{"id":4107,"date":"2026-08-14T08:16:38","date_gmt":"2026-08-14T08:16:38","guid":{"rendered":"https:\/\/heartitout.in\/career-form\/?page_id=4107"},"modified":"2026-08-17T08:05:07","modified_gmt":"2026-08-17T08:05:07","slug":"application-form-for-counselling-psychologist-lgbtqia-affirmative","status":"publish","type":"page","link":"https:\/\/heartitout.in\/career-form\/application-form-for-counselling-psychologist-lgbtqia-affirmative\/","title":{"rendered":"application form for counselling psychologist LGBTQIA Affirmative"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4107\" class=\"elementor elementor-4107\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-cb2b359 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"cb2b359\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-89b4b97\" data-id=\"89b4b97\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0bb89c3 elementor-widget__width-inherit elementor-widget elementor-widget-html\" data-id=\"0bb89c3\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t   <!-- Google Tag Manager (noscript) -->\n   <noscript><iframe src=\"https:\/\/www.googletagmanager.com\/ns.html?id=GTM-56CS6TH\" height=\"0\" width=\"0\"\n         style=\"display:none;visibility:hidden\"><\/iframe><\/noscript>\n   <!-- End Google Tag Manager (noscript) -->\n   <!--............... start header section ...............-->\n   <header 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class=\"nav-link dropdown-toggle\" href=\"#\" id=\"navbarDropdown\" role=\"button\"\n                        data-bs-toggle=\"dropdown\" aria-expanded=\"false\">\n                        SERVICES\n                     <\/a>\n                     <ul class=\"dropdown-menu\" aria-labelledby=\"navbarDropdown\">\n                        <li><a class=\"dropdown-item\" href=\"https:\/\/heartitout.in\/individual-therapy\/\">Individual\n                              Therapy<\/a>\n                        <\/li>\n                        <li><a class=\"dropdown-item\" href=\"https:\/\/heartitout.in\/couples-therapy\/\">Couples Therapy<\/a>\n                        <\/li>\n                        <li><a class=\"dropdown-item\" href=\"https:\/\/heartitout.in\/family-therapy\/\">Family Therapy<\/a>\n                        <\/li>\n                        <li><a class=\"dropdown-item\" href=\"https:\/\/heartitout.in\/child-therapy\/\">Child Therapy<\/a><\/li>\n                        <li><a 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href=\"https:\/\/heartitout.in\/events\" target=\"_blank\">EVENTS<\/a>\n                  <\/li>\n\n                  <li class=\"nav-item\">\n                     <a class=\"nav-link \" aria-current=\"page\" href=\"\/corporate\/\" target=\"_blank\">CORPORATE<\/a>\n                  <\/li>\n\n\n                  <li class=\"nav-item d-none\">\n                     <a class=\"nav-link\" href=\"https:\/\/heartitout.in\/events\/\">EVENTS<\/a>\n                  <\/li>\n\n\n                  <li class=\"nav-item\">\n\n                     <a class=\"nav-link\" href=\"https:\/\/heartitout.in\/about-us\/\" target=\"_blank\">ABOUT <\/a>\n                  <\/li>\n                  <li class=\"nav-item d-none\">\n                     <a class=\"nav-link\" href=\"https:\/\/heartitout.in\/blogs\/\">BLOG<\/a>\n                  <\/li>\n                  <li class=\"nav-item\">\n\n                     <a class=\"nav-link\" href=\"https:\/\/heartitout.in\/careers\/\" target=\"_blank\">CAREERS<\/a>\n                  <\/li>\n\n                  <li class=\"nav-item\">\n                     <a class=\"btn btn_pri d-block\" href=\"https:\/\/heartitout.in\/welcome\/\" target=\"_blank\">LOGIN \/ SIGN UP<\/a>\n                  <\/li>\n               <\/ul>\n            <\/div>\n         <\/div>\n      <\/nav>\n   <\/header>\n   <!--............... end header section ...............-->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-section elementor-top-section elementor-element elementor-element-9f9ad93 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9f9ad93\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-417f870\" data-id=\"417f870\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fd387f7 elementor-widget elementor-widget-heading\" data-id=\"fd387f7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Application Form for Counselling Psychologist (LGBTQIA+ Affirmative)<\/p>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3088a08 elementor-widget elementor-widget-text-editor\" data-id=\"3088a08\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Hello Humans! Welcome to the application form for the position of Counselling Psychologist (LGBTQIA+ Affirmative) at Heart it Out. We are pleased to see that you are interested to be joining our family \ud83d\ude42 Do take out 5 minutes of your time to fill out this application and we will get back to you as soon as possible. Have a great day!<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1b7468c elementor-button-align-center elementor-widget__width-inherit elementor-widget elementor-widget-form\" data-id=\"1b7468c\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;dce_confirm_dialog_enabled&quot;:&quot;no&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;,&quot;label_icon_size&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;field_icon_size&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"dce-conditions-js-error-notice elementor-message elementor-message-danger\" style=\"display: none;\">A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator.<\/div>\t\t\t<script>\n\t\t\tsetTimeout(function() {\n\t\t\t\tlet el = document.querySelector(\".dce-conditions-js-error-notice\");\n\t\t\t\tif (el)\n\t\t\t\t\tel.style.display = \"block\";\n\t\t\t}, 6000);\n\t\t\t<\/script>\t\t<form class=\"elementor-form\" method=\"post\" name=\"Application Form for Counselling Psychologist (LGBTQIA+ Affirmative)\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"4107\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"1b7468c\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div data-field-conditions=\"[{&quot;id&quot;:&quot;languages_others&quot;,&quot;condition&quot;:&quot;(languages == \\&quot;Other\\&quot;)&quot;,&quot;mode&quot;:&quot;show&quot;,&quot;disableOnly&quot;:false}]\" data-field-ids=\"[&quot;email_id&quot;,&quot;whats_ur_name&quot;,&quot;birthday_date&quot;,&quot;gender_identify&quot;,&quot;your_pronouns&quot;,&quot;currently_reside&quot;,&quot;contact_num&quot;,&quot;languages&quot;,&quot;languages_others&quot;,&quot;cv&quot;,&quot;visit&quot;,&quot;graduate_school&quot;,&quot;undergraduate_school&quot;,&quot;field_d4364d5&quot;,&quot;counselling_psychologist&quot;,&quot;therapy_plan_to_practice&quot;,&quot;primarily_inclined_towards&quot;,&quot;mental_health&quot;,&quot;committed_to_projects&quot;,&quot;undergoing_therapy&quot;,&quot;field_be29181&quot;,&quot;name_reference&quot;,&quot;awesome_human&quot;,&quot;contact_them&quot;,&quot;any_other_references&quot;]\" class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email_id elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email_id\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email_id]\" id=\"form-field-email_id\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Your email address\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-whats_ur_name elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-whats_ur_name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHi! What's your name?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[whats_ur_name]\" id=\"form-field-whats_ur_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-birthday_date elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-birthday_date\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhen is your birthday?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[birthday_date]\" id=\"form-field-birthday_date\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" required=\"required\" aria-required=\"true\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-gender_identify elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-gender_identify\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhich gender do you identify with?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[gender_identify]\" id=\"form-field-gender_identify\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-your_pronouns elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-your_pronouns\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat are your pronouns?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[your_pronouns]\" id=\"form-field-your_pronouns\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-currently_reside elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-currently_reside\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhere do you currently reside?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[currently_reside]\" id=\"form-field-currently_reside\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-contact_num elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-contact_num\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your contact number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[contact_num]\" id=\"form-field-contact_num\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\" min=\"\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-languages elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-languages\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhich languages are you comfortable with?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"English\" id=\"form-field-languages-0\" name=\"form_fields[languages][]\"> <label for=\"form-field-languages-0\">English<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Hindi\" id=\"form-field-languages-1\" name=\"form_fields[languages][]\"> <label for=\"form-field-languages-1\">Hindi<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Kannada\" id=\"form-field-languages-2\" name=\"form_fields[languages][]\"> <label for=\"form-field-languages-2\">Kannada<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-languages-3\" name=\"form_fields[languages][]\"> <label for=\"form-field-languages-3\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-languages_others elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-languages_others\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhich languages are you comfortable with?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[languages_others]\" id=\"form-field-languages_others\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-cv elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-cv\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCV\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[cv]\" id=\"form-field-cv\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\" aria-required=\"true\" data-maxsize=\"2\" data-maxsize-message=\"This file exceeds the maximum allowed size.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-visit elementor-col-100\">\n\t\t\t\t\t<h1 style=\"text-align:center; color:#01818C;\">Educational Qualification<\/h1>\n\t<p style=\"text-align:center;color:#01818C;\">Tell us where you studied and the amazing things you have done there! Here is a sample of how you need to write the information under each question:\n\t<br>\n\t1. Name of the institution -<br>\n\t2.  Name of Degree awarded -<br>\n\t3.  Subjects -<br>\n\t4.  Year of Completion\/Duration -<br>\n\tFeel free to add major awards, recognition and other tidbits. It will take 5 minutes approximately.\n\t\n\t \n\t<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-graduate_school elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-graduate_school\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGraduate School Information\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[graduate_school]\" id=\"form-field-graduate_school\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-undergraduate_school elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-undergraduate_school\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tUndergraduate School Information\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[undergraduate_school]\" id=\"form-field-undergraduate_school\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_d4364d5 elementor-col-100\">\n\t\t\t\t\t\t<h1 style=\"text-align:center; color:#01818C;\">Counseling Psychologist Details<\/h1>\n\t<p style=\"text-align:center;color:#01818C;\"> Here are some questions to help us understand a little more about why you are looking out for this job!<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-counselling_psychologist elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-counselling_psychologist\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat, according to you, would make you a good Counselling Psychologist at Heart It Out?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[counselling_psychologist]\" id=\"form-field-counselling_psychologist\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-therapy_plan_to_practice elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-therapy_plan_to_practice\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat kind of therapy do you practice\/ plan to practice?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[therapy_plan_to_practice]\" id=\"form-field-therapy_plan_to_practice\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-primarily_inclined_towards elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-primarily_inclined_towards\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhich school of thought are you primarily inclined towards?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[primarily_inclined_towards]\" id=\"form-field-primarily_inclined_towards\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-mental_health elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-mental_health\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat does mental health mean to you?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[mental_health]\" id=\"form-field-mental_health\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-committed_to_projects elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-committed_to_projects\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you currently committed to any professional projects\/ work?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[committed_to_projects]\" id=\"form-field-committed_to_projects\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-undergoing_therapy elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-undergoing_therapy\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you currently undergoing therapy?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-undergoing_therapy-0\" name=\"form_fields[undergoing_therapy]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-undergoing_therapy-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-undergoing_therapy-1\" name=\"form_fields[undergoing_therapy]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-undergoing_therapy-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_be29181 elementor-col-100\">\n\t\t\t\t\t\t<h1 style=\"text-align:center; color:#01818C;\">References<\/h1>\n\t<p style=\"text-align:center;color:#01818C;\"> Psst...tell us who thinks you are amazing \ud83d\ude42<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name_reference elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name_reference\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName of Reference\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name_reference]\" id=\"form-field-name_reference\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-awesome_human elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-awesome_human\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhere did you meet this awesome human?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[awesome_human]\" id=\"form-field-awesome_human\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-contact_them elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-contact_them\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow can we contact them?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[contact_them]\" id=\"form-field-contact_them\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-any_other_references elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-any_other_references\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny other References?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[any_other_references]\" id=\"form-field-any_other_references\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t<style>.elementor-element.elementor-element-1b7468c .elementor-field-group { align-self: flex-start; 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