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Please complete in capital letter.<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_textbox" id="id_3"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top" id="label_3" for="input_3"> University of Newcastle </label><!-- [et_pb_line_break_holder] --> <div id="cid_3" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_3" name="q3_universityOf3" data-type="input-textbox" class="form-textbox" size="60" value="" data-component="textbox" aria-labelledby="label_3 sublabel_input_3" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_3" id="sublabel_input_3" style="min-height:13px"> ID </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li id="cid_4" class="form-input-wide" data-type="control_head"><!-- [et_pb_line_break_holder] --> <div class="form-header-group "><!-- [et_pb_line_break_holder] --> <div class="header-text httal htvam"><!-- [et_pb_line_break_holder] --> <h2 id="header_4" class="form-header" data-component="header"><!-- [et_pb_line_break_holder] --> Personal Details<!-- [et_pb_line_break_holder] --> </h2><!-- [et_pb_line_break_holder] --> <div id="subHeader_4" class="form-subHeader"><!-- [et_pb_line_break_holder] --> Section 1<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_number" id="id_14"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" 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aria-labelledby="label_5 sublabel_5_first" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="first_5" id="sublabel_5_first" style="min-height:13px"> Surname/family name </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="middle_5" name="q5_title[middle]" class="form-textbox" size="10" value="" data-component="middle" aria-labelledby="label_5 sublabel_5_middle" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="middle_5" id="sublabel_5_middle" style="min-height:13px"> Forenames (in full) </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="last_5" name="q5_title[last]" class="form-textbox" size="15" value="" data-component="last" aria-labelledby="label_5 sublabel_5_last" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="last_5" id="sublabel_5_last" style="min-height:13px"> Preferred first name </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_dropdown" id="id_6"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_6" for="input_6"> Gender </label><!-- [et_pb_line_break_holder] --> <div id="cid_6" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown" id="input_6" name="q6_gender" style="width:150px" data-component="dropdown" aria-labelledby="label_6"><!-- [et_pb_line_break_holder] --> <option value=""> </option><!-- [et_pb_line_break_holder] --> <option value="Male"> Male </option><!-- [et_pb_line_break_holder] --> <option value="Female"> Female </option><!-- [et_pb_line_break_holder] --> <option value="N/A"> N/A </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_datetime" id="id_7"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_7" for="month_7"> Date of birth </label><!-- [et_pb_line_break_holder] --> <div id="cid_7" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="month_7" name="q7_dateOf[month]" size="2" data-maxlength="2" value="09" aria-labelledby="label_7 sublabel_7_month" /><!-- [et_pb_line_break_holder] --> <span class="date-separate" aria-hidden="true"><!-- [et_pb_line_break_holder] --> /<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="month_7" id="sublabel_7_month" style="min-height:13px"> Month </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="day_7" name="q7_dateOf[day]" size="2" data-maxlength="2" value="19" aria-labelledby="label_7 sublabel_7_day" /><!-- [et_pb_line_break_holder] --> <span class="date-separate" aria-hidden="true"><!-- [et_pb_line_break_holder] --> /<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="day_7" id="sublabel_7_day" style="min-height:13px"> Day </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="year_7" name="q7_dateOf[year]" size="4" data-maxlength="4" value="2019" aria-labelledby="label_7 sublabel_7_year" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="year_7" id="sublabel_7_year" style="min-height:13px"> Year </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <img class="showAutoCalendar" alt="Pick a Date" id="input_7_pick" src="https://cdn.jotfor.ms/images/calendar.png" style="vertical-align:middle;margin-left:5px" data-component="datetime" aria-hidden="true" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_7_pick" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap"> Date Picker Icon </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_address" id="id_8"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top" id="label_8" for="input_8_addr_line1"> Home/permanent Correspondence address </label><!-- [et_pb_line_break_holder] --> <div id="cid_8" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <table summary="" class="form-address-table"><!-- [et_pb_line_break_holder] --> <tbody><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td colSpan="2"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_8_addr_line1" name="q8_homepermanentCorrespondence[addr_line1]" class="form-textbox form-address-line" autoComplete="address-line1" value="" data-component="address_line_1" aria-labelledby="label_8 sublabel_8_addr_line1" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_8_addr_line1" id="sublabel_8_addr_line1" style="min-height:13px"> Street Address </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td colSpan="2"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_8_addr_line2" name="q8_homepermanentCorrespondence[addr_line2]" class="form-textbox form-address-line" autoComplete="address-line2" size="46" value="" data-component="address_line_2" aria-labelledby="label_8 sublabel_8_addr_line2" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_8_addr_line2" id="sublabel_8_addr_line2" style="min-height:13px"> Street Address Line 2 </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_8_city" name="q8_homepermanentCorrespondence[city]" class="form-textbox form-address-city" autoComplete="address-level2" size="21" value="" data-component="city" aria-labelledby="label_8 sublabel_8_city" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_8_city" id="sublabel_8_city" style="min-height:13px"> City </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_8_state" name="q8_homepermanentCorrespondence[state]" class="form-textbox form-address-state" autoComplete="address-level1" size="22" value="" data-component="state" aria-labelledby="label_8 sublabel_8_state" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_8_state" id="sublabel_8_state" style="min-height:13px"> State / Province </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_8_postal" name="q8_homepermanentCorrespondence[postal]" class="form-textbox form-address-postal" autoComplete="postal-code" size="10" value="" data-component="zip" aria-labelledby="label_8 sublabel_8_postal" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_8_postal" id="sublabel_8_postal" style="min-height:13px"> Postal / Zip Code </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="display:none"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown form-address-country noTranslate" name="q8_homepermanentCorrespondence[country]" id="input_8_country" data-component="country" aria-labelledby="label_8 sublabel_8_country" autoComplete="new-password"><!-- [et_pb_line_break_holder] --> <option value=""> Please Select </option><!-- [et_pb_line_break_holder] --> <option value="United States"> United States </option><!-- [et_pb_line_break_holder] --> <option value="Afghanistan"> Afghanistan </option><!-- [et_pb_line_break_holder] --> <option value="Albania"> Albania </option><!-- [et_pb_line_break_holder] --> <option value="Algeria"> Algeria </option><!-- [et_pb_line_break_holder] --> <option value="American Samoa"> American Samoa </option><!-- [et_pb_line_break_holder] --> <option value="Andorra"> Andorra </option><!-- [et_pb_line_break_holder] --> <option value="Angola"> Angola </option><!-- [et_pb_line_break_holder] --> <option value="Anguilla"> Anguilla </option><!-- [et_pb_line_break_holder] --> <option value="Antigua and Barbuda"> Antigua and Barbuda </option><!-- [et_pb_line_break_holder] --> <option value="Argentina"> Argentina </option><!-- [et_pb_line_break_holder] --> <option value="Armenia"> Armenia </option><!-- [et_pb_line_break_holder] --> <option value="Aruba"> Aruba </option><!-- [et_pb_line_break_holder] --> <option value="Australia"> Australia </option><!-- [et_pb_line_break_holder] --> <option value="Austria"> Austria </option><!-- [et_pb_line_break_holder] --> <option value="Azerbaijan"> Azerbaijan </option><!-- [et_pb_line_break_holder] --> <option value="The Bahamas"> The Bahamas </option><!-- [et_pb_line_break_holder] --> <option value="Bahrain"> Bahrain </option><!-- [et_pb_line_break_holder] --> <option value="Bangladesh"> Bangladesh </option><!-- [et_pb_line_break_holder] --> <option value="Barbados"> Barbados </option><!-- [et_pb_line_break_holder] --> <option value="Belarus"> Belarus </option><!-- [et_pb_line_break_holder] --> <option value="Belgium"> Belgium </option><!-- [et_pb_line_break_holder] --> <option value="Belize"> Belize </option><!-- [et_pb_line_break_holder] --> <option value="Benin"> Benin </option><!-- [et_pb_line_break_holder] --> <option value="Bermuda"> Bermuda </option><!-- [et_pb_line_break_holder] --> <option value="Bhutan"> Bhutan </option><!-- [et_pb_line_break_holder] --> <option value="Bolivia"> Bolivia </option><!-- [et_pb_line_break_holder] --> <option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option><!-- [et_pb_line_break_holder] --> <option value="Botswana"> Botswana </option><!-- [et_pb_line_break_holder] --> <option value="Brazil"> Brazil </option><!-- [et_pb_line_break_holder] --> <option value="Brunei"> Brunei </option><!-- [et_pb_line_break_holder] --> <option value="Bulgaria"> Bulgaria </option><!-- [et_pb_line_break_holder] --> <option value="Burkina Faso"> Burkina Faso </option><!-- [et_pb_line_break_holder] --> <option value="Burundi"> Burundi </option><!-- [et_pb_line_break_holder] --> <option value="Cambodia"> Cambodia </option><!-- [et_pb_line_break_holder] --> <option value="Cameroon"> Cameroon </option><!-- [et_pb_line_break_holder] --> <option value="Canada"> Canada </option><!-- [et_pb_line_break_holder] --> <option value="Cape Verde"> Cape Verde </option><!-- [et_pb_line_break_holder] --> <option value="Cayman Islands"> Cayman Islands </option><!-- [et_pb_line_break_holder] --> <option value="Central African Republic"> Central African Republic </option><!-- [et_pb_line_break_holder] --> <option value="Chad"> Chad </option><!-- [et_pb_line_break_holder] --> <option value="Chile"> Chile </option><!-- [et_pb_line_break_holder] --> <option value="China"> China </option><!-- [et_pb_line_break_holder] --> <option value="Christmas Island"> Christmas Island </option><!-- [et_pb_line_break_holder] --> <option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option><!-- [et_pb_line_break_holder] --> <option value="Colombia"> Colombia </option><!-- [et_pb_line_break_holder] --> <option value="Comoros"> Comoros </option><!-- [et_pb_line_break_holder] --> <option value="Congo"> Congo </option><!-- [et_pb_line_break_holder] --> <option value="Cook Islands"> Cook Islands </option><!-- [et_pb_line_break_holder] --> <option value="Costa Rica"> Costa Rica </option><!-- [et_pb_line_break_holder] --> <option value="Cote d'Ivoire"> Cote d'Ivoire </option><!-- [et_pb_line_break_holder] --> <option value="Croatia"> Croatia </option><!-- [et_pb_line_break_holder] --> <option value="Cuba"> Cuba </option><!-- [et_pb_line_break_holder] --> <option value="Cyprus"> Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Czech Republic"> Czech Republic </option><!-- [et_pb_line_break_holder] --> <option value="Democratic Republic of the Congo"> Democratic Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Denmark"> Denmark </option><!-- [et_pb_line_break_holder] --> <option value="Djibouti"> Djibouti </option><!-- [et_pb_line_break_holder] --> <option value="Dominica"> Dominica </option><!-- [et_pb_line_break_holder] --> <option value="Dominican Republic"> Dominican Republic </option><!-- [et_pb_line_break_holder] --> <option value="Ecuador"> Ecuador </option><!-- [et_pb_line_break_holder] --> <option value="Egypt"> Egypt </option><!-- [et_pb_line_break_holder] --> <option value="El Salvador"> El Salvador </option><!-- [et_pb_line_break_holder] --> <option value="Equatorial Guinea"> Equatorial Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Eritrea"> Eritrea </option><!-- [et_pb_line_break_holder] --> <option value="Estonia"> Estonia </option><!-- [et_pb_line_break_holder] --> <option value="Ethiopia"> Ethiopia </option><!-- [et_pb_line_break_holder] --> <option value="Falkland Islands"> Falkland Islands </option><!-- [et_pb_line_break_holder] --> <option value="Faroe Islands"> Faroe Islands </option><!-- [et_pb_line_break_holder] --> <option value="Fiji"> Fiji </option><!-- [et_pb_line_break_holder] --> <option value="Finland"> Finland </option><!-- [et_pb_line_break_holder] --> <option value="France"> France </option><!-- [et_pb_line_break_holder] --> <option value="French Polynesia"> French Polynesia </option><!-- [et_pb_line_break_holder] --> <option value="Gabon"> Gabon </option><!-- [et_pb_line_break_holder] --> <option value="The Gambia"> The Gambia </option><!-- [et_pb_line_break_holder] --> <option value="Georgia"> Georgia </option><!-- [et_pb_line_break_holder] --> <option value="Germany"> Germany </option><!-- [et_pb_line_break_holder] --> <option value="Ghana"> Ghana </option><!-- [et_pb_line_break_holder] --> <option value="Gibraltar"> Gibraltar </option><!-- [et_pb_line_break_holder] --> <option value="Greece"> Greece </option><!-- [et_pb_line_break_holder] --> <option value="Greenland"> Greenland </option><!-- [et_pb_line_break_holder] --> <option value="Grenada"> Grenada </option><!-- [et_pb_line_break_holder] --> <option value="Guadeloupe"> Guadeloupe </option><!-- [et_pb_line_break_holder] --> <option value="Guam"> Guam </option><!-- [et_pb_line_break_holder] --> <option value="Guatemala"> Guatemala </option><!-- [et_pb_line_break_holder] --> <option value="Guernsey"> Guernsey </option><!-- [et_pb_line_break_holder] --> <option value="Guinea"> Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Guinea-Bissau"> Guinea-Bissau </option><!-- [et_pb_line_break_holder] --> <option value="Guyana"> Guyana </option><!-- [et_pb_line_break_holder] --> <option value="Haiti"> Haiti </option><!-- [et_pb_line_break_holder] --> <option value="Honduras"> Honduras </option><!-- [et_pb_line_break_holder] --> <option value="Hong Kong"> Hong Kong </option><!-- [et_pb_line_break_holder] --> <option value="Hungary"> Hungary </option><!-- [et_pb_line_break_holder] --> <option value="Iceland"> Iceland </option><!-- [et_pb_line_break_holder] --> <option value="India"> India </option><!-- [et_pb_line_break_holder] --> <option value="Indonesia"> Indonesia </option><!-- [et_pb_line_break_holder] --> <option value="Iran"> Iran </option><!-- [et_pb_line_break_holder] --> <option value="Iraq"> Iraq </option><!-- [et_pb_line_break_holder] --> <option value="Ireland"> Ireland </option><!-- [et_pb_line_break_holder] --> <option value="Israel"> Israel </option><!-- [et_pb_line_break_holder] --> <option value="Italy"> Italy </option><!-- [et_pb_line_break_holder] --> <option value="Jamaica"> Jamaica </option><!-- [et_pb_line_break_holder] --> <option value="Japan"> Japan </option><!-- [et_pb_line_break_holder] --> <option value="Jersey"> Jersey </option><!-- [et_pb_line_break_holder] --> <option value="Jordan"> Jordan </option><!-- [et_pb_line_break_holder] --> <option value="Kazakhstan"> Kazakhstan </option><!-- [et_pb_line_break_holder] --> <option value="Kenya"> Kenya </option><!-- [et_pb_line_break_holder] --> <option value="Kiribati"> Kiribati </option><!-- [et_pb_line_break_holder] --> <option value="North Korea"> North Korea </option><!-- [et_pb_line_break_holder] --> <option value="South Korea"> South Korea </option><!-- [et_pb_line_break_holder] --> <option value="Kosovo"> Kosovo </option><!-- [et_pb_line_break_holder] --> <option value="Kuwait"> Kuwait </option><!-- [et_pb_line_break_holder] --> <option value="Kyrgyzstan"> Kyrgyzstan </option><!-- [et_pb_line_break_holder] --> <option value="Laos"> Laos </option><!-- [et_pb_line_break_holder] --> <option value="Latvia"> Latvia </option><!-- [et_pb_line_break_holder] --> <option value="Lebanon"> Lebanon </option><!-- [et_pb_line_break_holder] --> <option value="Lesotho"> Lesotho </option><!-- [et_pb_line_break_holder] --> <option value="Liberia"> Liberia </option><!-- [et_pb_line_break_holder] --> <option value="Libya"> Libya </option><!-- [et_pb_line_break_holder] --> <option value="Liechtenstein"> Liechtenstein </option><!-- [et_pb_line_break_holder] --> <option value="Lithuania"> Lithuania </option><!-- [et_pb_line_break_holder] --> <option value="Luxembourg"> Luxembourg </option><!-- [et_pb_line_break_holder] --> <option value="Macau"> Macau </option><!-- [et_pb_line_break_holder] --> <option value="Macedonia"> Macedonia </option><!-- [et_pb_line_break_holder] --> <option value="Madagascar"> Madagascar </option><!-- [et_pb_line_break_holder] --> <option value="Malawi"> Malawi </option><!-- [et_pb_line_break_holder] --> <option value="Malaysia"> Malaysia </option><!-- [et_pb_line_break_holder] --> <option value="Maldives"> Maldives </option><!-- [et_pb_line_break_holder] --> <option value="Mali"> Mali </option><!-- [et_pb_line_break_holder] --> <option value="Malta"> Malta </option><!-- [et_pb_line_break_holder] --> <option value="Marshall Islands"> Marshall Islands </option><!-- [et_pb_line_break_holder] --> <option value="Martinique"> Martinique </option><!-- [et_pb_line_break_holder] --> <option value="Mauritania"> Mauritania </option><!-- [et_pb_line_break_holder] --> <option value="Mauritius"> Mauritius </option><!-- [et_pb_line_break_holder] --> <option value="Mayotte"> Mayotte </option><!-- [et_pb_line_break_holder] --> <option value="Mexico"> Mexico </option><!-- [et_pb_line_break_holder] --> <option value="Micronesia"> Micronesia </option><!-- [et_pb_line_break_holder] --> <option value="Moldova"> Moldova </option><!-- [et_pb_line_break_holder] --> <option value="Monaco"> Monaco </option><!-- [et_pb_line_break_holder] --> <option value="Mongolia"> Mongolia </option><!-- [et_pb_line_break_holder] --> <option value="Montenegro"> Montenegro </option><!-- [et_pb_line_break_holder] --> <option value="Montserrat"> Montserrat </option><!-- [et_pb_line_break_holder] --> <option value="Morocco"> Morocco </option><!-- [et_pb_line_break_holder] --> <option value="Mozambique"> Mozambique </option><!-- [et_pb_line_break_holder] --> <option value="Myanmar"> Myanmar </option><!-- [et_pb_line_break_holder] --> <option value="Nagorno-Karabakh"> Nagorno-Karabakh </option><!-- [et_pb_line_break_holder] --> <option value="Namibia"> Namibia </option><!-- [et_pb_line_break_holder] --> <option value="Nauru"> Nauru </option><!-- [et_pb_line_break_holder] --> <option value="Nepal"> Nepal </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands"> Netherlands </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands Antilles"> Netherlands Antilles </option><!-- [et_pb_line_break_holder] --> <option value="New Caledonia"> New Caledonia </option><!-- [et_pb_line_break_holder] --> <option value="New Zealand"> New Zealand </option><!-- [et_pb_line_break_holder] --> <option value="Nicaragua"> Nicaragua </option><!-- [et_pb_line_break_holder] --> <option value="Niger"> Niger </option><!-- [et_pb_line_break_holder] --> <option value="Nigeria"> Nigeria </option><!-- [et_pb_line_break_holder] --> <option value="Niue"> Niue </option><!-- [et_pb_line_break_holder] --> <option value="Norfolk Island"> Norfolk Island </option><!-- [et_pb_line_break_holder] --> <option value="Turkish Republic of Northern Cyprus"> Turkish Republic of Northern Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Northern Mariana"> Northern Mariana </option><!-- [et_pb_line_break_holder] --> <option value="Norway"> Norway </option><!-- [et_pb_line_break_holder] --> <option value="Oman"> Oman </option><!-- [et_pb_line_break_holder] --> <option value="Pakistan"> Pakistan </option><!-- [et_pb_line_break_holder] --> <option value="Palau"> Palau </option><!-- [et_pb_line_break_holder] --> <option value="Palestine"> Palestine </option><!-- [et_pb_line_break_holder] --> <option value="Panama"> Panama </option><!-- [et_pb_line_break_holder] --> <option value="Papua New Guinea"> Papua New Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Paraguay"> Paraguay </option><!-- [et_pb_line_break_holder] --> <option value="Peru"> Peru </option><!-- [et_pb_line_break_holder] --> <option value="Philippines"> Philippines </option><!-- [et_pb_line_break_holder] --> <option value="Pitcairn Islands"> Pitcairn Islands </option><!-- [et_pb_line_break_holder] --> <option value="Poland"> Poland </option><!-- [et_pb_line_break_holder] --> <option value="Portugal"> Portugal </option><!-- [et_pb_line_break_holder] --> <option value="Puerto Rico"> Puerto Rico </option><!-- [et_pb_line_break_holder] --> <option value="Qatar"> Qatar </option><!-- [et_pb_line_break_holder] --> <option value="Republic of the Congo"> Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Romania"> Romania </option><!-- [et_pb_line_break_holder] --> <option value="Russia"> Russia </option><!-- [et_pb_line_break_holder] --> <option value="Rwanda"> Rwanda </option><!-- [et_pb_line_break_holder] --> <option value="Saint Barthelemy"> Saint Barthelemy </option><!-- [et_pb_line_break_holder] --> <option value="Saint Helena"> Saint Helena </option><!-- [et_pb_line_break_holder] --> <option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option><!-- [et_pb_line_break_holder] --> <option value="Saint Lucia"> Saint Lucia </option><!-- [et_pb_line_break_holder] --> <option value="Saint Martin"> Saint Martin </option><!-- [et_pb_line_break_holder] --> <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option><!-- [et_pb_line_break_holder] --> <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option><!-- [et_pb_line_break_holder] --> <option value="Samoa"> Samoa </option><!-- [et_pb_line_break_holder] --> <option value="San Marino"> San Marino </option><!-- [et_pb_line_break_holder] --> <option value="Sao Tome and Principe"> Sao Tome and Principe </option><!-- [et_pb_line_break_holder] --> <option value="Saudi Arabia"> Saudi Arabia </option><!-- [et_pb_line_break_holder] --> <option value="Senegal"> Senegal </option><!-- [et_pb_line_break_holder] --> <option value="Serbia"> Serbia </option><!-- [et_pb_line_break_holder] --> <option value="Seychelles"> Seychelles </option><!-- [et_pb_line_break_holder] --> <option value="Sierra Leone"> Sierra Leone </option><!-- [et_pb_line_break_holder] --> <option value="Singapore"> Singapore </option><!-- [et_pb_line_break_holder] --> <option value="Slovakia"> Slovakia </option><!-- [et_pb_line_break_holder] --> <option value="Slovenia"> Slovenia </option><!-- [et_pb_line_break_holder] --> <option value="Solomon Islands"> Solomon Islands </option><!-- [et_pb_line_break_holder] --> <option value="Somalia"> Somalia </option><!-- [et_pb_line_break_holder] --> <option value="Somaliland"> Somaliland </option><!-- [et_pb_line_break_holder] --> <option value="South Africa"> South Africa </option><!-- [et_pb_line_break_holder] --> <option value="South Ossetia"> South Ossetia </option><!-- [et_pb_line_break_holder] --> <option value="South Sudan"> South Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Spain"> Spain </option><!-- [et_pb_line_break_holder] --> <option value="Sri Lanka"> Sri Lanka </option><!-- [et_pb_line_break_holder] --> <option value="Sudan"> Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Suriname"> Suriname </option><!-- [et_pb_line_break_holder] --> <option value="Svalbard"> Svalbard </option><!-- [et_pb_line_break_holder] --> <option value="eSwatini"> eSwatini </option><!-- [et_pb_line_break_holder] --> <option value="Sweden"> Sweden </option><!-- [et_pb_line_break_holder] --> <option value="Switzerland"> Switzerland </option><!-- [et_pb_line_break_holder] --> <option value="Syria"> Syria </option><!-- [et_pb_line_break_holder] --> <option value="Taiwan"> Taiwan </option><!-- [et_pb_line_break_holder] --> <option value="Tajikistan"> Tajikistan </option><!-- [et_pb_line_break_holder] --> <option value="Tanzania"> Tanzania </option><!-- [et_pb_line_break_holder] --> <option value="Thailand"> Thailand </option><!-- [et_pb_line_break_holder] --> <option value="Timor-Leste"> Timor-Leste </option><!-- [et_pb_line_break_holder] --> <option value="Togo"> Togo </option><!-- [et_pb_line_break_holder] --> <option value="Tokelau"> Tokelau </option><!-- [et_pb_line_break_holder] --> <option value="Tonga"> Tonga </option><!-- [et_pb_line_break_holder] --> <option value="Transnistria Pridnestrovie"> Transnistria Pridnestrovie </option><!-- [et_pb_line_break_holder] --> <option value="Trinidad and Tobago"> Trinidad and Tobago </option><!-- [et_pb_line_break_holder] --> <option value="Tristan da Cunha"> Tristan da Cunha </option><!-- [et_pb_line_break_holder] --> <option value="Tunisia"> Tunisia </option><!-- [et_pb_line_break_holder] --> <option value="Turkey"> Turkey </option><!-- [et_pb_line_break_holder] --> <option value="Turkmenistan"> Turkmenistan </option><!-- [et_pb_line_break_holder] --> <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option><!-- [et_pb_line_break_holder] --> <option value="Tuvalu"> Tuvalu </option><!-- [et_pb_line_break_holder] --> <option value="Uganda"> Uganda </option><!-- [et_pb_line_break_holder] --> <option value="Ukraine"> Ukraine </option><!-- [et_pb_line_break_holder] --> <option value="United Arab Emirates"> United Arab Emirates </option><!-- [et_pb_line_break_holder] --> <option value="United Kingdom"> United Kingdom </option><!-- [et_pb_line_break_holder] --> <option value="Uruguay"> Uruguay </option><!-- [et_pb_line_break_holder] --> <option value="Uzbekistan"> Uzbekistan </option><!-- [et_pb_line_break_holder] --> <option value="Vanuatu"> Vanuatu </option><!-- [et_pb_line_break_holder] --> <option value="Vatican City"> Vatican City </option><!-- [et_pb_line_break_holder] --> <option value="Venezuela"> Venezuela </option><!-- [et_pb_line_break_holder] --> <option value="Vietnam"> Vietnam </option><!-- [et_pb_line_break_holder] --> <option value="British Virgin Islands"> British Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Isle of Man"> Isle of Man </option><!-- [et_pb_line_break_holder] --> <option value="US Virgin Islands"> US Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Wallis and Futuna"> Wallis and Futuna </option><!-- [et_pb_line_break_holder] --> <option value="Western Sahara"> Western Sahara </option><!-- [et_pb_line_break_holder] --> <option value="Yemen"> Yemen </option><!-- [et_pb_line_break_holder] --> <option value="Zambia"> Zambia </option><!-- [et_pb_line_break_holder] --> <option value="Zimbabwe"> Zimbabwe </option><!-- [et_pb_line_break_holder] --> <option value="other"> Other </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_8_country" id="sublabel_8_country" style="min-height:13px"> Country </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> </tbody><!-- [et_pb_line_break_holder] --> </table><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_phone" id="id_12"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_12" for="input_12_area"> Phone Number </label><!-- [et_pb_line_break_holder] --> <div id="cid_12" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" id="input_12_area" name="q12_phoneNumber[area]" class="form-textbox" size="6" value="" data-component="areaCode" aria-labelledby="label_12 sublabel_12_area" /><!-- [et_pb_line_break_holder] --> <span class="phone-separate" aria-hidden="true"><!-- [et_pb_line_break_holder] --> -<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_12_area" id="sublabel_12_area" style="min-height:13px"> Area Code </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" id="input_12_phone" name="q12_phoneNumber[phone]" class="form-textbox" size="12" value="" data-component="phone" aria-labelledby="label_12 sublabel_12_phone" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_12_phone" id="sublabel_12_phone" style="min-height:13px"> Phone Number </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li id="cid_13" class="form-input-wide" data-type="control_head"><!-- [et_pb_line_break_holder] --> <div class="form-header-group "><!-- [et_pb_line_break_holder] --> <div class="header-text httal htvam"><!-- [et_pb_line_break_holder] --> <h2 id="header_13" class="form-header" data-component="header"><!-- [et_pb_line_break_holder] --> Programme of Study<!-- [et_pb_line_break_holder] --> </h2><!-- [et_pb_line_break_holder] --> <div id="subHeader_13" class="form-subHeader"><!-- [et_pb_line_break_holder] --> Section 2<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_textbox" id="id_15"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_15" for="input_15"> Title of course applied for </label><!-- [et_pb_line_break_holder] --> <div id="cid_15" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_15" name="q15_titleOf" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_15 sublabel_input_15" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_15" id="sublabel_input_15" style="min-height:13px"> (e.g. Bachelor of Law) </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_dropdown" id="id_16"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_16" for="input_16"> Mode of study </label><!-- [et_pb_line_break_holder] --> <div id="cid_16" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown" id="input_16" name="q16_modeOf" style="width:150px" data-component="dropdown" aria-labelledby="label_16"><!-- [et_pb_line_break_holder] --> <option value=""> </option><!-- [et_pb_line_break_holder] --> <option value="Full Time"> Full Time </option><!-- [et_pb_line_break_holder] --> <option value="Part Time"> Part Time </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_datetime" id="id_17"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_17" for="lite_mode_17"> Start date </label><!-- [et_pb_line_break_holder] --> <div id="cid_17" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <div style="display:none"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="month_17" name="q17_startDate[month]" size="2" data-maxlength="2" value="" aria-labelledby="label_17 sublabel_17_month" /><!-- [et_pb_line_break_holder] --> <span class="date-separate" aria-hidden="true"><!-- [et_pb_line_break_holder] --> -<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="month_17" id="sublabel_17_month" style="min-height:13px"> Month </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="day_17" name="q17_startDate[day]" size="2" data-maxlength="2" value="" aria-labelledby="label_17 sublabel_17_day" /><!-- [et_pb_line_break_holder] --> <span class="date-separate" aria-hidden="true"><!-- [et_pb_line_break_holder] --> -<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="day_17" id="sublabel_17_day" style="min-height:13px"> Day </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="year_17" name="q17_startDate[year]" size="4" data-maxlength="4" value="" aria-labelledby="label_17 sublabel_17_year" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="year_17" id="sublabel_17_year" style="min-height:13px"> Year </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_17" size="12" data-maxlength="12" data-age="" value="" data-format="mmddyyyy" data-seperator="-" placeholder="mm-dd-yyyy" aria-labelledby="label_17 sublabel_17_litemode" /><!-- [et_pb_line_break_holder] --> <img alt="Pick a Date" id="input_17_pick" src="https://cdn.jotfor.ms/images/calendar.png" style="vertical-align:middle;margin-left:5px" data-component="datetime" aria-hidden="true" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="lite_mode_17" id="sublabel_17_litemode" style="min-height:13px"> Date </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_17_pick" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap"> Date Picker Icon </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_textbox" id="id_18"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_18" for="input_18"> Point of entry </label><!-- [et_pb_line_break_holder] --> <div id="cid_18" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_18" name="q18_pointOf" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_18" /><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_dropdown" id="id_19"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_19" for="input_19"> Location </label><!-- [et_pb_line_break_holder] --> <div id="cid_19" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown" id="input_19" name="q19_location" style="width:150px" data-component="dropdown" aria-labelledby="label_19"><!-- [et_pb_line_break_holder] --> <option value=""> </option><!-- [et_pb_line_break_holder] --> <option value="Distance learning"> Distance learning </option><!-- [et_pb_line_break_holder] --> <option value="Campus-based"> Campus-based </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_textbox" id="id_20"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_20" for="input_20"> Alternative choice </label><!-- [et_pb_line_break_holder] --> <div id="cid_20" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_20" name="q20_alternativeChoice" data-type="input-textbox" class="form-textbox" size="20" value="" data-component="textbox" aria-labelledby="label_20" /><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_dropdown" id="id_21"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_21" for="input_21"> Have you studied at the University of Newcastle previously? </label><!-- [et_pb_line_break_holder] --> <div id="cid_21" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown" id="input_21" name="q21_haveYou" style="width:150px" data-component="dropdown" aria-labelledby="label_21"><!-- [et_pb_line_break_holder] --> <option value=""> </option><!-- [et_pb_line_break_holder] --> <option value="Yes"> Yes </option><!-- [et_pb_line_break_holder] --> <option value="No"> No </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_matrix" id="id_22"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_22" for="input_22"> If yes, which course(s)? </label><!-- [et_pb_line_break_holder] --> <div id="cid_22" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <table summary="" cellPadding="4" cellSpacing="0" class="form-matrix-table" data-component="matrix"><!-- [et_pb_line_break_holder] --> <tbody><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th style="border:none"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_0"><!-- [et_pb_line_break_holder] --> <label id="label_22_col_0"> Year of leaving </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_1"><!-- [et_pb_line_break_holder] --> <label id="label_22_col_1"> Student number </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_22_row_0"> 1 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_0_0" class="form-textbox" size="5" name="q22_ifYes[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_0 label_22_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_0_1" class="form-textbox" size="5" name="q22_ifYes[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_0 label_22_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_22_row_1"> 2 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_1_0" class="form-textbox" size="5" name="q22_ifYes[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_1 label_22_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_1_1" class="form-textbox" size="5" name="q22_ifYes[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_1 label_22_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_22_row_2"> 3 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_2_0" class="form-textbox" size="5" name="q22_ifYes[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_2 label_22_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_2_1" class="form-textbox" size="5" name="q22_ifYes[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_2 label_22_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_22_row_3"> 4 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_3_0" class="form-textbox" size="5" name="q22_ifYes[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_3 label_22_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_22_3_1" class="form-textbox" size="5" name="q22_ifYes[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_22 label_22_row_3 label_22_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> </tbody><!-- [et_pb_line_break_holder] --> </table><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li id="cid_23" class="form-input-wide" data-type="control_head"><!-- [et_pb_line_break_holder] --> <div class="form-header-group "><!-- [et_pb_line_break_holder] --> <div class="header-text httal htvam"><!-- [et_pb_line_break_holder] --> <h2 id="header_23" class="form-header" data-component="header"><!-- [et_pb_line_break_holder] --> Residence<!-- [et_pb_line_break_holder] --> </h2><!-- [et_pb_line_break_holder] --> <div id="subHeader_23" class="form-subHeader"><!-- [et_pb_line_break_holder] --> Section 3<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_dropdown" id="id_24"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_24" for="input_24"> Nationality </label><!-- [et_pb_line_break_holder] --> <div id="cid_24" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown" id="input_24" name="q24_nationality" style="width:150px" data-component="dropdown" aria-labelledby="label_24 sublabel_input_24"><!-- [et_pb_line_break_holder] --> <option value=""> </option><!-- [et_pb_line_break_holder] --> <option value="United States"> United States </option><!-- [et_pb_line_break_holder] --> <option value="Afghanistan"> Afghanistan </option><!-- [et_pb_line_break_holder] --> <option value="Albania"> Albania </option><!-- [et_pb_line_break_holder] --> <option value="Algeria"> Algeria </option><!-- [et_pb_line_break_holder] --> <option value="American Samoa"> American Samoa </option><!-- [et_pb_line_break_holder] --> <option value="Andorra"> Andorra </option><!-- [et_pb_line_break_holder] --> <option value="Angola"> Angola </option><!-- [et_pb_line_break_holder] --> <option value="Anguilla"> Anguilla </option><!-- [et_pb_line_break_holder] --> <option value="Antigua and Barbuda"> Antigua and Barbuda </option><!-- [et_pb_line_break_holder] --> <option value="Argentina"> Argentina </option><!-- [et_pb_line_break_holder] --> <option value="Armenia"> Armenia </option><!-- [et_pb_line_break_holder] --> <option value="Aruba"> Aruba </option><!-- [et_pb_line_break_holder] --> <option value="Australia"> Australia </option><!-- [et_pb_line_break_holder] --> <option value="Austria"> Austria </option><!-- [et_pb_line_break_holder] --> <option value="Azerbaijan"> Azerbaijan </option><!-- [et_pb_line_break_holder] --> <option value="The Bahamas"> The Bahamas </option><!-- [et_pb_line_break_holder] --> <option value="Bahrain"> Bahrain </option><!-- [et_pb_line_break_holder] --> <option value="Bangladesh"> Bangladesh </option><!-- [et_pb_line_break_holder] --> <option value="Barbados"> Barbados </option><!-- [et_pb_line_break_holder] --> <option value="Belarus"> Belarus </option><!-- [et_pb_line_break_holder] --> <option value="Belgium"> Belgium </option><!-- [et_pb_line_break_holder] --> <option value="Belize"> Belize </option><!-- [et_pb_line_break_holder] --> <option value="Benin"> Benin </option><!-- [et_pb_line_break_holder] --> <option value="Bermuda"> Bermuda </option><!-- [et_pb_line_break_holder] --> <option value="Bhutan"> Bhutan </option><!-- [et_pb_line_break_holder] --> <option value="Bolivia"> Bolivia </option><!-- [et_pb_line_break_holder] --> <option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option><!-- [et_pb_line_break_holder] --> <option value="Botswana"> Botswana </option><!-- [et_pb_line_break_holder] --> <option value="Brazil"> Brazil </option><!-- [et_pb_line_break_holder] --> <option value="Brunei"> Brunei </option><!-- [et_pb_line_break_holder] --> <option value="Bulgaria"> Bulgaria </option><!-- [et_pb_line_break_holder] --> <option value="Burkina Faso"> Burkina Faso </option><!-- [et_pb_line_break_holder] --> <option value="Burundi"> Burundi </option><!-- [et_pb_line_break_holder] --> <option value="Cambodia"> Cambodia </option><!-- [et_pb_line_break_holder] --> <option value="Cameroon"> Cameroon </option><!-- [et_pb_line_break_holder] --> <option value="Canada"> Canada </option><!-- [et_pb_line_break_holder] --> <option value="Cape Verde"> Cape Verde </option><!-- [et_pb_line_break_holder] --> <option value="Cayman Islands"> Cayman Islands </option><!-- [et_pb_line_break_holder] --> <option value="Central African Republic"> Central African Republic </option><!-- [et_pb_line_break_holder] --> <option value="Chad"> Chad </option><!-- [et_pb_line_break_holder] --> <option value="Chile"> Chile </option><!-- [et_pb_line_break_holder] --> <option value="China"> China </option><!-- [et_pb_line_break_holder] --> <option value="Christmas Island"> Christmas Island </option><!-- [et_pb_line_break_holder] --> <option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option><!-- [et_pb_line_break_holder] --> <option value="Colombia"> Colombia </option><!-- [et_pb_line_break_holder] --> <option value="Comoros"> Comoros </option><!-- [et_pb_line_break_holder] --> <option value="Congo"> Congo </option><!-- [et_pb_line_break_holder] --> <option value="Cook Islands"> Cook Islands </option><!-- [et_pb_line_break_holder] --> <option value="Costa Rica"> Costa Rica </option><!-- [et_pb_line_break_holder] --> <option value="Cote d'Ivoire"> Cote d'Ivoire </option><!-- [et_pb_line_break_holder] --> <option value="Croatia"> Croatia </option><!-- [et_pb_line_break_holder] --> <option value="Cuba"> Cuba </option><!-- [et_pb_line_break_holder] --> <option value="Cyprus"> Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Czech Republic"> Czech Republic </option><!-- [et_pb_line_break_holder] --> <option value="Democratic Republic of the Congo"> Democratic Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Denmark"> Denmark </option><!-- [et_pb_line_break_holder] --> <option value="Djibouti"> Djibouti </option><!-- [et_pb_line_break_holder] --> <option value="Dominica"> Dominica </option><!-- [et_pb_line_break_holder] --> <option value="Dominican Republic"> Dominican Republic </option><!-- [et_pb_line_break_holder] --> <option value="Ecuador"> Ecuador </option><!-- [et_pb_line_break_holder] --> <option value="Egypt"> Egypt </option><!-- [et_pb_line_break_holder] --> <option value="El Salvador"> El Salvador </option><!-- [et_pb_line_break_holder] --> <option value="Equatorial Guinea"> Equatorial Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Eritrea"> Eritrea </option><!-- [et_pb_line_break_holder] --> <option value="Estonia"> Estonia </option><!-- [et_pb_line_break_holder] --> <option value="Ethiopia"> Ethiopia </option><!-- [et_pb_line_break_holder] --> <option value="Falkland Islands"> Falkland Islands </option><!-- [et_pb_line_break_holder] --> <option value="Faroe Islands"> Faroe Islands </option><!-- [et_pb_line_break_holder] --> <option value="Fiji"> Fiji </option><!-- [et_pb_line_break_holder] --> <option value="Finland"> Finland </option><!-- [et_pb_line_break_holder] --> <option value="France"> France </option><!-- [et_pb_line_break_holder] --> <option value="French Polynesia"> French Polynesia </option><!-- [et_pb_line_break_holder] --> <option value="Gabon"> Gabon </option><!-- [et_pb_line_break_holder] --> <option value="The Gambia"> The Gambia </option><!-- [et_pb_line_break_holder] --> <option value="Georgia"> Georgia </option><!-- [et_pb_line_break_holder] --> <option value="Germany"> Germany </option><!-- [et_pb_line_break_holder] --> <option value="Ghana"> Ghana </option><!-- [et_pb_line_break_holder] --> <option value="Gibraltar"> Gibraltar </option><!-- [et_pb_line_break_holder] --> <option value="Greece"> Greece </option><!-- [et_pb_line_break_holder] --> <option value="Greenland"> Greenland </option><!-- [et_pb_line_break_holder] --> <option value="Grenada"> Grenada </option><!-- [et_pb_line_break_holder] --> <option value="Guadeloupe"> Guadeloupe </option><!-- [et_pb_line_break_holder] --> <option value="Guam"> Guam </option><!-- [et_pb_line_break_holder] --> <option value="Guatemala"> Guatemala </option><!-- [et_pb_line_break_holder] --> <option value="Guernsey"> Guernsey </option><!-- [et_pb_line_break_holder] --> <option value="Guinea"> Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Guinea-Bissau"> Guinea-Bissau </option><!-- [et_pb_line_break_holder] --> <option value="Guyana"> Guyana </option><!-- [et_pb_line_break_holder] --> <option value="Haiti"> Haiti </option><!-- [et_pb_line_break_holder] --> <option value="Honduras"> Honduras </option><!-- [et_pb_line_break_holder] --> <option value="Hong Kong"> Hong Kong </option><!-- [et_pb_line_break_holder] --> <option value="Hungary"> Hungary </option><!-- [et_pb_line_break_holder] --> <option value="Iceland"> Iceland </option><!-- [et_pb_line_break_holder] --> <option value="India"> India </option><!-- [et_pb_line_break_holder] --> <option value="Indonesia"> Indonesia </option><!-- [et_pb_line_break_holder] --> <option value="Iran"> Iran </option><!-- [et_pb_line_break_holder] --> <option value="Iraq"> Iraq </option><!-- [et_pb_line_break_holder] --> <option value="Ireland"> Ireland </option><!-- [et_pb_line_break_holder] --> <option value="Israel"> Israel </option><!-- [et_pb_line_break_holder] --> <option value="Italy"> Italy </option><!-- [et_pb_line_break_holder] --> <option value="Jamaica"> Jamaica </option><!-- [et_pb_line_break_holder] --> <option value="Japan"> Japan </option><!-- [et_pb_line_break_holder] --> <option value="Jersey"> Jersey </option><!-- [et_pb_line_break_holder] --> <option value="Jordan"> Jordan </option><!-- [et_pb_line_break_holder] --> <option value="Kazakhstan"> Kazakhstan </option><!-- [et_pb_line_break_holder] --> <option value="Kenya"> Kenya </option><!-- [et_pb_line_break_holder] --> <option value="Kiribati"> Kiribati </option><!-- [et_pb_line_break_holder] --> <option value="North Korea"> North Korea </option><!-- [et_pb_line_break_holder] --> <option value="South Korea"> South Korea </option><!-- [et_pb_line_break_holder] --> <option value="Kosovo"> Kosovo </option><!-- [et_pb_line_break_holder] --> <option value="Kuwait"> Kuwait </option><!-- [et_pb_line_break_holder] --> <option value="Kyrgyzstan"> Kyrgyzstan </option><!-- [et_pb_line_break_holder] --> <option value="Laos"> Laos </option><!-- [et_pb_line_break_holder] --> <option value="Latvia"> Latvia </option><!-- [et_pb_line_break_holder] --> <option value="Lebanon"> Lebanon </option><!-- [et_pb_line_break_holder] --> <option value="Lesotho"> Lesotho </option><!-- [et_pb_line_break_holder] --> <option value="Liberia"> Liberia </option><!-- [et_pb_line_break_holder] --> <option value="Libya"> Libya </option><!-- [et_pb_line_break_holder] --> <option value="Liechtenstein"> Liechtenstein </option><!-- [et_pb_line_break_holder] --> <option value="Lithuania"> Lithuania </option><!-- [et_pb_line_break_holder] --> <option value="Luxembourg"> Luxembourg </option><!-- [et_pb_line_break_holder] --> <option value="Macau"> Macau </option><!-- [et_pb_line_break_holder] --> <option value="Macedonia"> Macedonia </option><!-- [et_pb_line_break_holder] --> <option value="Madagascar"> Madagascar </option><!-- [et_pb_line_break_holder] --> <option value="Malawi"> Malawi </option><!-- [et_pb_line_break_holder] --> <option value="Malaysia"> Malaysia </option><!-- [et_pb_line_break_holder] --> <option value="Maldives"> Maldives </option><!-- [et_pb_line_break_holder] --> <option value="Mali"> Mali </option><!-- [et_pb_line_break_holder] --> <option value="Malta"> Malta </option><!-- [et_pb_line_break_holder] --> <option value="Marshall Islands"> Marshall Islands </option><!-- [et_pb_line_break_holder] --> <option value="Martinique"> Martinique </option><!-- [et_pb_line_break_holder] --> <option value="Mauritania"> Mauritania </option><!-- [et_pb_line_break_holder] --> <option value="Mauritius"> Mauritius </option><!-- [et_pb_line_break_holder] --> <option value="Mayotte"> Mayotte </option><!-- [et_pb_line_break_holder] --> <option value="Mexico"> Mexico </option><!-- [et_pb_line_break_holder] --> <option value="Micronesia"> Micronesia </option><!-- [et_pb_line_break_holder] --> <option value="Moldova"> Moldova </option><!-- [et_pb_line_break_holder] --> <option value="Monaco"> Monaco </option><!-- [et_pb_line_break_holder] --> <option value="Mongolia"> Mongolia </option><!-- [et_pb_line_break_holder] --> <option value="Montenegro"> Montenegro </option><!-- [et_pb_line_break_holder] --> <option value="Montserrat"> Montserrat </option><!-- [et_pb_line_break_holder] --> <option value="Morocco"> Morocco </option><!-- [et_pb_line_break_holder] --> <option value="Mozambique"> Mozambique </option><!-- [et_pb_line_break_holder] --> <option value="Myanmar"> Myanmar </option><!-- [et_pb_line_break_holder] --> <option value="Nagorno-Karabakh"> Nagorno-Karabakh </option><!-- [et_pb_line_break_holder] --> <option value="Namibia"> Namibia </option><!-- [et_pb_line_break_holder] --> <option value="Nauru"> Nauru </option><!-- [et_pb_line_break_holder] --> <option value="Nepal"> Nepal </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands"> Netherlands </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands Antilles"> Netherlands Antilles </option><!-- [et_pb_line_break_holder] --> <option value="New Caledonia"> New Caledonia </option><!-- [et_pb_line_break_holder] --> <option value="New Zealand"> New Zealand </option><!-- [et_pb_line_break_holder] --> <option value="Nicaragua"> Nicaragua </option><!-- [et_pb_line_break_holder] --> <option value="Niger"> Niger </option><!-- [et_pb_line_break_holder] --> <option value="Nigeria"> Nigeria </option><!-- [et_pb_line_break_holder] --> <option value="Niue"> Niue </option><!-- [et_pb_line_break_holder] --> <option value="Norfolk Island"> Norfolk Island </option><!-- [et_pb_line_break_holder] --> <option value="Turkish Republic of Northern Cyprus"> Turkish Republic of Northern Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Northern Mariana"> Northern Mariana </option><!-- [et_pb_line_break_holder] --> <option value="Norway"> Norway </option><!-- [et_pb_line_break_holder] --> <option value="Oman"> Oman </option><!-- [et_pb_line_break_holder] --> <option value="Pakistan"> Pakistan </option><!-- [et_pb_line_break_holder] --> <option value="Palau"> Palau </option><!-- [et_pb_line_break_holder] --> <option value="Palestine"> Palestine </option><!-- [et_pb_line_break_holder] --> <option value="Panama"> Panama </option><!-- [et_pb_line_break_holder] --> <option value="Papua New Guinea"> Papua New Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Paraguay"> Paraguay </option><!-- [et_pb_line_break_holder] --> <option value="Peru"> Peru </option><!-- [et_pb_line_break_holder] --> <option value="Philippines"> Philippines </option><!-- [et_pb_line_break_holder] --> <option value="Pitcairn Islands"> Pitcairn Islands </option><!-- [et_pb_line_break_holder] --> <option value="Poland"> Poland </option><!-- [et_pb_line_break_holder] --> <option value="Portugal"> Portugal </option><!-- [et_pb_line_break_holder] --> <option value="Puerto Rico"> Puerto Rico </option><!-- [et_pb_line_break_holder] --> <option value="Qatar"> Qatar </option><!-- [et_pb_line_break_holder] --> <option value="Republic of the Congo"> Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Romania"> Romania </option><!-- [et_pb_line_break_holder] --> <option value="Russia"> Russia </option><!-- [et_pb_line_break_holder] --> <option value="Rwanda"> Rwanda </option><!-- [et_pb_line_break_holder] --> <option value="Saint Barthelemy"> Saint Barthelemy </option><!-- [et_pb_line_break_holder] --> <option value="Saint Helena"> Saint Helena </option><!-- [et_pb_line_break_holder] --> <option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option><!-- [et_pb_line_break_holder] --> <option value="Saint Lucia"> Saint Lucia </option><!-- [et_pb_line_break_holder] --> <option value="Saint Martin"> Saint Martin </option><!-- [et_pb_line_break_holder] --> <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option><!-- [et_pb_line_break_holder] --> <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option><!-- [et_pb_line_break_holder] --> <option value="Samoa"> Samoa </option><!-- [et_pb_line_break_holder] --> <option value="San Marino"> San Marino </option><!-- [et_pb_line_break_holder] --> <option value="Sao Tome and Principe"> Sao Tome and Principe </option><!-- [et_pb_line_break_holder] --> <option value="Saudi Arabia"> Saudi Arabia </option><!-- [et_pb_line_break_holder] --> <option value="Senegal"> Senegal </option><!-- [et_pb_line_break_holder] --> <option value="Serbia"> Serbia </option><!-- [et_pb_line_break_holder] --> <option value="Seychelles"> Seychelles </option><!-- [et_pb_line_break_holder] --> <option value="Sierra Leone"> Sierra Leone </option><!-- [et_pb_line_break_holder] --> <option value="Singapore"> Singapore </option><!-- [et_pb_line_break_holder] --> <option value="Slovakia"> Slovakia </option><!-- [et_pb_line_break_holder] --> <option value="Slovenia"> Slovenia </option><!-- [et_pb_line_break_holder] --> <option value="Solomon Islands"> Solomon Islands </option><!-- [et_pb_line_break_holder] --> <option value="Somalia"> Somalia </option><!-- [et_pb_line_break_holder] --> <option value="Somaliland"> Somaliland </option><!-- [et_pb_line_break_holder] --> <option value="South Africa"> South Africa </option><!-- [et_pb_line_break_holder] --> <option value="South Ossetia"> South Ossetia </option><!-- [et_pb_line_break_holder] --> <option value="South Sudan"> South Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Spain"> Spain </option><!-- [et_pb_line_break_holder] --> <option value="Sri Lanka"> Sri Lanka </option><!-- [et_pb_line_break_holder] --> <option value="Sudan"> Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Suriname"> Suriname </option><!-- [et_pb_line_break_holder] --> <option value="Svalbard"> Svalbard </option><!-- [et_pb_line_break_holder] --> <option value="eSwatini"> eSwatini </option><!-- [et_pb_line_break_holder] --> <option value="Sweden"> Sweden </option><!-- [et_pb_line_break_holder] --> <option value="Switzerland"> Switzerland </option><!-- [et_pb_line_break_holder] --> <option value="Syria"> Syria </option><!-- [et_pb_line_break_holder] --> <option value="Taiwan"> Taiwan </option><!-- [et_pb_line_break_holder] --> <option value="Tajikistan"> Tajikistan </option><!-- [et_pb_line_break_holder] --> <option value="Tanzania"> Tanzania </option><!-- [et_pb_line_break_holder] --> <option value="Thailand"> Thailand </option><!-- [et_pb_line_break_holder] --> <option value="Timor-Leste"> Timor-Leste </option><!-- [et_pb_line_break_holder] --> <option value="Togo"> Togo </option><!-- [et_pb_line_break_holder] --> <option value="Tokelau"> Tokelau </option><!-- [et_pb_line_break_holder] --> <option value="Tonga"> Tonga </option><!-- [et_pb_line_break_holder] --> <option value="Transnistria Pridnestrovie"> Transnistria Pridnestrovie </option><!-- [et_pb_line_break_holder] --> <option value="Trinidad and Tobago"> Trinidad and Tobago </option><!-- [et_pb_line_break_holder] --> <option value="Tristan da Cunha"> Tristan da Cunha </option><!-- [et_pb_line_break_holder] --> <option value="Tunisia"> Tunisia </option><!-- [et_pb_line_break_holder] --> <option value="Turkey"> Turkey </option><!-- [et_pb_line_break_holder] --> <option value="Turkmenistan"> Turkmenistan </option><!-- [et_pb_line_break_holder] --> <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option><!-- [et_pb_line_break_holder] --> <option value="Tuvalu"> Tuvalu </option><!-- [et_pb_line_break_holder] --> <option value="Uganda"> Uganda </option><!-- [et_pb_line_break_holder] --> <option value="Ukraine"> Ukraine </option><!-- [et_pb_line_break_holder] --> <option value="United Arab Emirates"> United Arab Emirates </option><!-- [et_pb_line_break_holder] --> <option value="United Kingdom"> United Kingdom </option><!-- [et_pb_line_break_holder] --> <option value="Uruguay"> Uruguay </option><!-- [et_pb_line_break_holder] --> <option value="Uzbekistan"> Uzbekistan </option><!-- [et_pb_line_break_holder] --> <option value="Vanuatu"> Vanuatu </option><!-- [et_pb_line_break_holder] --> <option value="Vatican City"> Vatican City </option><!-- [et_pb_line_break_holder] --> <option value="Venezuela"> Venezuela </option><!-- [et_pb_line_break_holder] --> <option value="Vietnam"> Vietnam </option><!-- [et_pb_line_break_holder] --> <option value="British Virgin Islands"> British Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Isle of Man"> Isle of Man </option><!-- [et_pb_line_break_holder] --> <option value="US Virgin Islands"> US Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Wallis and Futuna"> Wallis and Futuna </option><!-- [et_pb_line_break_holder] --> <option value="Western Sahara"> Western Sahara </option><!-- [et_pb_line_break_holder] --> <option value="Yemen"> Yemen </option><!-- [et_pb_line_break_holder] --> <option value="Zambia"> Zambia </option><!-- [et_pb_line_break_holder] --> <option value="Zimbabwe"> Zimbabwe </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_24" id="sublabel_input_24" style="min-height:13px"> (as stated in your passport) </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_dropdown" id="id_25"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_25" for="input_25"> Country of birth </label><!-- [et_pb_line_break_holder] --> <div id="cid_25" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown" id="input_25" name="q25_countryOf" style="width:150px" data-component="dropdown" aria-labelledby="label_25"><!-- [et_pb_line_break_holder] --> <option value=""> </option><!-- [et_pb_line_break_holder] --> <option value="United States"> United States </option><!-- [et_pb_line_break_holder] --> <option value="Afghanistan"> Afghanistan </option><!-- [et_pb_line_break_holder] --> <option value="Albania"> Albania </option><!-- [et_pb_line_break_holder] --> <option value="Algeria"> Algeria </option><!-- [et_pb_line_break_holder] --> <option value="American Samoa"> American Samoa </option><!-- [et_pb_line_break_holder] --> <option value="Andorra"> Andorra </option><!-- [et_pb_line_break_holder] --> <option value="Angola"> Angola </option><!-- [et_pb_line_break_holder] --> <option value="Anguilla"> Anguilla </option><!-- [et_pb_line_break_holder] --> <option value="Antigua and Barbuda"> Antigua and Barbuda </option><!-- [et_pb_line_break_holder] --> <option value="Argentina"> Argentina </option><!-- [et_pb_line_break_holder] --> <option value="Armenia"> Armenia </option><!-- [et_pb_line_break_holder] --> <option value="Aruba"> Aruba </option><!-- [et_pb_line_break_holder] --> <option value="Australia"> Australia </option><!-- [et_pb_line_break_holder] --> <option value="Austria"> Austria </option><!-- [et_pb_line_break_holder] --> <option value="Azerbaijan"> Azerbaijan </option><!-- [et_pb_line_break_holder] --> <option value="The Bahamas"> The Bahamas </option><!-- [et_pb_line_break_holder] --> <option value="Bahrain"> Bahrain </option><!-- [et_pb_line_break_holder] --> <option value="Bangladesh"> Bangladesh </option><!-- [et_pb_line_break_holder] --> <option value="Barbados"> Barbados </option><!-- [et_pb_line_break_holder] --> <option value="Belarus"> Belarus </option><!-- [et_pb_line_break_holder] --> <option value="Belgium"> Belgium </option><!-- [et_pb_line_break_holder] --> <option value="Belize"> Belize </option><!-- [et_pb_line_break_holder] --> <option value="Benin"> Benin </option><!-- [et_pb_line_break_holder] --> <option value="Bermuda"> Bermuda </option><!-- [et_pb_line_break_holder] --> <option value="Bhutan"> Bhutan </option><!-- [et_pb_line_break_holder] --> <option value="Bolivia"> Bolivia </option><!-- [et_pb_line_break_holder] --> <option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option><!-- [et_pb_line_break_holder] --> <option value="Botswana"> Botswana </option><!-- [et_pb_line_break_holder] --> <option value="Brazil"> Brazil </option><!-- [et_pb_line_break_holder] --> <option value="Brunei"> Brunei </option><!-- [et_pb_line_break_holder] --> <option value="Bulgaria"> Bulgaria </option><!-- [et_pb_line_break_holder] --> <option value="Burkina Faso"> Burkina Faso </option><!-- [et_pb_line_break_holder] --> <option value="Burundi"> Burundi </option><!-- [et_pb_line_break_holder] --> <option value="Cambodia"> Cambodia </option><!-- [et_pb_line_break_holder] --> <option value="Cameroon"> Cameroon </option><!-- [et_pb_line_break_holder] --> <option value="Canada"> Canada </option><!-- [et_pb_line_break_holder] --> <option value="Cape Verde"> Cape Verde </option><!-- [et_pb_line_break_holder] --> <option value="Cayman Islands"> Cayman Islands </option><!-- [et_pb_line_break_holder] --> <option value="Central African Republic"> Central African Republic </option><!-- [et_pb_line_break_holder] --> <option value="Chad"> Chad </option><!-- [et_pb_line_break_holder] --> <option value="Chile"> Chile </option><!-- [et_pb_line_break_holder] --> <option value="China"> China </option><!-- [et_pb_line_break_holder] --> <option value="Christmas Island"> Christmas Island </option><!-- [et_pb_line_break_holder] --> <option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option><!-- [et_pb_line_break_holder] --> <option value="Colombia"> Colombia </option><!-- [et_pb_line_break_holder] --> <option value="Comoros"> Comoros </option><!-- [et_pb_line_break_holder] --> <option value="Congo"> Congo </option><!-- [et_pb_line_break_holder] --> <option value="Cook Islands"> Cook Islands </option><!-- [et_pb_line_break_holder] --> <option value="Costa Rica"> Costa Rica </option><!-- [et_pb_line_break_holder] --> <option value="Cote d'Ivoire"> Cote d'Ivoire </option><!-- [et_pb_line_break_holder] --> <option value="Croatia"> Croatia </option><!-- [et_pb_line_break_holder] --> <option value="Cuba"> Cuba </option><!-- [et_pb_line_break_holder] --> <option value="Cyprus"> Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Czech Republic"> Czech Republic </option><!-- [et_pb_line_break_holder] --> <option value="Democratic Republic of the Congo"> Democratic Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Denmark"> Denmark </option><!-- [et_pb_line_break_holder] --> <option value="Djibouti"> Djibouti </option><!-- [et_pb_line_break_holder] --> <option value="Dominica"> Dominica </option><!-- [et_pb_line_break_holder] --> <option value="Dominican Republic"> Dominican Republic </option><!-- [et_pb_line_break_holder] --> <option value="Ecuador"> Ecuador </option><!-- [et_pb_line_break_holder] --> <option value="Egypt"> Egypt </option><!-- [et_pb_line_break_holder] --> <option value="El Salvador"> El Salvador </option><!-- [et_pb_line_break_holder] --> <option value="Equatorial Guinea"> Equatorial Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Eritrea"> Eritrea </option><!-- [et_pb_line_break_holder] --> <option value="Estonia"> Estonia </option><!-- [et_pb_line_break_holder] --> <option value="Ethiopia"> Ethiopia </option><!-- [et_pb_line_break_holder] --> <option value="Falkland Islands"> Falkland Islands </option><!-- [et_pb_line_break_holder] --> <option value="Faroe Islands"> Faroe Islands </option><!-- [et_pb_line_break_holder] --> <option value="Fiji"> Fiji </option><!-- [et_pb_line_break_holder] --> <option value="Finland"> Finland </option><!-- [et_pb_line_break_holder] --> <option value="France"> France </option><!-- [et_pb_line_break_holder] --> <option value="French Polynesia"> French Polynesia </option><!-- [et_pb_line_break_holder] --> <option value="Gabon"> Gabon </option><!-- [et_pb_line_break_holder] --> <option value="The Gambia"> The Gambia </option><!-- [et_pb_line_break_holder] --> <option value="Georgia"> Georgia </option><!-- [et_pb_line_break_holder] --> <option value="Germany"> Germany </option><!-- [et_pb_line_break_holder] --> <option value="Ghana"> Ghana </option><!-- [et_pb_line_break_holder] --> <option value="Gibraltar"> Gibraltar </option><!-- [et_pb_line_break_holder] --> <option value="Greece"> Greece </option><!-- [et_pb_line_break_holder] --> <option value="Greenland"> Greenland </option><!-- [et_pb_line_break_holder] --> <option value="Grenada"> Grenada </option><!-- [et_pb_line_break_holder] --> <option value="Guadeloupe"> Guadeloupe </option><!-- [et_pb_line_break_holder] --> <option value="Guam"> Guam </option><!-- [et_pb_line_break_holder] --> <option value="Guatemala"> Guatemala </option><!-- [et_pb_line_break_holder] --> <option value="Guernsey"> Guernsey </option><!-- [et_pb_line_break_holder] --> <option value="Guinea"> Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Guinea-Bissau"> Guinea-Bissau </option><!-- [et_pb_line_break_holder] --> <option value="Guyana"> Guyana </option><!-- [et_pb_line_break_holder] --> <option value="Haiti"> Haiti </option><!-- [et_pb_line_break_holder] --> <option value="Honduras"> Honduras </option><!-- [et_pb_line_break_holder] --> <option value="Hong Kong"> Hong Kong </option><!-- [et_pb_line_break_holder] --> <option value="Hungary"> Hungary </option><!-- [et_pb_line_break_holder] --> <option value="Iceland"> Iceland </option><!-- [et_pb_line_break_holder] --> <option value="India"> India </option><!-- [et_pb_line_break_holder] --> <option value="Indonesia"> Indonesia </option><!-- [et_pb_line_break_holder] --> <option value="Iran"> Iran </option><!-- [et_pb_line_break_holder] --> <option value="Iraq"> Iraq </option><!-- [et_pb_line_break_holder] --> <option value="Ireland"> Ireland </option><!-- [et_pb_line_break_holder] --> <option value="Israel"> Israel </option><!-- [et_pb_line_break_holder] --> <option value="Italy"> Italy </option><!-- [et_pb_line_break_holder] --> <option value="Jamaica"> Jamaica </option><!-- [et_pb_line_break_holder] --> <option value="Japan"> Japan </option><!-- [et_pb_line_break_holder] --> <option value="Jersey"> Jersey </option><!-- [et_pb_line_break_holder] --> <option value="Jordan"> Jordan </option><!-- [et_pb_line_break_holder] --> <option value="Kazakhstan"> Kazakhstan </option><!-- [et_pb_line_break_holder] --> <option value="Kenya"> Kenya </option><!-- [et_pb_line_break_holder] --> <option value="Kiribati"> Kiribati </option><!-- [et_pb_line_break_holder] --> <option value="North Korea"> North Korea </option><!-- [et_pb_line_break_holder] --> <option value="South Korea"> South Korea </option><!-- [et_pb_line_break_holder] --> <option value="Kosovo"> Kosovo </option><!-- [et_pb_line_break_holder] --> <option value="Kuwait"> Kuwait </option><!-- [et_pb_line_break_holder] --> <option value="Kyrgyzstan"> Kyrgyzstan </option><!-- [et_pb_line_break_holder] --> <option value="Laos"> Laos </option><!-- [et_pb_line_break_holder] --> <option value="Latvia"> Latvia </option><!-- [et_pb_line_break_holder] --> <option value="Lebanon"> Lebanon </option><!-- [et_pb_line_break_holder] --> <option value="Lesotho"> Lesotho </option><!-- [et_pb_line_break_holder] --> <option value="Liberia"> Liberia </option><!-- [et_pb_line_break_holder] --> <option value="Libya"> Libya </option><!-- [et_pb_line_break_holder] --> <option value="Liechtenstein"> Liechtenstein </option><!-- [et_pb_line_break_holder] --> <option value="Lithuania"> Lithuania </option><!-- [et_pb_line_break_holder] --> <option value="Luxembourg"> Luxembourg </option><!-- [et_pb_line_break_holder] --> <option value="Macau"> Macau </option><!-- [et_pb_line_break_holder] --> <option value="Macedonia"> Macedonia </option><!-- [et_pb_line_break_holder] --> <option value="Madagascar"> Madagascar </option><!-- [et_pb_line_break_holder] --> <option value="Malawi"> Malawi </option><!-- [et_pb_line_break_holder] --> <option value="Malaysia"> Malaysia </option><!-- [et_pb_line_break_holder] --> <option value="Maldives"> Maldives </option><!-- [et_pb_line_break_holder] --> <option value="Mali"> Mali </option><!-- [et_pb_line_break_holder] --> <option value="Malta"> Malta </option><!-- [et_pb_line_break_holder] --> <option value="Marshall Islands"> Marshall Islands </option><!-- [et_pb_line_break_holder] --> <option value="Martinique"> Martinique </option><!-- [et_pb_line_break_holder] --> <option value="Mauritania"> Mauritania </option><!-- [et_pb_line_break_holder] --> <option value="Mauritius"> Mauritius </option><!-- [et_pb_line_break_holder] --> <option value="Mayotte"> Mayotte </option><!-- [et_pb_line_break_holder] --> <option value="Mexico"> Mexico </option><!-- [et_pb_line_break_holder] --> <option value="Micronesia"> Micronesia </option><!-- [et_pb_line_break_holder] --> <option value="Moldova"> Moldova </option><!-- [et_pb_line_break_holder] --> <option value="Monaco"> Monaco </option><!-- [et_pb_line_break_holder] --> <option value="Mongolia"> Mongolia </option><!-- [et_pb_line_break_holder] --> <option value="Montenegro"> Montenegro </option><!-- [et_pb_line_break_holder] --> <option value="Montserrat"> Montserrat </option><!-- [et_pb_line_break_holder] --> <option value="Morocco"> Morocco </option><!-- [et_pb_line_break_holder] --> <option value="Mozambique"> Mozambique </option><!-- [et_pb_line_break_holder] --> <option value="Myanmar"> Myanmar </option><!-- [et_pb_line_break_holder] --> <option value="Nagorno-Karabakh"> Nagorno-Karabakh </option><!-- [et_pb_line_break_holder] --> <option value="Namibia"> Namibia </option><!-- [et_pb_line_break_holder] --> <option value="Nauru"> Nauru </option><!-- [et_pb_line_break_holder] --> <option value="Nepal"> Nepal </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands"> Netherlands </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands Antilles"> Netherlands Antilles </option><!-- [et_pb_line_break_holder] --> <option value="New Caledonia"> New Caledonia </option><!-- [et_pb_line_break_holder] --> <option value="New Zealand"> New Zealand </option><!-- [et_pb_line_break_holder] --> <option value="Nicaragua"> Nicaragua </option><!-- [et_pb_line_break_holder] --> <option value="Niger"> Niger </option><!-- [et_pb_line_break_holder] --> <option value="Nigeria"> Nigeria </option><!-- [et_pb_line_break_holder] --> <option value="Niue"> Niue </option><!-- [et_pb_line_break_holder] --> <option value="Norfolk Island"> Norfolk Island </option><!-- [et_pb_line_break_holder] --> <option value="Turkish Republic of Northern Cyprus"> Turkish Republic of Northern Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Northern Mariana"> Northern Mariana </option><!-- [et_pb_line_break_holder] --> <option value="Norway"> Norway </option><!-- [et_pb_line_break_holder] --> <option value="Oman"> Oman </option><!-- [et_pb_line_break_holder] --> <option value="Pakistan"> Pakistan </option><!-- [et_pb_line_break_holder] --> <option value="Palau"> Palau </option><!-- [et_pb_line_break_holder] --> <option value="Palestine"> Palestine </option><!-- [et_pb_line_break_holder] --> <option value="Panama"> Panama </option><!-- [et_pb_line_break_holder] --> <option value="Papua New Guinea"> Papua New Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Paraguay"> Paraguay </option><!-- [et_pb_line_break_holder] --> <option value="Peru"> Peru </option><!-- [et_pb_line_break_holder] --> <option value="Philippines"> Philippines </option><!-- [et_pb_line_break_holder] --> <option value="Pitcairn Islands"> Pitcairn Islands </option><!-- [et_pb_line_break_holder] --> <option value="Poland"> Poland </option><!-- [et_pb_line_break_holder] --> <option value="Portugal"> Portugal </option><!-- [et_pb_line_break_holder] --> <option value="Puerto Rico"> Puerto Rico </option><!-- [et_pb_line_break_holder] --> <option value="Qatar"> Qatar </option><!-- [et_pb_line_break_holder] --> <option value="Republic of the Congo"> Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Romania"> Romania </option><!-- [et_pb_line_break_holder] --> <option value="Russia"> Russia </option><!-- [et_pb_line_break_holder] --> <option value="Rwanda"> Rwanda </option><!-- [et_pb_line_break_holder] --> <option value="Saint Barthelemy"> Saint Barthelemy </option><!-- [et_pb_line_break_holder] --> <option value="Saint Helena"> Saint Helena </option><!-- [et_pb_line_break_holder] --> <option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option><!-- [et_pb_line_break_holder] --> <option value="Saint Lucia"> Saint Lucia </option><!-- [et_pb_line_break_holder] --> <option value="Saint Martin"> Saint Martin </option><!-- [et_pb_line_break_holder] --> <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option><!-- [et_pb_line_break_holder] --> <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option><!-- [et_pb_line_break_holder] --> <option value="Samoa"> Samoa </option><!-- [et_pb_line_break_holder] --> <option value="San Marino"> San Marino </option><!-- [et_pb_line_break_holder] --> <option value="Sao Tome and Principe"> Sao Tome and Principe </option><!-- [et_pb_line_break_holder] --> <option value="Saudi Arabia"> Saudi Arabia </option><!-- [et_pb_line_break_holder] --> <option value="Senegal"> Senegal </option><!-- [et_pb_line_break_holder] --> <option value="Serbia"> Serbia </option><!-- [et_pb_line_break_holder] --> <option value="Seychelles"> Seychelles </option><!-- [et_pb_line_break_holder] --> <option value="Sierra Leone"> Sierra Leone </option><!-- [et_pb_line_break_holder] --> <option value="Singapore"> Singapore </option><!-- [et_pb_line_break_holder] --> <option value="Slovakia"> Slovakia </option><!-- [et_pb_line_break_holder] --> <option value="Slovenia"> Slovenia </option><!-- [et_pb_line_break_holder] --> <option value="Solomon Islands"> Solomon Islands </option><!-- [et_pb_line_break_holder] --> <option value="Somalia"> Somalia </option><!-- [et_pb_line_break_holder] --> <option value="Somaliland"> Somaliland </option><!-- [et_pb_line_break_holder] --> <option value="South Africa"> South Africa </option><!-- [et_pb_line_break_holder] --> <option value="South Ossetia"> South Ossetia </option><!-- [et_pb_line_break_holder] --> <option value="South Sudan"> South Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Spain"> Spain </option><!-- [et_pb_line_break_holder] --> <option value="Sri Lanka"> Sri Lanka </option><!-- [et_pb_line_break_holder] --> <option value="Sudan"> Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Suriname"> Suriname </option><!-- [et_pb_line_break_holder] --> <option value="Svalbard"> Svalbard </option><!-- [et_pb_line_break_holder] --> <option value="eSwatini"> eSwatini </option><!-- [et_pb_line_break_holder] --> <option value="Sweden"> Sweden </option><!-- [et_pb_line_break_holder] --> <option value="Switzerland"> Switzerland </option><!-- [et_pb_line_break_holder] --> <option value="Syria"> Syria </option><!-- [et_pb_line_break_holder] --> <option value="Taiwan"> Taiwan </option><!-- [et_pb_line_break_holder] --> <option value="Tajikistan"> Tajikistan </option><!-- [et_pb_line_break_holder] --> <option value="Tanzania"> Tanzania </option><!-- [et_pb_line_break_holder] --> <option value="Thailand"> Thailand </option><!-- [et_pb_line_break_holder] --> <option value="Timor-Leste"> Timor-Leste </option><!-- [et_pb_line_break_holder] --> <option value="Togo"> Togo </option><!-- [et_pb_line_break_holder] --> <option value="Tokelau"> Tokelau </option><!-- [et_pb_line_break_holder] --> <option value="Tonga"> Tonga </option><!-- [et_pb_line_break_holder] --> <option value="Transnistria Pridnestrovie"> Transnistria Pridnestrovie </option><!-- [et_pb_line_break_holder] --> <option value="Trinidad and Tobago"> Trinidad and Tobago </option><!-- [et_pb_line_break_holder] --> <option value="Tristan da Cunha"> Tristan da Cunha </option><!-- [et_pb_line_break_holder] --> <option value="Tunisia"> Tunisia </option><!-- [et_pb_line_break_holder] --> <option value="Turkey"> Turkey </option><!-- [et_pb_line_break_holder] --> <option value="Turkmenistan"> Turkmenistan </option><!-- [et_pb_line_break_holder] --> <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option><!-- [et_pb_line_break_holder] --> <option value="Tuvalu"> Tuvalu </option><!-- [et_pb_line_break_holder] --> <option value="Uganda"> Uganda </option><!-- [et_pb_line_break_holder] --> <option value="Ukraine"> Ukraine </option><!-- [et_pb_line_break_holder] --> <option value="United Arab Emirates"> United Arab Emirates </option><!-- [et_pb_line_break_holder] --> <option value="United Kingdom"> United Kingdom </option><!-- [et_pb_line_break_holder] --> <option value="Uruguay"> Uruguay </option><!-- [et_pb_line_break_holder] --> <option value="Uzbekistan"> Uzbekistan </option><!-- [et_pb_line_break_holder] --> <option value="Vanuatu"> Vanuatu </option><!-- [et_pb_line_break_holder] --> <option value="Vatican City"> Vatican City </option><!-- [et_pb_line_break_holder] --> <option value="Venezuela"> Venezuela </option><!-- [et_pb_line_break_holder] --> <option value="Vietnam"> Vietnam </option><!-- [et_pb_line_break_holder] --> <option value="British Virgin Islands"> British Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Isle of Man"> Isle of Man </option><!-- [et_pb_line_break_holder] --> <option value="US Virgin Islands"> US Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Wallis and Futuna"> Wallis and Futuna </option><!-- [et_pb_line_break_holder] --> <option value="Western Sahara"> Western Sahara </option><!-- [et_pb_line_break_holder] --> <option value="Yemen"> Yemen </option><!-- [et_pb_line_break_holder] --> <option value="Zambia"> Zambia </option><!-- [et_pb_line_break_holder] --> <option value="Zimbabwe"> Zimbabwe </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_dropdown" id="id_26"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_26" for="input_26"> Nationality of parent(s) </label><!-- [et_pb_line_break_holder] --> <div id="cid_26" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <select class="form-dropdown" id="input_26" name="q26_nationalityOf" style="width:150px" data-component="dropdown" aria-labelledby="label_26"><!-- [et_pb_line_break_holder] --> <option value=""> </option><!-- [et_pb_line_break_holder] --> <option value="United States"> United States </option><!-- [et_pb_line_break_holder] --> <option value="Afghanistan"> Afghanistan </option><!-- [et_pb_line_break_holder] --> <option value="Albania"> Albania </option><!-- [et_pb_line_break_holder] --> <option value="Algeria"> Algeria </option><!-- [et_pb_line_break_holder] --> <option value="American Samoa"> American Samoa </option><!-- [et_pb_line_break_holder] --> <option value="Andorra"> Andorra </option><!-- [et_pb_line_break_holder] --> <option value="Angola"> Angola </option><!-- [et_pb_line_break_holder] --> <option value="Anguilla"> Anguilla </option><!-- [et_pb_line_break_holder] --> <option value="Antigua and Barbuda"> Antigua and Barbuda </option><!-- [et_pb_line_break_holder] --> <option value="Argentina"> Argentina </option><!-- [et_pb_line_break_holder] --> <option value="Armenia"> Armenia </option><!-- [et_pb_line_break_holder] --> <option value="Aruba"> Aruba </option><!-- [et_pb_line_break_holder] --> <option value="Australia"> Australia </option><!-- [et_pb_line_break_holder] --> <option value="Austria"> Austria </option><!-- [et_pb_line_break_holder] --> <option value="Azerbaijan"> Azerbaijan </option><!-- [et_pb_line_break_holder] --> <option value="The Bahamas"> The Bahamas </option><!-- [et_pb_line_break_holder] --> <option value="Bahrain"> Bahrain </option><!-- [et_pb_line_break_holder] --> <option value="Bangladesh"> Bangladesh </option><!-- [et_pb_line_break_holder] --> <option value="Barbados"> Barbados </option><!-- [et_pb_line_break_holder] --> <option value="Belarus"> Belarus </option><!-- [et_pb_line_break_holder] --> <option value="Belgium"> Belgium </option><!-- [et_pb_line_break_holder] --> <option value="Belize"> Belize </option><!-- [et_pb_line_break_holder] --> <option value="Benin"> Benin </option><!-- [et_pb_line_break_holder] --> <option value="Bermuda"> Bermuda </option><!-- [et_pb_line_break_holder] --> <option value="Bhutan"> Bhutan </option><!-- [et_pb_line_break_holder] --> <option value="Bolivia"> Bolivia </option><!-- [et_pb_line_break_holder] --> <option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option><!-- [et_pb_line_break_holder] --> <option value="Botswana"> Botswana </option><!-- [et_pb_line_break_holder] --> <option value="Brazil"> Brazil </option><!-- [et_pb_line_break_holder] --> <option value="Brunei"> Brunei </option><!-- [et_pb_line_break_holder] --> <option value="Bulgaria"> Bulgaria </option><!-- [et_pb_line_break_holder] --> <option value="Burkina Faso"> Burkina Faso </option><!-- [et_pb_line_break_holder] --> <option value="Burundi"> Burundi </option><!-- [et_pb_line_break_holder] --> <option value="Cambodia"> Cambodia </option><!-- [et_pb_line_break_holder] --> <option value="Cameroon"> Cameroon </option><!-- [et_pb_line_break_holder] --> <option value="Canada"> Canada </option><!-- [et_pb_line_break_holder] --> <option value="Cape Verde"> Cape Verde </option><!-- [et_pb_line_break_holder] --> <option value="Cayman Islands"> Cayman Islands </option><!-- [et_pb_line_break_holder] --> <option value="Central African Republic"> Central African Republic </option><!-- [et_pb_line_break_holder] --> <option value="Chad"> Chad </option><!-- [et_pb_line_break_holder] --> <option value="Chile"> Chile </option><!-- [et_pb_line_break_holder] --> <option value="China"> China </option><!-- [et_pb_line_break_holder] --> <option value="Christmas Island"> Christmas Island </option><!-- [et_pb_line_break_holder] --> <option value="Cocos (Keeling) Islands"> Cocos (Keeling) Islands </option><!-- [et_pb_line_break_holder] --> <option value="Colombia"> Colombia </option><!-- [et_pb_line_break_holder] --> <option value="Comoros"> Comoros </option><!-- [et_pb_line_break_holder] --> <option value="Congo"> Congo </option><!-- [et_pb_line_break_holder] --> <option value="Cook Islands"> Cook Islands </option><!-- [et_pb_line_break_holder] --> <option value="Costa Rica"> Costa Rica </option><!-- [et_pb_line_break_holder] --> <option value="Cote d'Ivoire"> Cote d'Ivoire </option><!-- [et_pb_line_break_holder] --> <option value="Croatia"> Croatia </option><!-- [et_pb_line_break_holder] --> <option value="Cuba"> Cuba </option><!-- [et_pb_line_break_holder] --> <option value="Cyprus"> Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Czech Republic"> Czech Republic </option><!-- [et_pb_line_break_holder] --> <option value="Democratic Republic of the Congo"> Democratic Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Denmark"> Denmark </option><!-- [et_pb_line_break_holder] --> <option value="Djibouti"> Djibouti </option><!-- [et_pb_line_break_holder] --> <option value="Dominica"> Dominica </option><!-- [et_pb_line_break_holder] --> <option value="Dominican Republic"> Dominican Republic </option><!-- [et_pb_line_break_holder] --> <option value="Ecuador"> Ecuador </option><!-- [et_pb_line_break_holder] --> <option value="Egypt"> Egypt </option><!-- [et_pb_line_break_holder] --> <option value="El Salvador"> El Salvador </option><!-- [et_pb_line_break_holder] --> <option value="Equatorial Guinea"> Equatorial Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Eritrea"> Eritrea </option><!-- [et_pb_line_break_holder] --> <option value="Estonia"> Estonia </option><!-- [et_pb_line_break_holder] --> <option value="Ethiopia"> Ethiopia </option><!-- [et_pb_line_break_holder] --> <option value="Falkland Islands"> Falkland Islands </option><!-- [et_pb_line_break_holder] --> <option value="Faroe Islands"> Faroe Islands </option><!-- [et_pb_line_break_holder] --> <option value="Fiji"> Fiji </option><!-- [et_pb_line_break_holder] --> <option value="Finland"> Finland </option><!-- [et_pb_line_break_holder] --> <option value="France"> France </option><!-- [et_pb_line_break_holder] --> <option value="French Polynesia"> French Polynesia </option><!-- [et_pb_line_break_holder] --> <option value="Gabon"> Gabon </option><!-- [et_pb_line_break_holder] --> <option value="The Gambia"> The Gambia </option><!-- [et_pb_line_break_holder] --> <option value="Georgia"> Georgia </option><!-- [et_pb_line_break_holder] --> <option value="Germany"> Germany </option><!-- [et_pb_line_break_holder] --> <option value="Ghana"> Ghana </option><!-- [et_pb_line_break_holder] --> <option value="Gibraltar"> Gibraltar </option><!-- [et_pb_line_break_holder] --> <option value="Greece"> Greece </option><!-- [et_pb_line_break_holder] --> <option value="Greenland"> Greenland </option><!-- [et_pb_line_break_holder] --> <option value="Grenada"> Grenada </option><!-- [et_pb_line_break_holder] --> <option value="Guadeloupe"> Guadeloupe </option><!-- [et_pb_line_break_holder] --> <option value="Guam"> Guam </option><!-- [et_pb_line_break_holder] --> <option value="Guatemala"> Guatemala </option><!-- [et_pb_line_break_holder] --> <option value="Guernsey"> Guernsey </option><!-- [et_pb_line_break_holder] --> <option value="Guinea"> Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Guinea-Bissau"> Guinea-Bissau </option><!-- [et_pb_line_break_holder] --> <option value="Guyana"> Guyana </option><!-- [et_pb_line_break_holder] --> <option value="Haiti"> Haiti </option><!-- [et_pb_line_break_holder] --> <option value="Honduras"> Honduras </option><!-- [et_pb_line_break_holder] --> <option value="Hong Kong"> Hong Kong </option><!-- [et_pb_line_break_holder] --> <option value="Hungary"> Hungary </option><!-- [et_pb_line_break_holder] --> <option value="Iceland"> Iceland </option><!-- [et_pb_line_break_holder] --> <option value="India"> India </option><!-- [et_pb_line_break_holder] --> <option value="Indonesia"> Indonesia </option><!-- [et_pb_line_break_holder] --> <option value="Iran"> Iran </option><!-- [et_pb_line_break_holder] --> <option value="Iraq"> Iraq </option><!-- [et_pb_line_break_holder] --> <option value="Ireland"> Ireland </option><!-- [et_pb_line_break_holder] --> <option value="Israel"> Israel </option><!-- [et_pb_line_break_holder] --> <option value="Italy"> Italy </option><!-- [et_pb_line_break_holder] --> <option value="Jamaica"> Jamaica </option><!-- [et_pb_line_break_holder] --> <option value="Japan"> Japan </option><!-- [et_pb_line_break_holder] --> <option value="Jersey"> Jersey </option><!-- [et_pb_line_break_holder] --> <option value="Jordan"> Jordan </option><!-- [et_pb_line_break_holder] --> <option value="Kazakhstan"> Kazakhstan </option><!-- [et_pb_line_break_holder] --> <option value="Kenya"> Kenya </option><!-- [et_pb_line_break_holder] --> <option value="Kiribati"> Kiribati </option><!-- [et_pb_line_break_holder] --> <option value="North Korea"> North Korea </option><!-- [et_pb_line_break_holder] --> <option value="South Korea"> South Korea </option><!-- [et_pb_line_break_holder] --> <option value="Kosovo"> Kosovo </option><!-- [et_pb_line_break_holder] --> <option value="Kuwait"> Kuwait </option><!-- [et_pb_line_break_holder] --> <option value="Kyrgyzstan"> Kyrgyzstan </option><!-- [et_pb_line_break_holder] --> <option value="Laos"> Laos </option><!-- [et_pb_line_break_holder] --> <option value="Latvia"> Latvia </option><!-- [et_pb_line_break_holder] --> <option value="Lebanon"> Lebanon </option><!-- [et_pb_line_break_holder] --> <option value="Lesotho"> Lesotho </option><!-- [et_pb_line_break_holder] --> <option value="Liberia"> Liberia </option><!-- [et_pb_line_break_holder] --> <option value="Libya"> Libya </option><!-- [et_pb_line_break_holder] --> <option value="Liechtenstein"> Liechtenstein </option><!-- [et_pb_line_break_holder] --> <option value="Lithuania"> Lithuania </option><!-- [et_pb_line_break_holder] --> <option value="Luxembourg"> Luxembourg </option><!-- [et_pb_line_break_holder] --> <option value="Macau"> Macau </option><!-- [et_pb_line_break_holder] --> <option value="Macedonia"> Macedonia </option><!-- [et_pb_line_break_holder] --> <option value="Madagascar"> Madagascar </option><!-- [et_pb_line_break_holder] --> <option value="Malawi"> Malawi </option><!-- [et_pb_line_break_holder] --> <option value="Malaysia"> Malaysia </option><!-- [et_pb_line_break_holder] --> <option value="Maldives"> Maldives </option><!-- [et_pb_line_break_holder] --> <option value="Mali"> Mali </option><!-- [et_pb_line_break_holder] --> <option value="Malta"> Malta </option><!-- [et_pb_line_break_holder] --> <option value="Marshall Islands"> Marshall Islands </option><!-- [et_pb_line_break_holder] --> <option value="Martinique"> Martinique </option><!-- [et_pb_line_break_holder] --> <option value="Mauritania"> Mauritania </option><!-- [et_pb_line_break_holder] --> <option value="Mauritius"> Mauritius </option><!-- [et_pb_line_break_holder] --> <option value="Mayotte"> Mayotte </option><!-- [et_pb_line_break_holder] --> <option value="Mexico"> Mexico </option><!-- [et_pb_line_break_holder] --> <option value="Micronesia"> Micronesia </option><!-- [et_pb_line_break_holder] --> <option value="Moldova"> Moldova </option><!-- [et_pb_line_break_holder] --> <option value="Monaco"> Monaco </option><!-- [et_pb_line_break_holder] --> <option value="Mongolia"> Mongolia </option><!-- [et_pb_line_break_holder] --> <option value="Montenegro"> Montenegro </option><!-- [et_pb_line_break_holder] --> <option value="Montserrat"> Montserrat </option><!-- [et_pb_line_break_holder] --> <option value="Morocco"> Morocco </option><!-- [et_pb_line_break_holder] --> <option value="Mozambique"> Mozambique </option><!-- [et_pb_line_break_holder] --> <option value="Myanmar"> Myanmar </option><!-- [et_pb_line_break_holder] --> <option value="Nagorno-Karabakh"> Nagorno-Karabakh </option><!-- [et_pb_line_break_holder] --> <option value="Namibia"> Namibia </option><!-- [et_pb_line_break_holder] --> <option value="Nauru"> Nauru </option><!-- [et_pb_line_break_holder] --> <option value="Nepal"> Nepal </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands"> Netherlands </option><!-- [et_pb_line_break_holder] --> <option value="Netherlands Antilles"> Netherlands Antilles </option><!-- [et_pb_line_break_holder] --> <option value="New Caledonia"> New Caledonia </option><!-- [et_pb_line_break_holder] --> <option value="New Zealand"> New Zealand </option><!-- [et_pb_line_break_holder] --> <option value="Nicaragua"> Nicaragua </option><!-- [et_pb_line_break_holder] --> <option value="Niger"> Niger </option><!-- [et_pb_line_break_holder] --> <option value="Nigeria"> Nigeria </option><!-- [et_pb_line_break_holder] --> <option value="Niue"> Niue </option><!-- [et_pb_line_break_holder] --> <option value="Norfolk Island"> Norfolk Island </option><!-- [et_pb_line_break_holder] --> <option value="Turkish Republic of Northern Cyprus"> Turkish Republic of Northern Cyprus </option><!-- [et_pb_line_break_holder] --> <option value="Northern Mariana"> Northern Mariana </option><!-- [et_pb_line_break_holder] --> <option value="Norway"> Norway </option><!-- [et_pb_line_break_holder] --> <option value="Oman"> Oman </option><!-- [et_pb_line_break_holder] --> <option value="Pakistan"> Pakistan </option><!-- [et_pb_line_break_holder] --> <option value="Palau"> Palau </option><!-- [et_pb_line_break_holder] --> <option value="Palestine"> Palestine </option><!-- [et_pb_line_break_holder] --> <option value="Panama"> Panama </option><!-- [et_pb_line_break_holder] --> <option value="Papua New Guinea"> Papua New Guinea </option><!-- [et_pb_line_break_holder] --> <option value="Paraguay"> Paraguay </option><!-- [et_pb_line_break_holder] --> <option value="Peru"> Peru </option><!-- [et_pb_line_break_holder] --> <option value="Philippines"> Philippines </option><!-- [et_pb_line_break_holder] --> <option value="Pitcairn Islands"> Pitcairn Islands </option><!-- [et_pb_line_break_holder] --> <option value="Poland"> Poland </option><!-- [et_pb_line_break_holder] --> <option value="Portugal"> Portugal </option><!-- [et_pb_line_break_holder] --> <option value="Puerto Rico"> Puerto Rico </option><!-- [et_pb_line_break_holder] --> <option value="Qatar"> Qatar </option><!-- [et_pb_line_break_holder] --> <option value="Republic of the Congo"> Republic of the Congo </option><!-- [et_pb_line_break_holder] --> <option value="Romania"> Romania </option><!-- [et_pb_line_break_holder] --> <option value="Russia"> Russia </option><!-- [et_pb_line_break_holder] --> <option value="Rwanda"> Rwanda </option><!-- [et_pb_line_break_holder] --> <option value="Saint Barthelemy"> Saint Barthelemy </option><!-- [et_pb_line_break_holder] --> <option value="Saint Helena"> Saint Helena </option><!-- [et_pb_line_break_holder] --> <option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option><!-- [et_pb_line_break_holder] --> <option value="Saint Lucia"> Saint Lucia </option><!-- [et_pb_line_break_holder] --> <option value="Saint Martin"> Saint Martin </option><!-- [et_pb_line_break_holder] --> <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option><!-- [et_pb_line_break_holder] --> <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </option><!-- [et_pb_line_break_holder] --> <option value="Samoa"> Samoa </option><!-- [et_pb_line_break_holder] --> <option value="San Marino"> San Marino </option><!-- [et_pb_line_break_holder] --> <option value="Sao Tome and Principe"> Sao Tome and Principe </option><!-- [et_pb_line_break_holder] --> <option value="Saudi Arabia"> Saudi Arabia </option><!-- [et_pb_line_break_holder] --> <option value="Senegal"> Senegal </option><!-- [et_pb_line_break_holder] --> <option value="Serbia"> Serbia </option><!-- [et_pb_line_break_holder] --> <option value="Seychelles"> Seychelles </option><!-- [et_pb_line_break_holder] --> <option value="Sierra Leone"> Sierra Leone </option><!-- [et_pb_line_break_holder] --> <option value="Singapore"> Singapore </option><!-- [et_pb_line_break_holder] --> <option value="Slovakia"> Slovakia </option><!-- [et_pb_line_break_holder] --> <option value="Slovenia"> Slovenia </option><!-- [et_pb_line_break_holder] --> <option value="Solomon Islands"> Solomon Islands </option><!-- [et_pb_line_break_holder] --> <option value="Somalia"> Somalia </option><!-- [et_pb_line_break_holder] --> <option value="Somaliland"> Somaliland </option><!-- [et_pb_line_break_holder] --> <option value="South Africa"> South Africa </option><!-- [et_pb_line_break_holder] --> <option value="South Ossetia"> South Ossetia </option><!-- [et_pb_line_break_holder] --> <option value="South Sudan"> South Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Spain"> Spain </option><!-- [et_pb_line_break_holder] --> <option value="Sri Lanka"> Sri Lanka </option><!-- [et_pb_line_break_holder] --> <option value="Sudan"> Sudan </option><!-- [et_pb_line_break_holder] --> <option value="Suriname"> Suriname </option><!-- [et_pb_line_break_holder] --> <option value="Svalbard"> Svalbard </option><!-- [et_pb_line_break_holder] --> <option value="eSwatini"> eSwatini </option><!-- [et_pb_line_break_holder] --> <option value="Sweden"> Sweden </option><!-- [et_pb_line_break_holder] --> <option value="Switzerland"> Switzerland </option><!-- [et_pb_line_break_holder] --> <option value="Syria"> Syria </option><!-- [et_pb_line_break_holder] --> <option value="Taiwan"> Taiwan </option><!-- [et_pb_line_break_holder] --> <option value="Tajikistan"> Tajikistan </option><!-- [et_pb_line_break_holder] --> <option value="Tanzania"> Tanzania </option><!-- [et_pb_line_break_holder] --> <option value="Thailand"> Thailand </option><!-- [et_pb_line_break_holder] --> <option value="Timor-Leste"> Timor-Leste </option><!-- [et_pb_line_break_holder] --> <option value="Togo"> Togo </option><!-- [et_pb_line_break_holder] --> <option value="Tokelau"> Tokelau </option><!-- [et_pb_line_break_holder] --> <option value="Tonga"> Tonga </option><!-- [et_pb_line_break_holder] --> <option value="Transnistria Pridnestrovie"> Transnistria Pridnestrovie </option><!-- [et_pb_line_break_holder] --> <option value="Trinidad and Tobago"> Trinidad and Tobago </option><!-- [et_pb_line_break_holder] --> <option value="Tristan da Cunha"> Tristan da Cunha </option><!-- [et_pb_line_break_holder] --> <option value="Tunisia"> Tunisia </option><!-- [et_pb_line_break_holder] --> <option value="Turkey"> Turkey </option><!-- [et_pb_line_break_holder] --> <option value="Turkmenistan"> Turkmenistan </option><!-- [et_pb_line_break_holder] --> <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option><!-- [et_pb_line_break_holder] --> <option value="Tuvalu"> Tuvalu </option><!-- [et_pb_line_break_holder] --> <option value="Uganda"> Uganda </option><!-- [et_pb_line_break_holder] --> <option value="Ukraine"> Ukraine </option><!-- [et_pb_line_break_holder] --> <option value="United Arab Emirates"> United Arab Emirates </option><!-- [et_pb_line_break_holder] --> <option value="United Kingdom"> United Kingdom </option><!-- [et_pb_line_break_holder] --> <option value="Uruguay"> Uruguay </option><!-- [et_pb_line_break_holder] --> <option value="Uzbekistan"> Uzbekistan </option><!-- [et_pb_line_break_holder] --> <option value="Vanuatu"> Vanuatu </option><!-- [et_pb_line_break_holder] --> <option value="Vatican City"> Vatican City </option><!-- [et_pb_line_break_holder] --> <option value="Venezuela"> Venezuela </option><!-- [et_pb_line_break_holder] --> <option value="Vietnam"> Vietnam </option><!-- [et_pb_line_break_holder] --> <option value="British Virgin Islands"> British Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Isle of Man"> Isle of Man </option><!-- [et_pb_line_break_holder] --> <option value="US Virgin Islands"> US Virgin Islands </option><!-- [et_pb_line_break_holder] --> <option value="Wallis and Futuna"> Wallis and Futuna </option><!-- [et_pb_line_break_holder] --> <option value="Western Sahara"> Western Sahara </option><!-- [et_pb_line_break_holder] --> <option value="Yemen"> Yemen </option><!-- [et_pb_line_break_holder] --> <option value="Zambia"> Zambia </option><!-- [et_pb_line_break_holder] --> <option value="Zimbabwe"> Zimbabwe </option><!-- [et_pb_line_break_holder] --> </select><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li id="cid_27" class="form-input-wide" data-type="control_head"><!-- [et_pb_line_break_holder] --> <div class="form-header-group "><!-- [et_pb_line_break_holder] --> <div class="header-text httal htvam"><!-- [et_pb_line_break_holder] --> <h2 id="header_27" class="form-header" data-component="header"><!-- [et_pb_line_break_holder] --> Qualifications Completed or Certified<!-- [et_pb_line_break_holder] --> </h2><!-- [et_pb_line_break_holder] --> <div id="subHeader_27" class="form-subHeader"><!-- [et_pb_line_break_holder] --> Section 4<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_text" id="id_28"><!-- [et_pb_line_break_holder] --> <div id="cid_28" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div id="text_28" class="form-html" data-component="text"><!-- [et_pb_line_break_holder] --> <p>Examinations or assessments for which results are known, including those failed. Please list most recent qualifications first.</p><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_matrix" id="id_29"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_29" for="input_29"> </label><!-- [et_pb_line_break_holder] --> <div id="cid_29" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <table summary="" cellPadding="4" cellSpacing="0" class="form-matrix-table" data-component="matrix"><!-- [et_pb_line_break_holder] --> <tbody><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th style="border:none"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_0"><!-- [et_pb_line_break_holder] --> <label id="label_29_col_0"> Date taken </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_1"><!-- [et_pb_line_break_holder] --> <label id="label_29_col_1"> Awarding body </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_2"><!-- [et_pb_line_break_holder] --> <label id="label_29_col_2"> Subject/unit/module/component </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_3"><!-- [et_pb_line_break_holder] --> <label id="label_29_col_3"><!-- [et_pb_line_break_holder] --> Level/<!-- [et_pb_line_break_holder] --> <br /><!-- [et_pb_line_break_holder] --> qualification<!-- [et_pb_line_break_holder] --> </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_4"><!-- [et_pb_line_break_holder] --> <label id="label_29_col_4"> Result, grade,mark or band </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_29_row_0"> 1 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_0_0" class="form-textbox" size="5" name="q29_input29[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_0 label_29_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_0_1" class="form-textbox" size="5" name="q29_input29[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_0 label_29_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_0_2" class="form-textbox" size="5" name="q29_input29[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_0 label_29_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_0_3" class="form-textbox" size="5" name="q29_input29[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_0 label_29_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_0_4" class="form-textbox" size="5" name="q29_input29[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_0 label_29_col_4" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_29_row_1"> 2 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_1_0" class="form-textbox" size="5" name="q29_input29[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_1 label_29_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_1_1" class="form-textbox" size="5" name="q29_input29[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_1 label_29_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_1_2" class="form-textbox" size="5" name="q29_input29[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_1 label_29_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_1_3" class="form-textbox" size="5" name="q29_input29[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_1 label_29_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_1_4" class="form-textbox" size="5" name="q29_input29[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_1 label_29_col_4" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_29_row_2"> 3 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_2_0" class="form-textbox" size="5" name="q29_input29[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_2 label_29_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_2_1" class="form-textbox" size="5" name="q29_input29[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_2 label_29_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_2_2" class="form-textbox" size="5" name="q29_input29[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_2 label_29_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_2_3" class="form-textbox" size="5" name="q29_input29[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_2 label_29_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_2_4" class="form-textbox" size="5" name="q29_input29[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_2 label_29_col_4" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_29_row_3"> 4 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_3_0" class="form-textbox" size="5" name="q29_input29[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_3 label_29_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_3_1" class="form-textbox" size="5" name="q29_input29[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_3 label_29_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_3_2" class="form-textbox" size="5" name="q29_input29[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_3 label_29_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_3_3" class="form-textbox" size="5" name="q29_input29[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_3 label_29_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_3_4" class="form-textbox" size="5" name="q29_input29[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_3 label_29_col_4" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_29_row_4"> 5 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_4_0" class="form-textbox" size="5" name="q29_input29[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_4 label_29_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_4_1" class="form-textbox" size="5" name="q29_input29[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_4 label_29_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_4_2" class="form-textbox" size="5" name="q29_input29[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_4 label_29_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_4_3" class="form-textbox" size="5" name="q29_input29[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_4 label_29_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_29_4_4" class="form-textbox" size="5" name="q29_input29[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_29 label_29_row_4 label_29_col_4" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> </tbody><!-- [et_pb_line_break_holder] --> </table><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li id="cid_33" class="form-input-wide" data-type="control_head"><!-- [et_pb_line_break_holder] --> <div class="form-header-group "><!-- [et_pb_line_break_holder] --> <div class="header-text httal htvam"><!-- [et_pb_line_break_holder] --> <h2 id="header_33" class="form-header" data-component="header"><!-- [et_pb_line_break_holder] --> Employment and Work Experience<!-- [et_pb_line_break_holder] --> </h2><!-- [et_pb_line_break_holder] --> <div id="subHeader_33" class="form-subHeader"><!-- [et_pb_line_break_holder] --> Section 5<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_matrix" id="id_34"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_34" for="input_34"> </label><!-- [et_pb_line_break_holder] --> <div id="cid_34" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <table summary="" cellPadding="4" cellSpacing="0" class="form-matrix-table" data-component="matrix"><!-- [et_pb_line_break_holder] --> <tbody><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th style="border:none"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_0"><!-- [et_pb_line_break_holder] --> <label id="label_34_col_0"> Name of employer </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_1"><!-- [et_pb_line_break_holder] --> <label id="label_34_col_1"> Job title </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_2"><!-- [et_pb_line_break_holder] --> <label id="label_34_col_2"> Main responsibilities </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <th scope="col" class="form-matrix-column-headers form-matrix-column_3"><!-- [et_pb_line_break_holder] --> <label id="label_34_col_3"> Dates of employment </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_34_row_0"> 1 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_0_0" class="form-textbox" size="5" name="q34_input34[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_0 label_34_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_0_1" class="form-textbox" size="5" name="q34_input34[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_0 label_34_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_0_2" class="form-textbox" size="5" name="q34_input34[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_0 label_34_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_0_3" class="form-textbox" size="5" name="q34_input34[0][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_0 label_34_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_34_row_1"> 2 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_1_0" class="form-textbox" size="5" name="q34_input34[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_1 label_34_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_1_1" class="form-textbox" size="5" name="q34_input34[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_1 label_34_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_1_2" class="form-textbox" size="5" name="q34_input34[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_1 label_34_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_1_3" class="form-textbox" size="5" name="q34_input34[1][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_1 label_34_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_34_row_2"> 3 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_2_0" class="form-textbox" size="5" name="q34_input34[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_2 label_34_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_2_1" class="form-textbox" size="5" name="q34_input34[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_2 label_34_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_2_2" class="form-textbox" size="5" name="q34_input34[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_2 label_34_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_2_3" class="form-textbox" size="5" name="q34_input34[2][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_2 label_34_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_34_row_3"> 4 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_3_0" class="form-textbox" size="5" name="q34_input34[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_3 label_34_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_3_1" class="form-textbox" size="5" name="q34_input34[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_3 label_34_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_3_2" class="form-textbox" size="5" name="q34_input34[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_3 label_34_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_3_3" class="form-textbox" size="5" name="q34_input34[3][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_3 label_34_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <th scope="row" style="text-align:left" class="form-matrix-row-headers"><!-- [et_pb_line_break_holder] --> <label id="label_34_row_4"> 5 </label><!-- [et_pb_line_break_holder] --> </th><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_4_0" class="form-textbox" size="5" name="q34_input34[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_4 label_34_col_0" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_4_1" class="form-textbox" size="5" name="q34_input34[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_4 label_34_col_1" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_4_2" class="form-textbox" size="5" name="q34_input34[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_4 label_34_col_2" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td style="text-align:center" class="form-matrix-values"><!-- [et_pb_line_break_holder] --> <input type="text" id="input_34_4_3" class="form-textbox" size="5" name="q34_input34[4][]" style="width:100%;box-sizing:border-box" value="" aria-labelledby="label_34 label_34_row_4 label_34_col_3" /><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> </tbody><!-- [et_pb_line_break_holder] --> </table><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li id="cid_35" class="form-input-wide" data-type="control_head"><!-- [et_pb_line_break_holder] --> <div class="form-header-group "><!-- [et_pb_line_break_holder] --> <div class="header-text httal htvam"><!-- [et_pb_line_break_holder] --> <h2 id="header_35" class="form-header" data-component="header"><!-- [et_pb_line_break_holder] --> Personal Statement<!-- [et_pb_line_break_holder] --> </h2><!-- [et_pb_line_break_holder] --> <div id="subHeader_35" class="form-subHeader"><!-- [et_pb_line_break_holder] --> Section 6<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_text" id="id_36"><!-- [et_pb_line_break_holder] --> <div id="cid_36" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div id="text_36" class="form-html" data-component="text"><!-- [et_pb_line_break_holder] --> <p>Please write a personal statement on a separate sheet (provided) to support your application to study on this course. Please refer to the guidance notes for further assistance. Note that your application will not be processed without a personal statement.</p><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li id="cid_37" class="form-input-wide" data-type="control_head"><!-- [et_pb_line_break_holder] --> <div class="form-header-group "><!-- [et_pb_line_break_holder] --> <div class="header-text httal htvam"><!-- [et_pb_line_break_holder] --> <h2 id="header_37" class="form-header" data-component="header"><!-- [et_pb_line_break_holder] --> Declaration<!-- [et_pb_line_break_holder] --> </h2><!-- [et_pb_line_break_holder] --> <div id="subHeader_37" class="form-subHeader"><!-- [et_pb_line_break_holder] --> Section 6<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_text" id="id_38"><!-- [et_pb_line_break_holder] --> <div id="cid_38" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div id="text_38" class="form-html" data-component="text"><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"><span style="text-decoration: underline;"><strong>Waiver:</strong></span> In return for being permitted to participate in the following programme (“The Undergraduate Law Programme”), including any I, for myself, heirs, personal do hereby release, waive, discharge, and promise not to sue The Regents of the University of Newcastle, its directors, officers, employees, and agents (“The University”), from liability from any and all claims, including the negligence of The University, resulting in personal injury (including death), accidents or illnesses, and property loss, in connection with my participation in the Activity and any use of University premises and facilities or Authorized Teaching Center.</span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"> </span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"><span style="text-decoration: underline;"><strong>Indemnification and Hold Harmless:</strong></span><strong> </strong>I also agree to indemnify and hold The University harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees, arising out of my involvement in The Activity, and to reimburse it for any such expenses incurred.</span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"> </span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"><span style="text-decoration: underline;"><strong>Severability:</strong></span> I further agree that this Waiver of Liability, Assumption of Risk, and Indemnity Agreement is intended to be as broad and inclusive as permitted by law, and that if any portion is held invalid the remaining portions will continue to have full legal force and effect.</span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"> </span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"><span style="text-decoration: underline;"><strong>Governing Law and Jurisdiction:</strong></span> This Agreement shall be governed by the laws of the State of Delaware, and any disputes arising out of or in connection with this Agreement shall be under the exclusive jurisdiction of the Courts of the State of Delaware. Acknowledgment of Understanding:</span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;"> </span></p><!-- [et_pb_line_break_holder] --> <p><span style="font-size: 8pt;">I have read this Waiver of Liability and Indemnity Agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I confirm that I am signing the agreement freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.</span></p><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_signature" id="id_40"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_40" for="input_40"> Signature </label><!-- [et_pb_line_break_holder] --> <div id="cid_40" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <div id="signature_pad_40" class="signature-pad-wrapper" style="width:402px;height:202px"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <!--[if IE 7]><!-- [et_pb_line_break_holder] --> <script type="text/javascript" src="/js/vendor/json2.js"></script><!-- [et_pb_line_break_holder] --> <![endif]--><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div class="signature-line signature-wrapper" data-component="signature" style="width:402px;height:202px"><!-- [et_pb_line_break_holder] --> <div id="sig_pad_40" data-width="400" data-height="200" data-id="40" data-required="false" class="pad "><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <input type="hidden" name="q40_signature" class="output4" id="input_40" /><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <span class="clear-pad-btn clear-pad" role="button" tabindex="0"><!-- [et_pb_line_break_holder] --> Clear<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <script type="text/javascript"><!-- [et_pb_line_break_holder] --> window.signatureForm = true<!-- [et_pb_line_break_holder] --> </script><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_datetime" id="id_39"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_39" for="lite_mode_39"> Date </label><!-- [et_pb_line_break_holder] --> <div id="cid_39" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <div style="display:none"><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="month_39" name="q39_date[month]" size="2" data-maxlength="2" value="" aria-labelledby="label_39 sublabel_39_month" /><!-- [et_pb_line_break_holder] --> <span class="date-separate" aria-hidden="true"><!-- [et_pb_line_break_holder] --> -<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="month_39" id="sublabel_39_month" style="min-height:13px"> Month </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="day_39" name="q39_date[day]" size="2" data-maxlength="2" value="" aria-labelledby="label_39 sublabel_39_day" /><!-- [et_pb_line_break_holder] --> <span class="date-separate" aria-hidden="true"><!-- [et_pb_line_break_holder] --> -<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="day_39" id="sublabel_39_day" style="min-height:13px"> Day </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="tel" class="form-textbox validate[limitDate]" id="year_39" name="q39_date[year]" size="4" data-maxlength="4" value="" aria-labelledby="label_39 sublabel_39_year" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="year_39" id="sublabel_39_year" style="min-height:13px"> Year </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_39" size="12" data-maxlength="12" data-age="" value="" data-format="mmddyyyy" data-seperator="-" placeholder="mm-dd-yyyy" aria-labelledby="label_39 sublabel_39_litemode" /><!-- [et_pb_line_break_holder] --> <img alt="Pick a Date" id="input_39_pick" src="https://cdn.jotfor.ms/images/calendar.png" style="vertical-align:middle;margin-left:5px" data-component="datetime" aria-hidden="true" /><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="lite_mode_39" id="sublabel_39_litemode" style="min-height:13px"> Date </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span class="form-sub-label-container " style="vertical-align:top"><!-- [et_pb_line_break_holder] --> <label class="form-sub-label" for="input_39_pick" style="border:0;clip:rect(0 0 0 0);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px;white-space:nowrap"> Date Picker Icon </label><!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_text" id="id_11"><!-- [et_pb_line_break_holder] --> <div id="cid_11" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div id="text_11" class="form-html" data-component="text"><!-- [et_pb_line_break_holder] --> <p><strong>Attached Acadmic Docments </strong></p><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_fileupload" id="id_10"><!-- [et_pb_line_break_holder] --> <label class="form-label form-label-top form-label-auto" id="label_10" for="input_10"> Upload All Files </label><!-- [et_pb_line_break_holder] --> <div id="cid_10" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <div data-wrapper-react="true"><!-- [et_pb_line_break_holder] --> <div class="qq-uploader-buttonText-value"><!-- [et_pb_line_break_holder] --> Browse Files<!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <input type="file" id="input_10" name="q10_uploadAll[]" multiple="" class="form-upload-multiple" data-imagevalidate="yes" data-file-accept="pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif" data-file-maxsize="10854" data-file-minsize="0" data-file-limit="" data-component="fileupload" /><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <span style="display:none" class="cancelText"><!-- [et_pb_line_break_holder] --> Cancel<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> <span style="display:none" class="ofText"><!-- [et_pb_line_break_holder] --> of<!-- [et_pb_line_break_holder] --> </span><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li class="form-line" data-type="control_button" id="id_2"><!-- [et_pb_line_break_holder] --> <div id="cid_2" class="form-input-wide"><!-- [et_pb_line_break_holder] --> <div style="margin-left:156px" class="form-buttons-wrapper "><!-- [et_pb_line_break_holder] --> <button id="input_2" type="submit" class="form-submit-button" data-component="button"><!-- [et_pb_line_break_holder] --> Submit<!-- [et_pb_line_break_holder] --> </button><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> <li style="display:none"><!-- [et_pb_line_break_holder] --> Should be Empty:<!-- [et_pb_line_break_holder] --> <input type="text" name="website" value="" /><!-- [et_pb_line_break_holder] --> </li><!-- [et_pb_line_break_holder] --> </ul><!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </div><!-- [et_pb_line_break_holder] --></form>