical School<\/option><option value='1315' >The Montessori School of Camden<\/option><option value='1323' >Thornwell Charter School<\/option><option value='1324' >Virtus Academy of South Carolina<\/option><\/select><\/div><\/div><div id=\"field_10_98\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_98' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_98'>Cherokee County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_98' id='input_10_98' class='large gfield_select'  aria-describedby=\"gfield_description_10_98\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='286' >Alma Elementary<\/option><option value='287' >B. D. Lee Elementary<\/option><option value='288' >Blacksburg Elementary<\/option><option value='289' >Blacksburg High School<\/option><option value='290' >Blacksburg Middle<\/option><option value='291' >Blacksburg Primary<\/option><option value='292' >Cherokee Technology Center<\/option><option value='293' >Corinth Elementary<\/option><option value='294' >Draytonville Elementary<\/option><option value='295' >Gaffney High School<\/option><option value='296' >Gaffney Middle<\/option><option value='297' >Goucher Elementary<\/option><option value='298' >Granard Middle<\/option><option value='299' >Grassy Pond Elementary<\/option><option value='300' >John E. Ewing Middle<\/option><option value='301' >Limestone-Central Elementary<\/option><option value='302' >Luther L. Vaughan  Elementary<\/option><option value='303' >Mary Bramlett Elementary<\/option><option value='304' >Northwest Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_99\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_99' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_99'>Chester County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_99' id='input_10_99' class='large gfield_select'  aria-describedby=\"gfield_description_10_99\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='305' >Academy for Teaching and Learning  K-8<\/option><option value='306' >Chester County Career Center<\/option><option value='307' >Chester Middle<\/option><option value='308' >Chester Park Elementary of Inquiry<\/option><option value='309' >Chester Park Elementary School for the Arts<\/option><option value='310' >Chester Park Elementary School of Literacy and Technology<\/option><option value='311' >Chester Senior High School<\/option><option value='312' >Great Falls Elementary<\/option><option value='313' >Great Falls High School<\/option><option value='314' >Lewisville Elementary<\/option><option value='315' >Lewisville High School<\/option><option value='316' >Lewisville Middle<\/option><\/select><\/div><\/div><div id=\"field_10_100\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_100' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_100'>Chesterfield County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_100' id='input_10_100' class='large gfield_select'  aria-describedby=\"gfield_description_10_100\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='317' >Central High School<\/option><option value='1274' >Cheraw Headstart<\/option><option value='318' >Cheraw High School<\/option><option value='319' >Cheraw Intermediate<\/option><option value='320' >Cheraw Primary<\/option><option value='321' >Chesterfield High School<\/option><option value='322' >Chesterfield-Ruby Middle<\/option><option value='323' >Edwards Elementary<\/option><option value='26' >Jefferson Elementary-Chesterfield<\/option><option value='325' >Long Middle<\/option><option value='326' >McBee Elementary<\/option><option value='1262' >McBee HeadStart<\/option><option value='327' >McBee High School<\/option><option value='328' >New Heights Middle<\/option><option value='329' >Pageland Elementary<\/option><option value='330' >Petersburg Primary<\/option><option value='331' >Plainview Elementary<\/option><option value='332' >Ruby Elementary<\/option><option value='1263' >Ruby HeadStart<\/option><option value='1296' >Pageland Headstart<\/option><\/select><\/div><\/div><div id=\"field_10_101\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_101' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_101'>Clarendon County School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_101' id='input_10_101' class='large gfield_select'  aria-describedby=\"gfield_description_10_101\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='333' >Scott&#039;s Branch High School<\/option><option value='334' >Scott&#039;s Branch Middle<\/option><option value='335' >St. Paul Elementary<\/option><option value='336' >Summerton Early Childhood Center<\/option><\/select><\/div><\/div><div id=\"field_10_102\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_102' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_102'>Clarendon County School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_102' id='input_10_102' class='large gfield_select'  aria-describedby=\"gfield_description_10_102\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='337' >Manning Early Childhood Center<\/option><option value='338' >Manning Elementary<\/option><option value='339' >Manning High School<\/option><option value='340' >Manning Junior High<\/option><option value='341' >Manning Primary<\/option><option value='342' >Phoenix Charter High School<\/option><\/select><\/div><\/div><div id=\"field_10_103\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_103' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_103'>Clarendon County School District Three<\/div><div class='ginput_container ginput_container_select'><select name='input_103' id='input_10_103' class='large gfield_select'  aria-describedby=\"gfield_description_10_103\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='343' >East Clarendon Middle-High School<\/option><option value='344' >Walker-Gamble Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_105\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_105' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_105'>Colleton County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_105' id='input_10_105' class='large gfield_select'  aria-describedby=\"gfield_description_10_105\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='346' >Bells Elementary<\/option><option value='347' >Black Street Early Childhood Center<\/option><option value='348' >Colleton County High School<\/option><option value='349' >Colleton County Middle<\/option><option value='350' >Cottageville Elementary<\/option><option value='351' >Forest Hills Elementary<\/option><option value='352' >Hendersonville Elementary<\/option><option value='353' >Northside Elementary-Colleton<\/option><option value='354' >Thunderbolt Career and Technology Center<\/option><\/select><\/div><\/div><div id=\"field_10_152\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_152' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_152'>Cope Area Career Center<\/div><div class='ginput_container ginput_container_select'><select name='input_152' id='input_10_152' class='large gfield_select'  aria-describedby=\"gfield_description_10_152\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='902' >Cope Area Career Ctr<\/option><\/select><\/div><\/div><div id=\"field_10_153\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_153' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_153'>Daniel Morgan Vocational Center<\/div><div class='ginput_container ginput_container_select'><select name='input_153' id='input_10_153' class='large gfield_select'  aria-describedby=\"gfield_description_10_153\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1088' >Daniel Morgan Technolgy Center<\/option><\/select><\/div><\/div><div id=\"field_10_106\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_106' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_106'>Darlington County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_106' id='input_10_106' class='large gfield_select'  aria-describedby=\"gfield_description_10_106\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='355' >Brockington Elementary<\/option><option value='356' >Brunson-Dargan Elementary<\/option><option value='357' >Cain Elementary<\/option><option value='358' >Carolina Elementary<\/option><option value='359' >Darlington County Institute Of<\/option><option value='360' >Darlington High School<\/option><option value='361' >Darlington Middle<\/option><option value='362' >Hartsville High School<\/option><option value='363' >Hartsville Middle<\/option><option value='364' >Lamar Elementary<\/option><option value='365' >Lamar High School<\/option><option value='366' >Mayo High School for Math, Science, and Technology<\/option><option value='367' >North Hartsville Elementary<\/option><option value='368' >Pate Elementary<\/option><option value='369' >Rosenwald Elementary-Middle<\/option><option value='370' >Southside Early Childhood Education Center<\/option><option value='371' >Spaulding Elementary<\/option><option value='372' >Spaulding Middle<\/option><option value='373' >St. Johns Elementary<\/option><option value='374' >Thornwell School for the Arts<\/option><option value='375' >Washington St. Elementary<\/option><option value='376' >West Hartsville Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_109\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_109' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_109'>Dillon County Applied Tech Center<\/div><div class='ginput_container ginput_container_select'><select name='input_109' id='input_10_109' class='large gfield_select'  aria-describedby=\"gfield_description_10_109\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='388' >Dillon County Applied Technology Center<\/option><\/select><\/div><\/div><div id=\"field_10_107\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_107' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_107'>Dillon School District Three<\/div><div class='ginput_container ginput_container_select'><select name='input_107' id='input_10_107' class='large gfield_select'  aria-describedby=\"gfield_description_10_107\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='377' >Latta Elementary<\/option><option value='378' >Latta High School<\/option><option value='379' >Latta Middle<\/option><\/select><\/div><\/div><div id=\"field_10_108\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_108' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_108'>Dillon School District Four<\/div><div class='ginput_container ginput_container_select'><select name='input_108' id='input_10_108' class='large gfield_select'  aria-describedby=\"gfield_description_10_108\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='380' >Dillon High School<\/option><option value='381' >Dillon Middle<\/option><option value='382' >East Elementary<\/option><option value='383' >Gordon Elementary<\/option><option value='384' >Lake View Elementary<\/option><option value='385' >Lake View High School<\/option><option value='386' >South Elementary<\/option><option value='387' >Stewart Heights Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_154\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_154' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_154'>Spartanburg County District One<\/div><div class='ginput_container ginput_container_select'><select name='input_154' id='input_10_154' class='large gfield_select'  aria-describedby=\"gfield_description_10_154\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1015' >Campobello-Gramling School<\/option><option value='1016' >Chapman High School<\/option><option value='1017' >Holly Springs-Motlow Elementary<\/option><option value='1018' >Inman Elementary<\/option><option value='1019' >Inman Intermediate<\/option><option value='1020' >Landrum High School<\/option><option value='1021' >Landrum Middle<\/option><option value='1022' >New Prospect Elementary<\/option><option value='1023' >O. P. Earle Elementary<\/option><option value='1024' >T. E. Mabry Middle<\/option><\/select><\/div><\/div><div id=\"field_10_112\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_112' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_112'>Dorchester County Career School<\/div><div class='ginput_container ginput_container_select'><select name='input_112' id='input_10_112' class='large gfield_select'  aria-describedby=\"gfield_description_10_112\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='416' >Dorchester County Career &amp; Technology Center<\/option><\/select><\/div><\/div><div id=\"field_10_110\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_110' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_110'>Dorchester County School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_110' id='input_10_110' class='large gfield_select'  aria-describedby=\"gfield_description_10_110\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='389' >Alston Middle<\/option><option value='390' >Ashley Ridge High School<\/option><option value='391' >Beech Hill Elementary<\/option><option value='392' >Charles B. DuBose Middle<\/option><option value='393' >Eagle Nest Elementary<\/option><option value='394' >Flowertown Elementary<\/option><option value='395' >Fort Dorchester Elementary<\/option><option value='396' >Fort Dorchester High School<\/option><option value='397' >Gregg Middle<\/option><option value='398' >James H. Spann Elementary<\/option><option value='399' >Joseph R. Pye Elementary<\/option><option value='400' >Knightsville Elementary<\/option><option value='401' >Newington Elementary<\/option><option value='402' >Oakbrook Elementary<\/option><option value='403' >Oakbrook Middle<\/option><option value='404' >River Oaks Middle<\/option><option value='405' >Rollings Middle School of the Arts<\/option><option value='406' >Summerville Elementary<\/option><option value='407' >Summerville High School<\/option><option value='408' >William M. Reeves Elementary<\/option><option value='409' >Windsor Hill Arts Infused Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_111\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_111' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_111'>Dorchester County School District Four<\/div><div class='ginput_container ginput_container_select'><select name='input_111' id='input_10_111' class='large gfield_select'  aria-describedby=\"gfield_description_10_111\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='410' >Clay Hill Elementary<\/option><option value='411' >Harleyville Elementary<\/option><option value='414' >Williams Memorial Elementary<\/option><option value='415' >Woodland High School<\/option><option value='1449' >Woodland Middle<\/option><\/select><\/div><\/div><div id=\"field_10_113\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_113' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_113'>Edgefield County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_113' id='input_10_113' class='large gfield_select'  aria-describedby=\"gfield_description_10_113\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='417' >Douglas Elementary<\/option><option value='418' >Johnston Elementary<\/option><option value='419' >Johnston-Edgefield-Trenton Middle<\/option><option value='420' >Merriwether Elementary<\/option><option value='421' >Merriwether Middle<\/option><option value='422' >Strom Thurmond Career Center<\/option><option value='423' >Strom Thurmond High School<\/option><option value='424' >W. E. Parker Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_104\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_104' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_104'>F E Dubose Vocational Center<\/div><div class='ginput_container ginput_container_select'><select name='input_104' id='input_10_104' class='large gfield_select'  aria-describedby=\"gfield_description_10_104\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='345' >F E Dubose Career Ctr<\/option><\/select><\/div><\/div><div id=\"field_10_114\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_114' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_114'>Fairfield County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_114' id='input_10_114' class='large gfield_select'  aria-describedby=\"gfield_description_10_114\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='425' >Fairfield Career and Technology Center<\/option><option value='426' >Fairfield Central High School<\/option><option value='427' >Fairfield Elementary<\/option><option value='428' >Fairfield Magnet for Math and Science<\/option><option value='429' >Fairfield Middle<\/option><option value='430' >Geiger Elementary<\/option><option value='431' >Kelly Miller Elementary<\/option><option value='432' >McCrorey-Liston School of Technology<\/option><\/select><\/div><\/div><div id=\"field_10_156\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_156' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_156'>Felton Laboratory School<\/div><div class='ginput_container ginput_container_select'><select name='input_156' id='input_10_156' class='large gfield_select'  aria-describedby=\"gfield_description_10_156\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1235' >Felton Laboratory Charter School<\/option><\/select><\/div><\/div><div id=\"field_10_115\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_115' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_115'>Florence School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_115' id='input_10_115' class='large gfield_select'  aria-describedby=\"gfield_description_10_115\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='433' >Alfred Rush Academy<\/option><option value='434' >Beck Learning Center<\/option><option value='435' >Briggs Elementary<\/option><option value='436' >Carver Elementary<\/option><option value='437' >Child Development Center at Woods Road<\/option><option value='438' >Delmae Elementary<\/option><option value='439' >Dewey-Carter Elementary<\/option><option value='440' >Florence Career Center<\/option><option value='441' >Greenwood Elementary<\/option><option value='442' >Henry L. Sneed Middle<\/option><option value='443' >Henry Timrod Elementary<\/option><option value='444' >John W. Moore Middle<\/option><option value='445' >Lucy T. Davis Elementary<\/option><option value='446' >McLaurin Elementary<\/option><option value='447' >North Vista Elementary<\/option><option value='448' >Palmetto Youth Academy Charter<\/option><option value='449' >Poynor Center<\/option><option value='450' >Royall Elementary<\/option><option value='451' >Savannah Grove Elementary<\/option><option value='452' >South Florence High School<\/option><option value='453' >Southside Middle<\/option><option value='454' >Theodore Lester Elementary<\/option><option value='455' >Wallace Gregg Elementary<\/option><option value='456' >West Florence High School<\/option><option value='457' >Williams Middle<\/option><option value='458' >Wilson High School<\/option><\/select><\/div><\/div><div id=\"field_10_116\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_116' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_116'>Florence School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_116' id='input_10_116' class='large gfield_select'  aria-describedby=\"gfield_description_10_116\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='459' >Early Childhood Success Center ANNEX<\/option><option value='460' >Hannah Pamplico High School<\/option><option value='461' >Hannah-Pamplico Elementary and Middle<\/option><\/select><\/div><\/div><div id=\"field_10_117\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_117' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_117'>Florence School District Three<\/div><div class='ginput_container ginput_container_select'><select name='input_117' id='input_10_117' class='large gfield_select'  aria-describedby=\"gfield_description_10_117\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='462' >J. C. Lynch Elementary<\/option><option value='463' >J. Paul Truluck Intermediate<\/option><option value='464' >Lake City Early Childhood Center<\/option><option value='465' >Lake City High School<\/option><option value='466' >Main Street Elementary<\/option><option value='467' >Olanta Elementary<\/option><option value='468' >Ronald E. McNair Junior High<\/option><option value='469' >Scranton Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_118\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_118' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_118'>Florence School District Four<\/div><div class='ginput_container ginput_container_select'><select name='input_118' id='input_10_118' class='large gfield_select'  aria-describedby=\"gfield_description_10_118\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='470' >Brockington Elementary<\/option><option value='471' >Johnson Middle<\/option><option value='472' >Timmonsville High School<\/option><option value='1275' >Woods Road HeadStart<\/option><\/select><\/div><\/div><div id=\"field_10_119\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_119' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_119'>Florence School District Five<\/div><div class='ginput_container ginput_container_select'><select name='input_119' id='input_10_119' class='large gfield_select'  aria-describedby=\"gfield_description_10_119\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='473' >Johnsonville Elementary<\/option><option value='474' >Johnsonville High School<\/option><option value='475' >Johnsonville Middle<\/option><\/select><\/div><\/div><div id=\"field_10_162\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_162' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_162'>Fort Mill School District<\/div><div class='ginput_container ginput_container_select'><select name='input_162' id='input_10_162' class='large gfield_select'  aria-describedby=\"gfield_description_10_162\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1187' >Banks Trail Middle<\/option><option value='1188' >Doby&#039;s Bridge Elementary<\/option><option value='1189' >Fort Mill Elementary<\/option><option value='1190' >Fort Mill High School<\/option><option value='1191' >Fort Mill Middle<\/option><option value='1192' >Gold Hill Elementary<\/option><option value='1193' >Gold Hill Middle<\/option><option value='1194' >Nation Ford High School<\/option><option value='1195' >Orchard Park Elementary-Fort Mill<\/option><option value='1196' >Pleasant Knoll Elementary<\/option><option value='1283' >Pleasant Knoll Middle<\/option><option value='1197' >Riverview Elementary<\/option><option value='1198' >Springfield Elementary<\/option><option value='1199' >Springfield Middle<\/option><option value='1200' >Sugar Creek Elementary<\/option><option value='1201' >Tega Cay Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_120\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_120' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_120'>Georgetown County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_120' id='input_10_120' class='large gfield_select'  aria-describedby=\"gfield_description_10_120\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='476' >Andrews Elementary<\/option><option value='477' >Andrews High School<\/option><option value='478' >Brown&#039;s Ferry Elementary<\/option><option value='479' >Carvers Bay High School<\/option><option value='480' >Carvers Bay Middle<\/option><option value='481' >Coastal Montessori Charter School<\/option><option value='482' >Georgetown High School<\/option><option value='483' >Georgetown Middle<\/option><option value='484' >Kensington Elementary<\/option><option value='485' >Maryville Elementary<\/option><option value='486' >McDonald Elementary<\/option><option value='487' >Plantersville Elementary<\/option><option value='488' >Pleasant Hill Elementary<\/option><option value='489' >Rosemary Middle<\/option><option value='490' >Sampit Elementary<\/option><option value='491' >Waccamaw Elementary<\/option><option value='492' >Waccamaw High  School<\/option><option value='493' >Waccamaw Intermediate<\/option><option value='494' >Waccamaw Middle<\/option><\/select><\/div><\/div><div id=\"field_10_163\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_163' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_163'>GLEAMNS Human Resources Commission, Inc.<\/div><div class='ginput_container ginput_container_select'><select name='input_163' id='input_10_163' class='large gfield_select'  aria-describedby=\"gfield_description_10_163\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1419' >Abbeville Early Head Start &amp; Head Start Center<\/option><option value='1420' >Batesburg Head Start Center<\/option><option value='1421' >Blythewood Head Start Center<\/option><option value='1422' >Edgefield Early Head Start &amp;  Head Start Center<\/option><option value='1423' >Greenwood Early Head Start &amp;  Head Start Center<\/option><option value='1424' >Lexington Head Start Center<\/option><option value='1425' >McCormick Head Start Center<\/option><option value='1426' >North Hodges Head Start Center<\/option><option value='1427' >Pineview  Head Start Center<\/option><option value='1428' >Platt Springs Head Start Center<\/option><option value='1429' >Rikard Head Start Center<\/option><option value='1430' >Saluda Early Head Start &amp; Head Start Center<\/option><option value='1431' >Sanders Head Start Center<\/option><option value='1432' >St. Andrews Head Start Center<\/option><\/select><\/div><\/div><div id=\"field_10_164\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_164' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_164'>Governor's School for the Arts and Humanities<\/div><div class='ginput_container ginput_container_select'><select name='input_164' id='input_10_164' class='large gfield_select'  aria-describedby=\"gfield_description_10_164\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1254' >SC Governor&#039;s School for the Arts and Humanities<\/option><\/select><\/div><\/div><div id=\"field_10_165\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_165' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_165'>Governor's School for Math and Science<\/div><div class='ginput_container ginput_container_select'><select name='input_165' id='input_10_165' class='large gfield_select'  aria-describedby=\"gfield_description_10_165\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1255' >Governor&#039;s School for Math and Science<\/option><\/select><\/div><\/div><div id=\"field_10_121\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_121' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_121'>Greenville County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_121' id='input_10_121' class='large gfield_select'  aria-describedby=\"gfield_description_10_121\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='495' >A.J. Whittenburg Elementary<\/option><option value='496' >Alexander Elementary<\/option><option value='497' >Armstrong Elementary<\/option><option value='498' >Augusta Circle Elementary<\/option><option value='499' >Beck Academy<\/option><option value='500' >Bell&#039;s Crossing Elementary<\/option><option value='501' >Berea Elementary<\/option><option value='502' >Berea High School<\/option><option value='503' >Berea Middle<\/option><option value='504' >Bethel Elementary<\/option><option value='505' >Blue Ridge High School<\/option><option value='506' >Blue Ridge Middle<\/option><option value='507' >Blythe Academy<\/option><option value='508' >Brashier Middle College Charter School<\/option><option value='509' >Brook Glenn Elementary<\/option><option value='510' >Brushy Creek Elementary<\/option><option value='511' >Bryson Elementary<\/option><option value='512' >Bryson Middle<\/option><option value='513' >Buena Vista Elementary<\/option><option value='514' >Carolina Academy<\/option><option value='515' >Chandler Creek Elementary<\/option><option value='516' >Cherrydale Elementary<\/option><option value='517' >Crestview Elementary<\/option><option value='518' >Donaldson Career Center<\/option><option value='519' >Dr. Phinnize J. Fisher Middle<\/option><option value='520' >Duncan Chapel Elementary<\/option><option value='521' >East North Street Academy<\/option><option value='522' >Eastside High School<\/option><option value='523' >Ellen Woodside Elementary<\/option><option value='524' >Enoree Career Center<\/option><option value='525' >Fork Shoals School<\/option><option value='526' >Fountain Inn Elementary<\/option><option value='527' >Gateway Elementary<\/option><option value='528' >Golden Strip Career and Technology Center<\/option><option value='529' >Greenbrier Elementary<\/option><option value='530' >Greenville Middle Academy<\/option><option value='531' >Greenville Senior High Academy<\/option><option value='532' >Greenville Technical Charter High School<\/option><option value='533' >Greer High School<\/option><option value='534' >Greer Middle<\/option><option value='535' >Greer Middle College Charter School<\/option><option value='536' >Grove Elementary<\/option><option value='537' >Heritage Elementary<\/option><option value='538' >Hillcrest High School<\/option><option value='539' >Hillcrest Middle<\/option><option value='540' >Hollis Academy<\/option><option value='541' >Hughes Academy of Science and Technology<\/option><option value='542' >J. Harley Bonds Career Center<\/option><option value='543' >J. L. Mann High Academy<\/option><option value='544' >Lake Forest Elementary<\/option><option value='545' >Lakeview Middle<\/option><option value='546' >Langston Charter Middle<\/option><option value='547' >League Academy<\/option><option value='548' >Legacy Charter School<\/option><option value='549' >Mauldin Elementary<\/option><option value='550' >Mauldin High School<\/option><option value='551' >Mauldin Middle<\/option><option value='552' >Meyer Center for Special Children Charter<\/option><option value='553' >Mitchell Road Elementary<\/option><option value='554' >Monarch Elementary-Greenville<\/option><option value='555' >Monaview Elementary<\/option><option value='556' >Mountain View Elementary<\/option><option value='557' >Northwest Middle<\/option><option value='558' >Northwood Middle<\/option><option value='559' >Oakview Elementary<\/option><option value='560' >Overbrook Child Development Center<\/option><option value='561' >Paris Elementary<\/option><option value='562' >Pelham Road Elementary<\/option><option value='563' >Plain Elementary<\/option><option value='564' >Ralph Chandler Middle<\/option><option value='565' >Riverside High School<\/option><option value='566' >Riverside Middle-Greenville<\/option><option value='567' >Robert E. Cashion Elementary<\/option><option value='568' >Rudolph Gordon Elementary<\/option><option value='569' >Sara Collins Elementary<\/option><option value='570' >Sevier Middle<\/option><option value='571' >Simpsonville Elementary<\/option><option value='572' >Skyland Elementary<\/option><option value='573' >Slater Marietta Elementary<\/option><option value='574' >Southside High School<\/option><option value='575' >Sterling School<\/option><option value='576' >Stone Academy<\/option><option value='577' >Sue Cleveland Elementary<\/option><option value='578' >Summit Drive Elementary<\/option><option value='579' >Tanglewood Middle<\/option><option value='580' >Taylors Elementary<\/option><option value='581' >Thomas E. Kerns Elementary<\/option><option value='582' >Tigerville Elementary<\/option><option value='583' >Travelers Rest High School<\/option><option value='584' >Wade Hampton High School<\/option><option value='585' >Washington Center<\/option><option value='586' >Welcome Elementary<\/option><option value='587' >Westcliffe Elementary<\/option><option value='588' >Woodland Elementary<\/option><option value='589' >Woodmont High School<\/option><option value='590' >Woodmont Middle<\/option><\/select><\/div><\/div><div id=\"field_10_125\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_125' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_125'>Greenwood County Career Center<\/div><div class='ginput_container ginput_container_select'><select name='input_125' id='input_10_125' class='large gfield_select'  aria-describedby=\"gfield_description_10_125\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='612' >G Frank Russell Technology Center<\/option><\/select><\/div><\/div><div id=\"field_10_122\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_122' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_122'>Greenwood County School District 50<\/div><div class='ginput_container ginput_container_select'><select name='input_122' id='input_10_122' class='large gfield_select'  aria-describedby=\"gfield_description_10_122\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='591' >Brewer Middle<\/option><option value='592' >Eleanor S. Rice Elementary<\/option><option value='593' >Emerald High School<\/option><option value='594' >Greenwood Early Childhood Center<\/option><option value='595' >Greenwood High School<\/option><option value='596' >Hodges Elementary<\/option><option value='597' >Lakeview Elementary<\/option><option value='598' >Mathews Elementary<\/option><option value='599' >Merrywood Elementary<\/option><option value='600' >Northside Middle-Greenwood<\/option><option value='601' >Pinecrest Elementary<\/option><option value='602' >Springfield Elementary<\/option><option value='603' >Westview Middle<\/option><option value='604' >Woodfields Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_123\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_123' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_123'>Greenwood County School District 51<\/div><div class='ginput_container ginput_container_select'><select name='input_123' id='input_10_123' class='large gfield_select'  aria-describedby=\"gfield_description_10_123\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='605' >Ware Shoals Elementary Middle<\/option><option value='606' >Ware Shoals High School<\/option><option value='607' >Ware Shoals Primary<\/option><\/select><\/div><\/div><div id=\"field_10_124\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_124' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_124'>Greenwood County School District 52<\/div><div class='ginput_container ginput_container_select'><select name='input_124' id='input_10_124' class='large gfield_select'  aria-describedby=\"gfield_description_10_124\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='608' >Edgewood Middle<\/option><option value='609' >Ninety Six Elementary<\/option><option value='610' >Ninety Six High School<\/option><option value='611' >Ninety Six Primary<\/option><\/select><\/div><\/div><div id=\"field_10_166\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_166' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_166'>H B Swofford AVC<\/div><div class='ginput_container ginput_container_select'><select name='input_166' id='input_10_166' class='large gfield_select'  aria-describedby=\"gfield_description_10_166\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1090' >H B Swofford Career Center<\/option><\/select><\/div><\/div><div id=\"field_10_126\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_126' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_126'>Hampton County School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_126' id='input_10_126' class='large gfield_select'  aria-describedby=\"gfield_description_10_126\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='613' >Ben Hazel Primary<\/option><option value='614' >Brunson Elementary<\/option><option value='615' >Fennell Elementary<\/option><option value='616' >Hampton Elementary<\/option><option value='617' >North District Middle<\/option><option value='618' >Varnville Elementary<\/option><option value='619' >Wade Hampton High School<\/option><\/select><\/div><\/div><div id=\"field_10_127\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_127' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_127'>Hampton County School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_127' id='input_10_127' class='large gfield_select'  aria-describedby=\"gfield_description_10_127\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='620' >Estill Elementary<\/option><option value='621' >Estill High School<\/option><option value='622' >Estill Middle<\/option><\/select><\/div><\/div><div id=\"field_10_128\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_128' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_128'>Horry County Schools<\/div><div class='ginput_container ginput_container_select'><select name='input_128' id='input_10_128' class='large gfield_select'  aria-describedby=\"gfield_description_10_128\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='623' >Academy For Arts Science Techn<\/option><option value='624' >Academy For Technolgy and Acad<\/option><option value='625' >Academy of Hope Charter<\/option><option value='626' >Aynor Elementary<\/option><option value='627' >Aynor High School<\/option><option value='628' >Aynor Middle<\/option><option value='629' >Black Water Middle<\/option><option value='630' >Bridgewater Academy Charter<\/option><option value='631' >Burgess Elementary<\/option><option value='632' >Carolina Forest Elementary<\/option><option value='633' >Carolina Forest High School<\/option><option value='634' >Conway Elementary<\/option><option value='635' >Conway High School<\/option><option value='636' >Conway Middle<\/option><option value='637' >Daisy Elementary<\/option><option value='638' >Forestbrook Elementary<\/option><option value='639' >Forestbrook Middle<\/option><option value='640' >Green Sea Floyds Elementary<\/option><option value='641' >Green Sea Floyds High School<\/option><option value='642' >HCS Early College High School<\/option><option value='643' >Homewood Elementary<\/option><option value='644' >Kingston Elementary<\/option><option value='645' >Lakewood Elementary<\/option><option value='646' >Loris Elementary<\/option><option value='647' >Loris High School<\/option><option value='648' >Loris Middle<\/option><option value='649' >Midland Elementary<\/option><option value='650' >Myrtle Beach Elementary<\/option><option value='651' >Myrtle Beach High School<\/option><option value='652' >Myrtle Beach Intermediate<\/option><option value='653' >Myrtle Beach Middle<\/option><option value='654' >Myrtle Beach Primary<\/option><option value='655' >North Myrtle Beach High School<\/option><option value='656' >North Myrtle Beach Middle<\/option><option value='657' >Ocean Bay Elementary<\/option><option value='658' >Ocean Bay Middle<\/option><option value='659' >Ocean Drive Elementary<\/option><option value='660' >Palmetto Academy for Learning Motorsports<\/option><option value='661' >Palmetto Academy of Learning and Success Charter<\/option><option value='662' >Palmetto Bays Elementary<\/option><option value='663' >Pee Dee Elementary<\/option><option value='664' >River Oaks Elementary<\/option><option value='665' >Riverside Elementary<\/option><option value='666' >Seaside Elementary<\/option><option value='667' >Socastee Elementary<\/option><option value='668' >Socastee High School<\/option><option value='669' >South Conway Elementary<\/option><option value='670' >St. James Elementary<\/option><option value='671' >St. James High School<\/option><option value='672' >St. James Middle<\/option><option value='673' >Waccamaw Elementary<\/option><option value='674' >Waterway Elementary<\/option><option value='675' >Whittemore Park Middle<\/option><\/select><\/div><\/div><div id=\"field_10_129\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_129' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_129'>Jasper County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_129' id='input_10_129' class='large gfield_select'  aria-describedby=\"gfield_description_10_129\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='676' >Hardeeville Elementary<\/option><option value='677' >Hardeeville-Ridgeland Middle<\/option><option value='678' >Ridgeland Elementary<\/option><option value='679' >Ridgeland-Hardeeville High School<\/option><\/select><\/div><\/div><div id=\"field_10_167\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_167' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_167'>John De La Howe<\/div><div class='ginput_container ginput_container_select'><select name='input_167' id='input_10_167' class='large gfield_select'  aria-describedby=\"gfield_description_10_167\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1236' >John De La Howe School<\/option><\/select><\/div><\/div><div id=\"field_10_168\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_168' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_168'>Juvenile Justice Schools<\/div><div class='ginput_container ginput_container_select'><select name='input_168' id='input_10_168' class='large gfield_select'  aria-describedby=\"gfield_description_10_168\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1242' >Birchwood School<\/option><option value='1243' >Evaluation and Detention Center<\/option><option value='1244' >Willow Lane School<\/option><\/select><\/div><\/div><div id=\"field_10_130\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_130' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_130'>Kershaw County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_130' id='input_10_130' class='large gfield_select'  aria-describedby=\"gfield_description_10_130\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='680' >Applied Technology Education Campus<\/option><option value='681' >Baron Dekalb Elementary<\/option><option value='682' >Bethune Elementary<\/option><option value='683' >Blaney Elementary<\/option><option value='684' >Camden Elementary of the Creative Arts<\/option><option value='685' >Camden High School<\/option><option value='686' >Camden Middle<\/option><option value='687' >Doby&#039;s Mill Elementary<\/option><option value='688' >Jackson School<\/option><option value='689' >Leslie M. Stover Middle<\/option><option value='690' >Lugoff Elementary<\/option><option value='691' >Lugoff-Elgin High School<\/option><option value='692' >Lugoff-Elgin Middle<\/option><option value='693' >Midway Elementary<\/option><option value='694' >Mt. Pisgah Elementary<\/option><option value='695' >North Central High School<\/option><option value='696' >North Central Middle<\/option><option value='697' >Pine Tree Hill Elementary<\/option><option value='698' >Wateree Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_131\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_131' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_131'>Lancaster County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_131' id='input_10_131' class='large gfield_select'  aria-describedby=\"gfield_description_10_131\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='699' >A. R. Rucker Middle<\/option><option value='700' >Andrew Jackson High School<\/option><option value='701' >Andrew Jackson Middle<\/option><option value='702' >Brooklyn Springs Elementary<\/option><option value='703' >Buford Elementary<\/option><option value='704' >Buford High School<\/option><option value='705' >Buford Middle<\/option><option value='728' >Clinton Elementary-Lancaster<\/option><option value='707' >Discovery Charter of Lancaster<\/option><option value='708' >Erwin Elementary<\/option><option value='709' >Harrisburg Elementary<\/option><option value='710' >Heath Springs Elementary<\/option><option value='711' >Indian Land Elementary<\/option><option value='712' >Indian Land High School<\/option><option value='713' >Indian Land Middle<\/option><option value='714' >Kershaw Elementary<\/option><option value='715' >Lancaster High School<\/option><option value='716' >McDonald Green Elementary<\/option><option value='717' >North Elementary<\/option><option value='718' >South Middle<\/option><\/select><\/div><\/div><div id=\"field_10_132\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_132' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_132'>Laurens County School District No. 55\n<\/div><div class='ginput_container ginput_container_select'><select name='input_132' id='input_10_132' class='large gfield_select'  aria-describedby=\"gfield_description_10_132\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='719' >E. B. Morse Elementary<\/option><option value='720' >Ford Elementary<\/option><option value='721' >Gray Court-Owings Elementary-Middle<\/option><option value='722' >Hickory Tavern Elementary-Middle<\/option><option value='723' >Laurens District 55 High School<\/option><option value='724' >Laurens Elementary<\/option><option value='725' >Laurens Middle<\/option><option value='726' >Sanders Middle<\/option><option value='727' >Waterloo Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_133\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_133' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_133'>Laurens County School District 56<\/div><div class='ginput_container ginput_container_select'><select name='input_133' id='input_10_133' class='large gfield_select'  aria-describedby=\"gfield_description_10_133\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='706' >Clinton Elementary-Laurens<\/option><option value='729' >Clinton High School<\/option><option value='730' >Clinton Middle<\/option><option value='731' >Eastside Elementary<\/option><option value='732' >Joanna-Woodson Elementary<\/option><option value='733' >M. S. Bailey Child Development Center<\/option><option value='1295' >Summit Classical Charter School<\/option><option value='1294' >Thornwell Charter School<\/option><\/select><\/div><\/div><div id=\"field_10_134\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_134' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_134'>Lee County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_134' id='input_10_134' class='large gfield_select'  aria-describedby=\"gfield_description_10_134\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='734' >Dennis Elementary<\/option><option value='735' >Lee Central High School<\/option><option value='736' >Lee Central Middle<\/option><option value='737' >Lee County Career and Technology Center<\/option><option value='738' >Lower Lee Elementary<\/option><option value='739' >West Lee Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_135\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_135' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_135'>Lexington County School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_135' id='input_10_135' class='large gfield_select'  aria-describedby=\"gfield_description_10_135\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1293' >Beechwood Middle<\/option><option value='740' >Carolina Springs Elementary<\/option><option value='741' >Carolina Springs Middle<\/option><option value='1297' >Centerville Elementary-Lexington 1<\/option><option value='742' >Deerfield Elementary<\/option><option value='1265' >East Pointe Academy Charter School<\/option><option value='743' >Forts Pond Elementary<\/option><option value='744' >Gilbert Elementary<\/option><option value='745' >Gilbert High School<\/option><option value='746' >Gilbert Middle<\/option><option value='747' >Gilbert Primary<\/option><option value='748' >Lake Murray Elementary<\/option><option value='1444' >Lakeside Middle School<\/option><option value='749' >Lexington Elementary<\/option><option value='750' >Lexington High School<\/option><option value='751' >Lexington Middle<\/option><option value='752' >Lexington Technology Center<\/option><option value='753' >Meadow Glen Elementary<\/option><option value='754' >Meadow Glen Middle<\/option><option value='755' >Midway Elementary<\/option><option value='756' >New Providence Elementary<\/option><option value='757' >Oak Grove Elementary<\/option><option value='758' >Pelion Elementary<\/option><option value='759' >Pelion High School<\/option><option value='760' >Pelion Middle<\/option><option value='761' >Pleasant Hill Elementary<\/option><option value='762' >Pleasant Hill Middle<\/option><option value='763' >Red Bank Elementary<\/option><option value='764' >River Bluff High School<\/option><option value='765' >Rocky Creek Elementary<\/option><option value='766' >Saxe Gotha Elementary<\/option><option value='1446' >South Lake Elementary<\/option><option value='767' >White Knoll Elementary<\/option><option value='768' >White Knoll High School<\/option><option value='769' >White Knoll Middle<\/option><\/select><\/div><\/div><div id=\"field_10_136\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_136' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_136'>Lexington County School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_136' id='input_10_136' class='large gfield_select'  aria-describedby=\"gfield_description_10_136\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='770' >Airport High School<\/option><option value='771' >Brookland Cayce Grammar School No. 1<\/option><option value='772' >Brookland-Cayce Senior High School<\/option><option value='1277' >Cayce Elementary<\/option><option value='774' >Congaree Elementary<\/option><option value='775' >Congaree-Wood Early Childhood Center<\/option><option value='776' >Cyril B. Busbee Creative Arts Academy<\/option><option value='777' >Herbert A. Wood Elementary<\/option><option value='1256' >New Bridge Academy<\/option><option value='778' >Northside Middle-Lexington 2<\/option><option value='779' >Pine Ridge Middle<\/option><option value='780' >Pineview Elementary<\/option><option value='781' >R. Earle Davis-CLOSED<\/option><option value='782' >R. H. Fulmer Middle<\/option><option value='1288' >Riverbank Elementary School<\/option><option value='783' >Saluda River Academy for the Arts<\/option><option value='784' >Springdale Elementary<\/option><option value='' ><\/option><\/select><\/div><\/div><div id=\"field_10_137\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_137' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_137'>Lexington County School District Three<\/div><div class='ginput_container ginput_container_select'><select name='input_137' id='input_10_137' class='large gfield_select'  aria-describedby=\"gfield_description_10_137\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='785' >Batesburg-Leesville Elementary<\/option><option value='786' >Batesburg-Leesville High School<\/option><option value='787' >Batesburg-Leesville Middle<\/option><option value='788' >Batesburg-Leesville Primary<\/option><\/select><\/div><\/div><div id=\"field_10_138\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_138' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_138'>Lexington County School District Four<\/div><div class='ginput_container ginput_container_select'><select name='input_138' id='input_10_138' class='large gfield_select'  aria-describedby=\"gfield_description_10_138\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='789' >Frances F. Mack Intermediate<\/option><option value='790' >Lexington Four Early Childhood Center<\/option><option value='791' >Sandhills Elementary<\/option><option value='792' >Sandhills Middle<\/option><option value='793' >Sandhills Primary<\/option><option value='794' >Swansea High Freshman Academy<\/option><option value='795' >Swansea High School<\/option><\/select><\/div><\/div><div id=\"field_10_139\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_139' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_139'>Lexington and Richland School District Five<\/div><div class='ginput_container ginput_container_select'><select name='input_139' id='input_10_139' class='large gfield_select'  aria-describedby=\"gfield_description_10_139\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='796' >Ballentine Elementary<\/option><option value='797' >Center for Advanced Technical Studies<\/option><option value='798' >Chapin Elementary<\/option><option value='799' >Chapin High School<\/option><option value='800' >Chapin Intermediate<\/option><option value='801' >Chapin Middle<\/option><option value='802' >CrossRoads Intermediate<\/option><option value='803' >Dutch Fork Elementary<\/option><option value='804' >Dutch Fork High School<\/option><option value='805' >Dutch Fork Middle<\/option><option value='806' >H. E. Corley Elementary<\/option><option value='807' >Harbison West Elementary<\/option><option value='808' >Irmo Elementary<\/option><option value='809' >Irmo High School<\/option><option value='810' >Irmo Middle<\/option><option value='811' >Lake Murray Elementary<\/option><option value='812' >Leaphart Elementary<\/option><option value='813' >Nursery Road Elementary<\/option><option value='814' >Oak Pointe Elementary<\/option><option value='1433' >Piney Woods Elementary<\/option><option value='815' >River Springs Elementary<\/option><option value='816' >Seven Oaks Elementary<\/option><option value='817' >Spring Hill High School<\/option><\/select><\/div><\/div><div id=\"field_10_169\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_169' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_169'>Marion County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_169' id='input_10_169' class='large gfield_select'  aria-describedby=\"gfield_description_10_169\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='821' >Academy of Careers and Technology<\/option><option value='822' >Britton&#039;s Neck Elementary<\/option><option value='823' >Creek Bridge High School<\/option><option value='824' >Easterling Primary<\/option><option value='825' >Johnakin Middle<\/option><option value='828' >McCormick Elementary-Marion<\/option><option value='826' >Manning High School<\/option><option value='1287' >Marion High School<\/option><option value='827' >Marion Intermediate<\/option><option value='829' >Mullins Early Childhood Center ANNEX<\/option><option value='830' >Mullins High School<\/option><option value='831' >North Mullins Primary<\/option><option value='832' >Palmetto Middle<\/option><\/select><\/div><\/div><div id=\"field_10_141\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_141' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_141'>Marlboro County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_141' id='input_10_141' class='large gfield_select'  aria-describedby=\"gfield_description_10_141\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='833' >Bennettsville Intermediate<\/option><option value='834' >Bennettsville Primary<\/option><option value='1264' >Blenheim HeadStart<\/option><option value='835' >Blenheim Middle School of Discovery<\/option><option value='836' >Clio Elementary<\/option><option value='837' >Marlboro County High School<\/option><option value='838' >Marlboro School of Discovery<\/option><option value='839' >McColl Elementary-Middle<\/option><option value='840' >Wallace Elementary-Middle<\/option><\/select><\/div><\/div><div id=\"field_10_140\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_140' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_140'>McCormick County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_140' id='input_10_140' class='large gfield_select'  aria-describedby=\"gfield_description_10_140\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='818' >McCormick Elementary-McCormick<\/option><option value='819' >McCormick High School<\/option><option value='820' >McCormick Middle<\/option><\/select><\/div><\/div><div id=\"field_10_190\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_190' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_190'>Movement School<\/div><div class='ginput_container ginput_container_select'><select name='input_190' id='input_10_190' class='large gfield_select'  aria-describedby=\"gfield_description_10_190\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='1451' >Bridge View Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_142\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_142' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_142'>Newberry County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_142' id='input_10_142' class='large gfield_select'  aria-describedby=\"gfield_description_10_142\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='841' >Boundary Street Elementary<\/option><option value='842' >Gallman Elementary<\/option><option value='843' >Little Mountain Elementary<\/option><option value='844' >Mid-Carolina High School<\/option><option value='845' >Mid-Carolina Middle<\/option><option value='846' >Newberry County Career Center<\/option><option value='847' >Newberry Elementary<\/option><option value='848' >Newberry High School<\/option><option value='849' >Newberry Middle<\/option><option value='850' >Pomaria-Garmany Elementary<\/option><option value='851' >Prosperity-Rikard Elementary<\/option><option value='852' >Reuben Elementary<\/option><option value='853' >Whitmire Community High School<\/option><option value='854' >Whitmire Community School (Elementary)<\/option><\/select><\/div><\/div><div id=\"field_10_143\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_143' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_143'>Oconee County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_143' id='input_10_143' class='large gfield_select'  aria-describedby=\"gfield_description_10_143\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='855' >Blue Ridge Elementary<\/option><option value='856' >Fair-Oak Elementary<\/option><option value='857' >Fred P. Hamilton Career Center<\/option><option value='858' >James M. Brown Elementary<\/option><option value='859' >Keowee Elementary<\/option><option value='860' >Northside Elementary-Oconee<\/option><option value='861' >Orchard Park Elementary<\/option><option value='862' >Ravenel Elementary<\/option><option value='863' >Seneca High School<\/option><option value='864' >Seneca Middle<\/option><option value='865' >Tamassee-Salem Elementary<\/option><option value='866' >Tamassee-Salem Middle-High School<\/option><option value='867' >Walhalla Elementary<\/option><option value='868' >Walhalla High School<\/option><option value='869' >Walhalla Middle<\/option><option value='870' >West Oak Middle<\/option><option value='871' >West-Oak High School<\/option><option value='872' >Westminster Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_146\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_146' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_146'>Orangeburg County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_146' id='input_10_146' class='large gfield_select'  aria-describedby=\"gfield_description_10_146\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='887' >Bethune-Bowman Elementary<\/option><option value='888' >Bethune-Bowman Middle-High School<\/option><option value='879' >Branchville High School<\/option><option value='889' >Brookdale Elementary<\/option><option value='880' >Carver Edisto Middle<\/option><option value='890' >Dover Elementary<\/option><option value='1454' >East Lake Elementary School<\/option><option value='881' >Edisto Elementary<\/option><option value='882' >Edisto High<\/option><option value='883' >Edisto Primary<\/option><option value='873' >Elloree Elementary<\/option><option value='884' >Hunter-Kinard-Tyler Elementary<\/option><option value='885' >Hunter-Kinard-Tyler High<\/option><option value='1455' >Lake Marion Middle School<\/option><option value='876' >Lake Marion High<\/option><option value='886' >Lockett Elementary<\/option><option value='891' >Marshall Elementary<\/option><option value='892' >Mellichamp Elementary<\/option><option value='893' >North Middle-High School<\/option><option value='894' >OCSD5 High School for Health Professions<\/option><option value='895' >Orangeburg Consolitated School District Five Technology Center<\/option><option value='896' >Orangeburg Wilkinson High School<\/option><option value='899' >Sheridan Elementary<\/option><option value='900' >Whittaker Elementary<\/option><option value='901' >William J. Clark Middle<\/option><\/select><\/div><\/div><div id=\"field_10_171\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_171' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_171'>Palmetto Unified<\/div><div class='ginput_container ginput_container_select'><select name='input_171' id='input_10_171' class='large gfield_select'  aria-describedby=\"gfield_description_10_171\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1245' >Lee  High School<\/option><option value='1246' >MacDougall High School<\/option><option value='1247' >Manning High School<\/option><option value='1248' >Ridgeland High School<\/option><option value='1249' >Sara Babb High School<\/option><option value='1250' >Trenton High School<\/option><option value='1251' >Turbeville High School<\/option><option value='1252' >Tyger River High School<\/option><option value='1253' >Wateree River High School<\/option><\/select><\/div><\/div><div id=\"field_10_170\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_170' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_170'>Pee Dee Head Starts<\/div><div class='ginput_container ginput_container_select'><select name='input_170' id='input_10_170' class='large gfield_select'  aria-describedby=\"gfield_description_10_170\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1292' >Lake City HS Center<\/option><\/select><\/div><\/div><div id=\"field_10_172\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_172' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_172'>Pickens County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_172' id='input_10_172' class='large gfield_select'  aria-describedby=\"gfield_description_10_172\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='903' >A. R. Lewis Elementary<\/option><option value='904' >Ambler Elementary<\/option><option value='905' >Central Elementary<\/option><option value='906' >Liberty Primary<\/option><option value='907' >Clemson Elementary<\/option><option value='908' >Crosswell Elementary-Pickens<\/option><option value='909' >D. W. Daniel High School<\/option><option value='910' >Dacusville Elementary<\/option><option value='911' >Dacusville Middle<\/option><option value='912' >Easley High School<\/option><option value='913' >East End Elementary<\/option><option value='914' >Forest Acres Elementary<\/option><option value='915' >Hagood Elementary<\/option><option value='916' >Holly Springs Elementary<\/option><option value='917' >Liberty Elementary<\/option><option value='918' >Liberty High School<\/option><option value='919' >Liberty Middle<\/option><option value='920' >McKissick Elementary<\/option><option value='921' >Pickens County Career and Technolgy Center<\/option><option value='922' >Pickens Elementary<\/option><option value='923' >Pickens High School<\/option><option value='924' >Pickens Middle<\/option><option value='925' >R. C. Edwards Middle<\/option><option value='926' >Richard H. Gettys Middle<\/option><option value='927' >Six Mile Elementary<\/option><option value='928' >West End Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_173\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_173' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_173'>R D Anderson Applied Technology Center<\/div><div class='ginput_container ginput_container_select'><select name='input_173' id='input_10_173' class='large gfield_select'  aria-describedby=\"gfield_description_10_173\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1089' >R. D. Anderson Applied Technology Center<\/option><\/select><\/div><\/div><div id=\"field_10_174\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_174' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_174'>Richland County School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_174' id='input_10_174' class='large gfield_select'  aria-describedby=\"gfield_description_10_174\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='929' >A. C. Flora High School<\/option><option value='930' >A. C. Moore Elementary<\/option><option value='931' >A. J. Lewis Greenview Elementary<\/option><option value='932' >Alcorn Middle<\/option><option value='933' >Annie Burnside Elementary<\/option><option value='934' >Arden Elementary<\/option><option value='935' >Bradley Elementary<\/option><option value='936' >Brennen Elementary<\/option><option value='937' >Brockman Elementary<\/option><option value='938' >Burton Pack Elementary<\/option><option value='939' >C. A. Johnson High School<\/option><option value='940' >Carolina School for Inquiry<\/option><option value='941' >Carver-Lyon Elementary<\/option><option value='942' >Caughman Road Elementary<\/option><option value='943' >Columbia High School<\/option><option value='944' >Crayton Middle<\/option><option value='945' >Dreher High School<\/option><option value='946' >Eau Claire High School<\/option><option value='947' >Edward E. Taylor Elementary<\/option><option value='948' >Forest Heights Elementary<\/option><option value='949' >Gadsden Elementary<\/option><option value='950' >H. B. Rhame Elementary<\/option><option value='951' >Hall Institute<\/option><option value='952' >Hand Middle<\/option><option value='953' >Heyward Gibbes Middle<\/option><option value='954' >Hopkins Elementary<\/option><option value='955' >Hopkins Middle<\/option><option value='956' >Horrell Hill Elementary<\/option><option value='957' >Hyatt Park Elementary<\/option><option value='958' >J. P. Thomas Elementary<\/option><option value='959' >Logan Elementary<\/option><option value='960' >Lower Richland High School<\/option><option value='961' >Meadowfield Elementary<\/option><option value='962' >Mill Creek Elementary<\/option><option value='963' >Pendergrass Fairwold School<\/option><option value='964' >Pine Grove Elementary<\/option><option value='965' >Richland One Charter Middle College<\/option><option value='966' >Rosewood Elementary<\/option><option value='967' >Samuel A. Heyward Career and Tech Center<\/option><option value='968' >Sandel Elementary<\/option><option value='969' >Satchel Ford Elementary<\/option><option value='970' >South Kilbourne Elementary<\/option><option value='971' >Southeast Middle<\/option><option value='972' >St. Andrews Middle<\/option><option value='973' >W. A. Perry Middle<\/option><option value='974' >W. G. Sanders Middle<\/option><option value='975' >W.J. Keenan High School<\/option><option value='976' >Watkins-Nance Elementary<\/option><option value='977' >Webber School<\/option><\/select><\/div><\/div><div id=\"field_10_175\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_175' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_175'>Richland County School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_175' id='input_10_175' class='large gfield_select'  aria-describedby=\"gfield_description_10_175\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='978' >Bethel-Hanberry Elementary<\/option><option value='979' >Blythewood High School<\/option><option value='980' >Blythewood Middle School<\/option><option value='981' >Bookman Road Elementary<\/option><option value='982' >Bridge Creek Elementary<\/option><option value='983' >Catawba Trail Elementary<\/option><option value='984' >Dent Middle<\/option><option value='985' >E. L. Wright Middle<\/option><option value='986' >Forest Lake Elementary<\/option><option value='1280' >Jackson Creek Elementary<\/option><option value='987' >Joseph Keels Elementary<\/option><option value='988' >Kelly Mill Middle<\/option><option value='989' >Killian Elementary<\/option><option value='990' >L. B. Nelson Elementary<\/option><option value='991' >L. W. Conder Elementary<\/option><option value='992' >Lake Carolina Elementary<\/option><option value='993' >Lake Carolina Elementary Upper Campus<\/option><option value='994' >Langford Elementary<\/option><option value='995' >Longleaf Middle<\/option><option value='996' >Muller Road Middle<\/option><option value='997' >North Springs Elementary<\/option><option value='998' >Polo Road Elementary<\/option><option value='999' >Pontiac Elementary<\/option><option value='1000' >Rice Creek Elementary<\/option><option value='1001' >Richland Northeast High School<\/option><option value='1002' >Richland Two Charter High School<\/option><option value='1003' >Ridge View High School<\/option><option value='1004' >Round Top Elementary<\/option><option value='1005' >Sandlapper Elementary<\/option><option value='1006' >Spring Valley High School<\/option><option value='1007' >Summit Parkway Middle<\/option><option value='1008' >Westwood High School<\/option><option value='1009' >Windsor Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_176\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_176' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_176'>Rock Hill School District Three of York County<\/div><div class='ginput_container ginput_container_select'><select name='input_176' id='input_10_176' class='large gfield_select'  aria-describedby=\"gfield_description_10_176\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1159' >Applied Technology Center<\/option><option value='1160' >Belleview Elementary<\/option><option value='1161' >Castle Heights Middle<\/option><option value='1162' >Central Child Development Center<\/option><option value='1163' >Dutchman Creek Middle<\/option><option value='1164' >Ebenezer Avenue Elementary<\/option><option value='1165' >Ebinport Elementary<\/option><option value='1166' >Finley Road Elementary<\/option><option value='1167' >Independence Elementary<\/option><option value='1168' >India Hook Elementary<\/option><option value='1169' >Lesslie Elementary<\/option><option value='1170' >Mount Gallant Elementary<\/option><option value='1171' >Mount Holly Elementary<\/option><option value='1172' >Northside Elementary-York 3<\/option><option value='1173' >Northwestern High School<\/option><option value='1174' >Oakdale Elementary<\/option><option value='1175' >Old Pointe Elementary<\/option><option value='1176' >Rawlinson Road Middle<\/option><option value='1177' >Richmond Drive Elementary<\/option><option value='1178' >Rock Hill High School<\/option><option value='1179' >Rosewood Elementary<\/option><option value='1180' >Saluda Trail Middle<\/option><option value='1181' >South Pointe High School<\/option><option value='1182' >Sunset Park Center for Accelerated Studies<\/option><option value='1183' >The Children&#039;s School at Sylvia Circle<\/option><option value='1184' >The Palmetto School at the Children&#039;s Attention Home<\/option><option value='1185' >W. C. Sullivan Middle<\/option><option value='1186' >York Road Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_177\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_177' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_177'>Saluda County School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_177' id='input_10_177' class='large gfield_select'  aria-describedby=\"gfield_description_10_177\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1010' >Hollywood Elementary<\/option><option value='1011' >Saluda Elementary<\/option><option value='1012' >Saluda High School<\/option><option value='1013' >Saluda Middle<\/option><option value='1014' >Saluda Primary<\/option><\/select><\/div><\/div><div id=\"field_10_178\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_178' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_178'>SC Public School Charter District<\/div><div class='ginput_container ginput_container_select'><select name='input_178' id='input_10_178' class='large gfield_select'  aria-describedby=\"gfield_description_10_178\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1202' >Bridges Preparatory School<\/option><option value='1203' >Calhoun Falls Charter School<\/option><option value='1204' >Cape Romain Environmental Education Charter<\/option><option value='1205' >Coastal Leadership Academy<\/option><option value='1206' >Cyber Academy of South Carolina<\/option><option value='1207' >East Point Academy<\/option><option value='1208' >Fox Creek High School<\/option><option value='1209' >Garden City Preparatory Academy for Boys<\/option><option value='1210' >Gray Collegiate Academy<\/option><option value='1211' >GREEN Charter School<\/option><option value='1212' >High Point Academy<\/option><option value='1213' >Imagine Columbia Leadership Academy Charter<\/option><option value='1214' >Lead Academy<\/option><option value='1215' >Lowcountry Leadership Charter School<\/option><option value='1216' >Lowcountry Montessori School<\/option><option value='1217' >Midlands Middle College<\/option><option value='1219' >NEXT High School<\/option><option value='1279' >Oceanside Collegiate Academy<\/option><option value='1220' >Palmetto Scholars Academy<\/option><option value='1221' >Pee Dee Math, Science, and Technology Academy<\/option><option value='1222' >Provost Academy South Carolina<\/option><option value='1223' >Quest Leadership Academy<\/option><option value='1224' >Riverwalk Academy<\/option><option value='1225' >Royal Live Oaks Academy of the Arts and Sciences Charter<\/option><option value='1226' >SC Connections Academy<\/option><option value='1227' >SC Science Academy<\/option><option value='1228' >SC Virtual Charter School<\/option><option value='1229' >SC Whitmore School<\/option><option value='1230' >South Carolina Calvert Academy<\/option><option value='1231' >Spartanburg Preparatory School<\/option><option value='1232' >York Preparatory Academy<\/option><option value='1233' >Youth Leadership Academy Charter<\/option><\/select><\/div><\/div><div id=\"field_10_179\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_179' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_179'>SC School for the Deaf and Blind<\/div><div class='ginput_container ginput_container_select'><select name='input_179' id='input_10_179' class='large gfield_select'  aria-describedby=\"gfield_description_10_179\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1237' >Cedar Springs Academy<\/option><option value='1238' >SC School For Blind Elementary-Middle<\/option><option value='1239' >SC School For Deaf Elementary-Middle<\/option><option value='1240' >SC School for the Blind High School<\/option><option value='1241' >SC School for the Deaf High School<\/option><\/select><\/div><\/div><div id=\"field_10_180\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_180' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_180'>Share Community Action Partnership<\/div><div class='ginput_container ginput_container_select'><select name='input_180' id='input_10_180' class='large gfield_select'  aria-describedby=\"gfield_description_10_180\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1399' >BHW Head Start\/Early Head Start Center<\/option><option value='1404' >Children&#039;s Center &quot;B&quot; Head Start Center<\/option><option value='1415' >Clemson  Head Start Center<\/option><option value='1405' >Easley Bridge Road Head Start Center<\/option><option value='1407' >Golden Strip Head Start\/Early Head Start Center<\/option><option value='1412' >Margaret A. Sherred Head Start Center<\/option><option value='1406' >North Franklin Road Head Start Center<\/option><option value='1409' >North Greenville  Head Start Center<\/option><option value='1408' >Parker Head Start\/Early Head Start Center<\/option><option value='1400' >Pendleton Head Start Center<\/option><option value='1416' >Pickens  Head Start Center<\/option><option value='1417' >Reece Mill Road Head Start\/Early Head Start Center<\/option><option value='1411' >Rubye H. Jones Head Start\/Early Head Start Center<\/option><option value='1414' >Seneca  Head Start\/Early Head Start Center<\/option><option value='1418' >Simpson Head  Head Start Center<\/option><option value='1401' >Starr Head Start Center<\/option><option value='1410' >Tommie C. Brooks Early Head Start Center<\/option><option value='1413' >Watkins Road  Head Start\/Early Head Start Center<\/option><option value='1402' >Westside Head Start Center<\/option><option value='1403' >Willis H. Crosby Head Start\/Early Head Start Center<\/option><\/select><\/div><\/div><div id=\"field_10_159\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_159' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_159'>Spartanburg County School District Two<\/div><div class='ginput_container ginput_container_select'><select name='input_159' id='input_10_159' class='large gfield_select'  aria-describedby=\"gfield_description_10_159\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='266' >Oakland Elementary-Spartanburg<\/option><option value='1025' >Boiling Springs Elementary<\/option><option value='1026' >Boiling Springs High Ninth Grade Campus<\/option><option value='1027' >Boiling Springs High School<\/option><option value='1028' >Sugar Ridge Elementary<\/option><option value='1029' >Boiling Springs Middle<\/option><option value='1030' >Carlisle-Foster&#039;s Grove Elementary<\/option><option value='1031' >Chesnee Elementary<\/option><option value='1032' >Chesnee High School<\/option><option value='1033' >Chesnee Middle<\/option><option value='1034' >Cooley Springs-Fingerville Elementary<\/option><option value='1035' >James H. Hendrix  Elementary<\/option><option value='1036' >Mayo Elementary<\/option><option value='1038' >Rainbow Lake Middle<\/option><option value='1260' >Shoally Creek Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_160\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_160' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_160'>Spartanburg County School District Three<\/div><div class='ginput_container ginput_container_select'><select name='input_160' id='input_10_160' class='large gfield_select'  aria-describedby=\"gfield_description_10_160\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1039' >Broome High School<\/option><option value='1040' >Cannons Elementary<\/option><option value='1041' >Cliffdale Middle<\/option><option value='1042' >Cowpens Elementary<\/option><option value='1045' >Pacolet Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_161\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_161' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_161'>Spartanburg County School District Four<\/div><div class='ginput_container ginput_container_select'><select name='input_161' id='input_10_161' class='large gfield_select'  aria-describedby=\"gfield_description_10_161\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1046' >Woodruff Elementary<\/option><option value='1047' >Woodruff High School<\/option><option value='1048' >Woodruff Middle<\/option><option value='1049' >Woodruff Primary<\/option><\/select><\/div><\/div><div id=\"field_10_155\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_155' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_155'>Spartanburg County School District Five<\/div><div class='ginput_container ginput_container_select'><select name='input_155' id='input_10_155' class='large gfield_select'  aria-describedby=\"gfield_description_10_155\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1050' >Abner Creek Academy<\/option><option value='1051' >Beech Springs Intermediate<\/option><option value='1052' >Berry Shoals Intermediate<\/option><option value='1053' >D. R. Hill Middle<\/option><option value='1054' >Duncan Elementary<\/option><option value='1055' >Florence Chapel Middle<\/option><option value='1056' >James Byrnes Freshman Academy<\/option><option value='1057' >James F. Byrnes High School<\/option><option value='1058' >Lyman Elementary<\/option><option value='1059' >Reidville Elementary<\/option><option value='1060' >River Ridge Elementary<\/option><option value='1061' >Wellford Academy of Science and Techology<\/option><\/select><\/div><\/div><div id=\"field_10_158\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_158' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_158'>Spartanburg County School District Six<\/div><div class='ginput_container ginput_container_select'><select name='input_158' id='input_10_158' class='large gfield_select'  aria-describedby=\"gfield_description_10_158\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1062' >Anderson Mill Elementary<\/option><option value='1063' >Arcadia Elementary<\/option><option value='1064' >Dorman High Freshman Campus<\/option><option value='1065' >Dorman High School<\/option><option value='1066' >Fairforest Elementary<\/option><option value='1067' >Fairforest Middle<\/option><option value='1068' >Jesse S. Bobo Elementary<\/option><option value='1069' >L. E. Gable Middle<\/option><option value='1070' >Lone Oak Elementary<\/option><option value='1071' >Pauline Glenn Springs Elementary<\/option><option value='1072' >R. P. Dawkins Middle<\/option><option value='1073' >Roebuck Elementary<\/option><option value='1074' >West View Elementary<\/option><option value='1075' >Woodland Heights Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_157\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_157' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_157'>Spartanburg County School District Seven<\/div><div class='ginput_container ginput_container_select'><select name='input_157' id='input_10_157' class='large gfield_select'  aria-describedby=\"gfield_description_10_157\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1076' >Carver Middle<\/option><option value='1077' >Cleveland Academy of Leadership<\/option><option value='1078' >E. P. Todd School<\/option><option value='1079' >Houston Elementary<\/option><option value='1080' >Jesse Boyd Elementary<\/option><option value='1081' >Mary H. Wright Elementary<\/option><option value='1082' >McCracken Middle<\/option><option value='1083' >Pine Street Elementary<\/option><option value='1084' >Spartanburg Freshman Academy<\/option><option value='1085' >Spartanburg High School<\/option><option value='1086' >Spartanburg School District 7 Early Childhood Center<\/option><option value='1087' >W. Herbert Chapman Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_181\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_181' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_181'>Sumter School District<\/div><div class='ginput_container ginput_container_select'><select name='input_181' id='input_10_181' class='large gfield_select'  aria-describedby=\"gfield_description_10_181\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1092' >Alice Drive Elementary<\/option><option value='1091' >Alice Drive Middle<\/option><option value='1093' >Bates Middle<\/option><option value='1273' >Brewington Alternative<\/option><option value='1094' >Cherryvale Elementary<\/option><option value='1095' >Chestnut Oaks Middle<\/option><option value='1096' >Crestwood High School<\/option><option value='1097' >Crosswell Elementary-Sumter<\/option><option value='1098' >Ebenezer Middle<\/option><option value='1099' >F. J. Delaine Elementary<\/option><option value='1100' >Furman Middle<\/option><option value='1101' >High Hills Elementary<\/option><option value='1102' >Hillcrest Middle<\/option><option value='1103' >Kingsbury  Elementary<\/option><option value='1104' >Lakewood High  School<\/option><option value='1105' >Lemira Elementary<\/option><option value='1106' >Manchester Elementary<\/option><option value='1107' >Mayewood Middle<\/option><option value='1108' >Millwood Elementary<\/option><option value='1109' >Oakland Primary-Sumter<\/option><option value='1110' >Pocalla Springs Elementary<\/option><option value='1111' >R. E. Davis College Preperatory Academy<\/option><option value='1112' >Rafting Creek Elementary<\/option><option value='1113' >Shaw Heights Elementary<\/option><option value='1114' >Sumter Career and Technology Center<\/option><option value='1115' >Sumter High  School<\/option><option value='1116' >Wilder Elementary<\/option><option value='1117' >Willow Drive Elementary<\/option><\/select><\/div><\/div><div id=\"field_10_182\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_182' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_182'>Union County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_182' id='input_10_182' class='large gfield_select'  aria-describedby=\"gfield_description_10_182\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1118' >Buffalo Elementary<\/option><option value='1119' >Foster Park Elementary<\/option><option value='1120' >Jonesville Elementary<\/option><option value='1121' >Jonesville Middle<\/option><option value='1122' >Lockhart School<\/option><option value='1123' >Lockhart School ANNEX<\/option><option value='1124' >Monarch Elementary-Union<\/option><option value='1125' >Sims Middle<\/option><option value='1126' >Union County Career and Technology Center<\/option><option value='1127' >Union County High School<\/option><\/select><\/div><\/div><div id=\"field_10_183\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_183' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_183'>Williamsburg County School District<\/div><div class='ginput_container ginput_container_select'><select name='input_183' id='input_10_183' class='large gfield_select'  aria-describedby=\"gfield_description_10_183\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1445' >C. E. Murray Elementary School<\/option><option value='1129' >C.E. Murray Middle<\/option><option value='1130' >D.P. Cooper Charter<\/option><option value='1331' >Greeleyville Primary<\/option><option value='1132' >Hemingway Career and Technology Center<\/option><option value='1133' >Hemingway Elementary<\/option><option value='1134' >Hemingway High School<\/option><option value='1135' >Hemingway MB Lee Middle<\/option><option value='1136' >Kenneth Gardner Leadership Academy<\/option><option value='1137' >Kingstree High School<\/option><option value='1138' >Kingstree Middle Magnet<\/option><option value='1139' >W.M. Anderson Primary<\/option><option value='1140' >Williamsburg Co. Magnet School<\/option><\/select><\/div><\/div><div id=\"field_10_184\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_184' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_184'>Williamsburg Tech<\/div><div class='ginput_container ginput_container_select'><select name='input_184' id='input_10_184' class='large gfield_select'  aria-describedby=\"gfield_description_10_184\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1234' >Wmsbg Tec Voc Adult Ed Ctr<\/option><\/select><\/div><\/div><div id=\"field_10_90\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_90' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_90'>Williston School District (Barnwell County 29)<\/div><div class='ginput_container ginput_container_select'><select name='input_90' id='input_10_90' class='large gfield_select'  aria-describedby=\"gfield_description_10_90\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='118' >Kelly Edwards Elementary<\/option><option value='119' >Williston-Elko High School<\/option><option value='120' >Williston-Elko Middle<\/option><\/select><\/div><\/div><div id=\"field_10_186\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_186' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_186'>York School District One<\/div><div class='ginput_container ginput_container_select'><select name='input_186' id='input_10_186' class='large gfield_select'  aria-describedby=\"gfield_description_10_186\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1141' >Cotton Belt Elementary<\/option><option value='1142' >Floyd D. Johnson Technology Ctr<\/option><option value='1143' >Harold C. Johnson Elementary<\/option><option value='1144' >Hickory Grove-Sharon Elementary<\/option><option value='1145' >Hunter Street Elementary<\/option><option value='1146' >Jefferson Elementary-York 1<\/option><option value='1147' >York Comprehensive High School<\/option><option value='1148' >York Intermediate<\/option><option value='1149' >York Middle<\/option><\/select><\/div><\/div><div id=\"field_10_185\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_185' >Nome da escola<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_185'>York County School District Two\n<\/div><div class='ginput_container ginput_container_select'><select name='input_185' id='input_10_185' class='large gfield_select'  aria-describedby=\"gfield_description_10_185\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1150' >Bethany Elementary<\/option><option value='1151' >Bethel Elementary<\/option><option value='1284' >Blue Eagle Academy<\/option><option value='1152' >Clover High School<\/option><option value='1153' >Clover Middle<\/option><option value='1282' >Clover Ninth Grade Campus<\/option><option value='1154' >Crowders Creek Elem<\/option><option value='1155' >Griggs Road Elementary<\/option><option value='1156' >Kinard Elementary<\/option><option value='1157' >Larne Elementary<\/option><option value='1289' >Oakridge Elementary<\/option><option value='1158' >Oakridge Middle<\/option><\/select><\/div><\/div><div id=\"field_10_50\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Informa\u00e7\u00f5es do Aluno<\/h3><\/div><fieldset id=\"field_10_2\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Nome do Aluno<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name' id='input_10_2'>\n                            \n                            <span id='input_10_2_3_container' class='name_first' >\n                                                    <input type='text' name='input_2.3' id='input_10_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_2_3' >Primeiro<\/label>\n                                                <\/span>\n                            <span id='input_10_2_4_container' class='name_middle' >\n                                                    <input type='text' name='input_2.4' id='input_10_2_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_10_2_4' >Meio<\/label>\n                                                <\/span>\n                            <span id='input_10_2_6_container' class='name_last' >\n                                                    <input type='text' name='input_2.6' id='input_10_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_2_6' >\u00daltimo<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_10_3\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >G\u00eanero<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_10_3'>\n\t\t\t<div class='gchoice gchoice_10_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Male'  id='choice_10_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_3_0' id='label_10_3_0'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Female'  id='choice_10_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_3_1' id='label_10_3_1'>Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_10\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Data de nascimento do aluno<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_10_10' class='ginput_container ginput_complex'><div class='gfield_date_month ginput_container ginput_container_date' id='input_10_10_1_container'>\n                                            <input type='number'  name='input_10[]' id='input_10_10_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_10_10_1' class='screen-reader-text'>M\u00eas<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date' id='input_10_10_2_container'>\n                                            <input type='number'  name='input_10[]' id='input_10_10_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_10_10_2' class='screen-reader-text'>Dia<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date' id='input_10_10_3_container'>\n                                            <input type='number'  name='input_10[]' id='input_10_10_3' value=''   aria-required='true'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_10_10_3' class='screen-reader-text'>Ano<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_10_188\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_188' >N\u00edvel de Ensino<\/label><div class='ginput_container ginput_container_text'><input name='input_188' id='input_10_188' type='text' value='' class='medium'  aria-describedby=\"gfield_description_10_188\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_10_188'>\"K, K1, K2, 3, 5, 9, etc\"<\/div><\/div><div id=\"field_10_189\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_189' >Professor de Sala<\/label><div class='ginput_container ginput_container_text'><input name='input_189' id='input_10_189' type='text' value='' class='large'  aria-describedby=\"gfield_description_10_189\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_10_189'>Professor prim\u00e1rio\/de sala de aula do aluno<\/div><\/div><div id=\"field_10_48\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_48' >Telefone celular<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_48' id='input_10_48' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_11\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_11' >Telefone Residencial<\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_10_11' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_75\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Endere\u00e7o de e-mail dos pais\/respons\u00e1veis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_10_75'>O endere\u00e7o de e-mail deve ser v\u00e1lido - voc\u00ea receber\u00e1 uma c\u00f3pia do consentimento enviado a ele.<\/div><div class='ginput_complex ginput_container ginput_container_email' id='input_10_75_container'>\n                                <span id='input_10_75_1_container' class='ginput_left'>\n                                    <input class='' type='email' name='input_75' id='input_10_75' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_10_75\" \/>\n                                    <label for='input_10_75' >Inserir e-mail<\/label>\n                                <\/span>\n                                <span id='input_10_75_2_container' class='ginput_right'>\n                                    <input class='' type='email' name='input_75_2' id='input_10_75_2' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_10_75\" \/>\n                                    <label for='input_10_75_2' >Confirmar e-mail<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_10_5\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Endere\u00e7o do Aluno<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address' id='input_10_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_10_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_10_5_1' value=''   placeholder='Street 1' aria-required='true'    \/>\n                                        <label for='input_10_5_1' id='input_10_5_1_label' class='hidden_sub_label screen-reader-text'>Rua<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_10_5_2_container' >\n                                        <input type='text' name='input_5.2' id='input_10_5_2' value=''   placeholder='Street 2'  aria-required='false'   \/>\n                                        <label for='input_10_5_2' id='input_10_5_2_label' class='hidden_sub_label screen-reader-text'>Bairro e Complemento<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_10_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_10_5_3' value=''   placeholder='City' aria-required='true'    \/>\n                                    <label for='input_10_5_3' id='input_10_5_3_label' class='hidden_sub_label screen-reader-text'>Cidade<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_10_5_4_container' >\n                                        <select name='input_5.4' id='input_10_5_4'     aria-required='true'    ><option value='' selected='selected'>State<\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='Calif\u00f3rnia' >Calif\u00f3rnia<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='Distrito de Columbia' >Distrito de Columbia<\/option><option value='Fl\u00f3rida' >Fl\u00f3rida<\/option><option value='Georgia' >Georgia<\/option><option value='Hava\u00ed' >Hava\u00ed<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='Nova Hampshire' >Nova Hampshire<\/option><option value='Nova Jersey' >Nova Jersey<\/option><option value='Novo M\u00e9xico' >Novo M\u00e9xico<\/option><option value='Nova Iorque' >Nova Iorque<\/option><option value='Carolina do Norte' >Carolina do Norte<\/option><option value='Dakota do Norte' >Dakota do Norte<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='Carolina do Sul' >Carolina do Sul<\/option><option value='Dakota do Sul' >Dakota do Sul<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virg\u00ednia' >Virg\u00ednia<\/option><option value='Washington' >Washington<\/option><option value='Virg\u00ednia Ocidental' >Virg\u00ednia Ocidental<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='For\u00e7as Armadas das Am\u00e9ricas' >For\u00e7as Armadas das Am\u00e9ricas<\/option><option value='For\u00e7as Armadas da Europa' >For\u00e7as Armadas da Europa<\/option><option value='For\u00e7as Armadas do Pac\u00edfico' >For\u00e7as Armadas do Pac\u00edfico<\/option><\/select>\n                                        <label for='input_10_5_4' id='input_10_5_4_label' class='hidden_sub_label screen-reader-text'>Estado<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_10_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_10_5_5' value=''   placeholder='ZIP Code' aria-required='true'    \/>\n                                    <label for='input_10_5_5' id='input_10_5_5_label' class='hidden_sub_label screen-reader-text'>CEP<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_10_5_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_10_54' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_10\").val(\"2\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_10\").val(\"2\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_10_8\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Quest\u00f5es  M\u00e9dicas<\/h3><\/div><div id=\"field_10_15\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_15' >M\u00e9dico da Crian\u00e7a<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_10_15' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_10_13\" class=\"gfield gfield--width-half field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_13' >Dentista da crian\u00e7a<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_10_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_10_14\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Data da \u00faltima limpeza dos dentes<\/legend><div id='input_10_14' class='ginput_container ginput_complex'><div class='gfield_date_month ginput_container ginput_container_date' id='input_10_14_1_container'>\n                                            <input type='number'  name='input_14[]' id='input_10_14_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_10_14_1' class='screen-reader-text'>M\u00eas<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date' id='input_10_14_2_container'>\n                                            <input type='number'  name='input_14[]' id='input_10_14_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_10_14_2' class='screen-reader-text'>Dia<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date' id='input_10_14_3_container'>\n                                            <input type='number'  name='input_14[]' id='input_10_14_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_10_14_3' class='screen-reader-text'>Ano<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_10_16\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Possui Alergias?<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_10_16'>\n\t\t\t<div class='gchoice gchoice_10_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Yes'  id='choice_10_16_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_10_16\"   \/>\n\t\t\t\t\t<label for='choice_10_16_0' id='label_10_16_0'>Sim<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='No'  id='choice_10_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_16_1' id='label_10_16_1'>N\u00e3o<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_10_16'>Incluindo alimentos, medicamentos e\/ou l\u00e1tex.<\/div><\/fieldset><div class=\"spacer gfield\" style=\"grid-column: span 6;\"><\/div><div id=\"field_10_17\" class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_17' >Articula\u00e7\u00f5es artificiais?<\/label><div class='gfield_description' id='gfield_description_10_17'>Por favor, liste-os aqui.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_17' id='input_10_17' class='textarea medium'  aria-describedby=\"gfield_description_10_17\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_10_18\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Voc\u00ea j\u00e1 foi diagnosticado com febre reum\u00e1tica?<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_10_18'>\n\t\t\t<div class='gchoice gchoice_10_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Yes'  id='choice_10_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_18_0' id='label_10_18_0'>Sim<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='No'  id='choice_10_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_18_1' id='label_10_18_1'>N\u00e3o<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_20\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Seu filho j\u00e1 foi diagnosticado com febre reum\u00e1tica?<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_10_20'>\n\t\t\t<div class='gchoice gchoice_10_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Yes'  id='choice_10_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_20_0' id='label_10_20_0'>Sim<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No'  id='choice_10_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_20_1' id='label_10_20_1'>N\u00e3o<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_21\" class=\"gfield gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Anemia falciforme (ou tra\u00e7o falciforme)?<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_10_21'>\n\t\t\t<div class='gchoice gchoice_10_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No'  id='choice_10_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_21_0' id='label_10_21_0'>Nenhum<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Sickle Cell Trait'  id='choice_10_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_21_1' id='label_10_21_1'>Tra\u00e7o Falciforme<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_21_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Sickle Cell Anemia'  id='choice_10_21_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_21_2' id='label_10_21_2'>Anemia falciforme<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div class=\"spacer gfield\" style=\"grid-column: span 6;\"><\/div><div id=\"field_10_25\" class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_25' >Outros problemas de sa\u00fade<\/label><div class='gfield_description' id='gfield_description_10_25'>Use o espa\u00e7o a seguir para listar quaisquer outros problemas de sa\u00fade graves que seu filho teve ou est\u00e1 enfrentando no momento. Deixe em branco se n\u00e3o houver<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_10_25' class='textarea medium'  aria-describedby=\"gfield_description_10_25\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_10_24\" class=\"gfield gfield--width-full field_sublabel_below field_description_above gfield_visibility_visible\" ><label class='gfield_label' for='input_10_24' >Liste todos os medicamentos e suplementos atuais<\/label><div class='gfield_description' id='gfield_description_10_24'>Liste todos os medicamentos, rem\u00e9dios de venda livre ou suplementos de ervas que seu filho est\u00e1 tomando neste momento. Deixe em branco se n\u00e3o houver<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_10_24' class='textarea medium'  aria-describedby=\"gfield_description_10_24\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_10_55' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_10\").val(\"1\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_10\").val(\"1\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_10_55' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_10\").val(\"3\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_10\").val(\"3\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_10_26\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Informa\u00e7\u00f5es de Pagamento<\/h3><div class='gsection_description' id='gfield_description_10_26'>Escolha uma fonte de pagamento e preencha todos os campos abaixo.<\/div><\/div><fieldset id=\"field_10_72\" class=\"gfield gfield--width-third field_sublabel_below field_description_above gfield_visibility_visible\" ><legend class='gfield_label'  >Informa\u00e7\u00f5es de Pagamento<\/legend><div class='gfield_description' id='gfield_description_10_72'>Escolha Uma<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_72'>\n\t\t\t<div class='gchoice gchoice_10_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Medicaid'  id='choice_10_72_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_10_72\"   \/>\n\t\t\t\t\t<label for='choice_10_72_0' id='label_10_72_0'>Medicaid<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Medicaid and Insurance'  id='choice_10_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_72_1' id='label_10_72_1'>Seguro Privado y Medicaid<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_72_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Private Insurance'  id='choice_10_72_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_72_2' id='label_10_72_2'>Seguro Privado<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_72_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Self-pay\/no insurance'  id='choice_10_72_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_72_3' id='label_10_72_3'>Pagamento pr\u00f3prio\/sem seguro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div class=\"spacer gfield\" style=\"grid-column: span 8;\"><\/div><div id=\"field_10_71\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_71' >N\u00famero de identifica\u00e7\u00e3o do Medicaid<\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_10_71' type='text' value='' class='medium'  aria-describedby=\"gfield_description_10_71\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_10_71'>N\u00famero individual de 10 d\u00edgitos da CRIAN\u00c7A (N\u00c3O o n\u00famero do plano)<\/div><\/div><div id=\"field_10_61\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_hidden\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">Pai\/Respons\u00e1vel do Segurado<\/h3><\/div><fieldset id=\"field_10_58\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Nome<\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_10_58'>\n                            \n                            <span id='input_10_58_3_container' class='name_first' >\n                                                    <input type='text' name='input_58.3' id='input_10_58_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_10_58_3' >Nome<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_58_6_container' class='name_last' >\n                                                    <input type='text' name='input_58.6' id='input_10_58_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_10_58_6' >Sobrenome<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_63\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_63' >Nome da Companhia de Seguros Odontol\u00f3gicos<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_10_63' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_10_65\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_65' >Telefone da Companhia de Seguros Odontol\u00f3gicos<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_65' id='input_10_65' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_66\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_hidden\" ><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h3 class=\"gsection_title\">Empregador Segurado<\/h3><\/div><div id=\"field_10_148\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_148' >Empregador Segurado<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_10_148' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_10_67\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Endere\u00e7o do pai\/respons\u00e1vel segurado<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address' id='input_10_67' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_10_67_1_container' >\n                                        <input type='text' name='input_67.1' id='input_10_67_1' value=''   placeholder='Street 1' aria-required='true'    \/>\n                                        <label for='input_10_67_1' id='input_10_67_1_label' class='hidden_sub_label screen-reader-text'>Endere\u00e7o<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_10_67_2_container' >\n                                        <input type='text' name='input_67.2' id='input_10_67_2' value=''   placeholder='Street 2'  aria-required='false'   \/>\n                                        <label for='input_10_67_2' id='input_10_67_2_label' class='hidden_sub_label screen-reader-text'>Endere\u00e7o<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_10_67_3_container' >\n                                    <input type='text' name='input_67.3' id='input_10_67_3' value=''   placeholder='City' aria-required='true'    \/>\n                                    <label for='input_10_67_3' id='input_10_67_3_label' class='hidden_sub_label screen-reader-text'>Cidade<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_10_67_4_container' >\n                                        <select name='input_67.4' id='input_10_67_4'     aria-required='true'    ><option value='' selected='selected'>State<\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='Calif\u00f3rnia' >Calif\u00f3rnia<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='Distrito de Columbia' >Distrito de Columbia<\/option><option value='Fl\u00f3rida' >Fl\u00f3rida<\/option><option value='Georgia' >Georgia<\/option><option value='Hava\u00ed' >Hava\u00ed<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='Nova Hampshire' >Nova Hampshire<\/option><option value='Nova Jersey' >Nova Jersey<\/option><option value='Novo M\u00e9xico' >Novo M\u00e9xico<\/option><option value='Nova Iorque' >Nova Iorque<\/option><option value='Carolina do Norte' >Carolina do Norte<\/option><option value='Dakota do Norte' >Dakota do Norte<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='Carolina do Sul' >Carolina do Sul<\/option><option value='Dakota do Sul' >Dakota do Sul<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virg\u00ednia' >Virg\u00ednia<\/option><option value='Washington' >Washington<\/option><option value='Virg\u00ednia Ocidental' >Virg\u00ednia Ocidental<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='For\u00e7as Armadas das Am\u00e9ricas' >For\u00e7as Armadas das Am\u00e9ricas<\/option><option value='For\u00e7as Armadas da Europa' >For\u00e7as Armadas da Europa<\/option><option value='For\u00e7as Armadas do Pac\u00edfico' >For\u00e7as Armadas do Pac\u00edfico<\/option><\/select>\n                                        <label for='input_10_67_4' id='input_10_67_4_label' class='hidden_sub_label screen-reader-text'>Estado<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_10_67_5_container' >\n                                    <input type='text' name='input_67.5' id='input_10_67_5' value=''   placeholder='ZIP' aria-required='true'    \/>\n                                    <label for='input_10_67_5' id='input_10_67_5_label' class='hidden_sub_label screen-reader-text'>CEP<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_67.6' id='input_10_67_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_78\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_78' >N\u00famero da Previd\u00eancia Social Segurada<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_10_78' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_10_35\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_hidden_label field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Endere\u00e7o da Companhia de Seguros Odontol\u00f3gicos<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address' id='input_10_35' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_10_35_1_container' >\n                                        <input type='text' name='input_35.1' id='input_10_35_1' value=''   placeholder='Street' aria-required='true'    \/>\n                                        <label for='input_10_35_1' id='input_10_35_1_label' class='hidden_sub_label screen-reader-text'>Endere\u00e7o<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_10_35_3_container' >\n                                    <input type='text' name='input_35.3' id='input_10_35_3' value=''   placeholder='City' aria-required='true'    \/>\n                                    <label for='input_10_35_3' id='input_10_35_3_label' class='hidden_sub_label screen-reader-text'>Cidade<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_10_35_4_container' >\n                                        <select name='input_35.4' id='input_10_35_4'     aria-required='true'    ><option value='' selected='selected'>State<\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='Calif\u00f3rnia' >Calif\u00f3rnia<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='Distrito de Columbia' >Distrito de Columbia<\/option><option value='Fl\u00f3rida' >Fl\u00f3rida<\/option><option value='Georgia' >Georgia<\/option><option value='Hava\u00ed' >Hava\u00ed<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='Nova Hampshire' >Nova Hampshire<\/option><option value='Nova Jersey' >Nova Jersey<\/option><option value='Novo M\u00e9xico' >Novo M\u00e9xico<\/option><option value='Nova Iorque' >Nova Iorque<\/option><option value='Carolina do Norte' >Carolina do Norte<\/option><option value='Dakota do Norte' >Dakota do Norte<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='Carolina do Sul' >Carolina do Sul<\/option><option value='Dakota do Sul' >Dakota do Sul<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virg\u00ednia' >Virg\u00ednia<\/option><option value='Washington' >Washington<\/option><option value='Virg\u00ednia Ocidental' >Virg\u00ednia Ocidental<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='For\u00e7as Armadas das Am\u00e9ricas' >For\u00e7as Armadas das Am\u00e9ricas<\/option><option value='For\u00e7as Armadas da Europa' >For\u00e7as Armadas da Europa<\/option><option value='For\u00e7as Armadas do Pac\u00edfico' >For\u00e7as Armadas do Pac\u00edfico<\/option><\/select>\n                                        <label for='input_10_35_4' id='input_10_35_4_label' class='hidden_sub_label screen-reader-text'>Estado<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_10_35_5_container' >\n                                    <input type='text' name='input_35.5' id='input_10_35_5' value=''   placeholder='ZIP' aria-required='true'    \/>\n                                    <label for='input_10_35_5' id='input_10_35_5_label' class='hidden_sub_label screen-reader-text'>CEP<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_35.6' id='input_10_35_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_147\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_147' >N\u00famero de identifica\u00e7\u00e3o do seguro<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_10_147' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_10_79\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_79' >N\u00famero de identifica\u00e7\u00e3o do Grupo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_10_79' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_10_69\" class=\"gfield gfield--width-half gf_left_half gfield--width-half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >Data de nascimento do pai\/respons\u00e1vel do segurado<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_10_69' class='ginput_container ginput_complex'><div class='gfield_date_month ginput_container ginput_container_date' id='input_10_69_1_container'>\n                                            <input type='number'  name='input_69[]' id='input_10_69_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_10_69_1' class='screen-reader-text'>M\u00eas<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date' id='input_10_69_2_container'>\n                                            <input type='number'  name='input_69[]' id='input_10_69_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_10_69_2' class='screen-reader-text'>Dia<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date' id='input_10_69_3_container'>\n                                            <input type='number'  name='input_69[]' id='input_10_69_3' value=''   aria-required='true'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_10_69_3' class='screen-reader-text'>Ano<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div class=\"spacer gfield\" style=\"grid-column: span 6;\"><\/div><div id=\"field_10_37\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_37' >Fale conosco<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_37' id='input_10_37' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_80\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_80' >Especialistas em Promo\u00e7\u00e3o da Sa\u00fade<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_80' id='input_10_80' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_10_80\"  \/><\/div><div class='gfield_description' id='gfield_description_10_80'>Reconfirme o n\u00famero do seu celular; entraremos em contato antes do atendimento.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_10_74' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_10\").val(\"2\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_10\").val(\"2\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_10_74' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_10\").val(\"4\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_10\").val(\"4\");  jQuery(\"#gform_10\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_4' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_10_70\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Se\u00e7\u00e3o de Assinatura e Consentimento<\/h3><\/div><div id=\"field_10_44\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Responsabilidade dos pais<\/h3><div class='gsection_description' id='gfield_description_10_44'>Concordo em pagar pelos servi\u00e7os.\n <br> <p style=\"margin-left:5%; margin-right:5%;\">  \u2022  Limpeza dos dentes - 11 anos ou menos - $ 40,00, 12 anos ou mais - $ 54,00 \n <br>   \u2022 Verniz de fl\u00faor - $ 26,00 \n <br>   \u2022\u00a0Selantes (apenas dentes posteriores permanentes) - $ 32 por dente  \n <br>   \u2022 SDF (fl\u00faor de diamina de prata) - $ 15 por dente \n<br>   \u2022 \u2022 Obtura\u00e7\u00f5es terap\u00eauticas - $ 50 por dente <\/div><\/div><div id=\"field_10_38\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">Assinatura e Consentimento<\/h3><div class='gsection_description' id='gfield_description_10_38'>Solicito e autorizo a HPS, seus dentistas contratados e funcion\u00e1rios, devidamente licenciados como Doutores em Odontologia ou higienistas dent\u00e1rios licenciados, a realizar quaisquer procedimentos de diagn\u00f3stico, procedimentos preventivos ou procedimentos de tratamento em meu filho. Eu entendo que os servi\u00e7os preventivos n\u00e3o tomam o lugar de um exame por um dentista licenciado. \nEntendo que a aplica\u00e7\u00e3o de SDF (Fluoreto de diamina de prata) causar\u00e1 colora\u00e7\u00e3o escura da estrutura dent\u00e1ria infectada. \nEntendo que fotos dent\u00e1rias podem ser tiradas para fins educacionais. \nEntendo que, se meu filho n\u00e3o estiver inscrito no Medicaid, sou financeiramente respons\u00e1vel perante a HPS pelos servi\u00e7os prestados. \nAutorizo o pagamento dos benef\u00edcios do Medicaid ou do Seguro diretamente \u00e0 HPS e aos dentistas parceiros. \nSolicito e autorizo a divulga\u00e7\u00e3o de informa\u00e7\u00f5es neste formul\u00e1rio ou adquiridas no decorrer do tratamento para fins de pagamento ou encaminhamento, e a todo o pessoal escolar apropriado, conforme considerado necess\u00e1rio pela HPS. \n<br>\nDou permiss\u00e3o para que o relat\u00f3rio de comunica\u00e7\u00e3o e tratamento seja enviado por e-mail ou texto.\n<\/div><\/div><fieldset id=\"field_10_39\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >O nome impresso \u00e9 considerado assinatura legal.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_10_39'>\n                            \n                            <span id='input_10_39_3_container' class='name_first' >\n                                                    <input type='text' name='input_39.3' id='input_10_39_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_39_3' >Primeiro<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_39_6_container' class='name_last' >\n                                                    <input type='text' name='input_39.6' id='input_10_39_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_10_39_6' >\u00daltimo<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_41\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_41' >Assinatura Impressa<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_10_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_10_42\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_10_42' >Rela\u00e7\u00e3o com a crian\u00e7a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_10_42' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_10' class='gform_previous_button button' value='Previous'  onclick='if(window[\"gf_submitting_10\"]){return false;}  if( !jQuery(\"#gform_10\")[0].checkValidity || jQuery(\"#gform_10\")[0].checkValidity()){window[\"gf_submitting_10\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_10\"]){return false;} if( !jQuery(\"#gform_10\")[0].checkValidity || jQuery(\"#gform_10\")[0].checkValidity()){window[\"gf_submitting_10\"]=true;}  jQuery(\"#gform_10\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_10' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_10\"]){return false;}  if( !jQuery(\"#gform_10\")[0].checkValidity || jQuery(\"#gform_10\")[0].checkValidity()){window[\"gf_submitting_10\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_10\"]){return false;} if( !jQuery(\"#gform_10\")[0].checkValidity || jQuery(\"#gform_10\")[0].checkValidity()){window[\"gf_submitting_10\"]=true;}  jQuery(\"#gform_10\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_10' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='10' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_10' value='WyJ7XCI3MlwiOltcIjdlMDY1ZTAyYjU1YjBmOTcxNDUxN2MyYzZhNGEyNzMzXCIsXCJmMTEyNDUwMjlmOTk5ZDZhOTVmYThlMDA1ZWVkMWZkM1wiLFwiMWRkOWM3MDczY2VhODVlYTM0NDU5YWFiYjVkZjQ0ZTdcIixcIjhiZDBiMzgzZWZjZGY1Njg3NTUwMzE0ZGJkMTE2MjM4XCJdfSIsIjI2YjE2ZmRiOThhZTJlODM2ZWFmNmJjMDNiNWI0YzU3Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_10' id='gform_target_page_number_10' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_10' id='gform_source_page_number_10' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div>\n","protected":false},"excerpt":{"rendered":"Consentimento para Tratamento Este formul\u00e1rio nos d\u00e1 permiss\u00e3o para tratar seu filho. Os dados s\u00e3o mantidos em sigilo e usados apenas para tratamento e faturamento, de acordo com as leis estaduais e federais. Se as informa\u00e7\u00f5es mudarem antes do tratamento, entre em contato conosco. &quot;*&quot; indica campos obrigat\u00f3rios 1Se\u00e7\u00e3o de informa\u00e7\u00f5es do Aluno2Se\u00e7\u00e3o Medica3Se\u00e7\u00e3o de","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"footnotes":""},"class_list":["post-1224","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/pages\/1224","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/comments?post=1224"}],"version-history":[{"count":19,"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/pages\/1224\/revisions"}],"predecessor-version":[{"id":1766,"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/pages\/1224\/revisions\/1766"}],"wp:attachment":[{"href":"https:\/\/www.hps-sc.com\/pb\/wp-json\/wp\/v2\/media?parent=1224"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}