{"id":39614,"date":"2024-08-19T16:02:11","date_gmt":"2024-08-19T21:02:11","guid":{"rendered":"https:\/\/uwm.edu\/studentinvolvement\/?page_id=39614"},"modified":"2026-09-23T12:15:50","modified_gmt":"2026-09-23T17:15:50","slug":"leave-your-mark-registration","status":"publish","type":"page","link":"https:\/\/uwm.edu\/studentinvolvement\/get-involved\/leadership\/leave-your-mark\/leave-your-mark-registration\/","title":{"rendered":"Leave Your Mark Registration"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_6' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Leave Your Mark Application Form<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_6'  action='\/studentinvolvement\/wp-json\/wp\/v2\/pages\/39614' data-formid='6' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_7a9b203e7e82f9458cd058edafb3b603\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_7a9b203e7e82f9458cd058edafb3b603\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_1'><span class='gform-field-label__text'>First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_6_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_3'><span class='gform-field-label__text'>Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_6_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_4'><span class='gform-field-label__text'>Preferred Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_6_4' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Pronouns<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_5'><div class='gchoice gchoice_6_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='They\/them\/theirs'  id='choice_6_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_5_1' id='label_6_5_1' class='gform-field-label gform-field-label--type-inline'>They\/them\/theirs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='She\/her\/hers'  id='choice_6_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_5_2' id='label_6_5_2' class='gform-field-label gform-field-label--type-inline'>She\/her\/hers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='He\/him\/his'  id='choice_6_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_5_3' id='label_6_5_3' class='gform-field-label gform-field-label--type-inline'>He\/him\/his<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='Prefer not to say'  id='choice_6_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_5_4' id='label_6_5_4' class='gform-field-label gform-field-label--type-inline'>Prefer not to say<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='Other (for example: She\/They, Ze\/hir\/hir, etc.)'  id='choice_6_5_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_5_5' id='label_6_5_5' class='gform-field-label gform-field-label--type-inline'>Other (for example: She\/They, Ze\/hir\/hir, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_6'><span class='gform-field-label__text'>Other<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_6_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_7'><span class='gform-field-label__text'>UWM Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_6_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Year in School<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_9'>\n\t\t\t<div class='gchoice gchoice_6_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='First Year'  id='choice_6_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_9_0' id='label_6_9_0' class='gform-field-label gform-field-label--type-inline'>First Year<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Second Year'  id='choice_6_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_9_1' id='label_6_9_1' class='gform-field-label gform-field-label--type-inline'>Second Year<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Third Year'  id='choice_6_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_9_2' id='label_6_9_2' class='gform-field-label gform-field-label--type-inline'>Third Year<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Fourth Year'  id='choice_6_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_9_3' id='label_6_9_3' class='gform-field-label gform-field-label--type-inline'>Fourth Year<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Fifth Year or Higher'  id='choice_6_9_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_9_4' id='label_6_9_4' class='gform-field-label gform-field-label--type-inline'>Fifth Year or Higher<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_9_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Graduate School'  id='choice_6_9_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_9_5' id='label_6_9_5' class='gform-field-label gform-field-label--type-inline'>Graduate School<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_10'><span class='gform-field-label__text'>Expected Date of Graduation<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_6_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_11'><span class='gform-field-label__text'>Do you need any accommodations to be able to fully participate in the program?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_6_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>How did you hear about the program?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_13'><div class='gchoice gchoice_6_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Nominated by a staff or faculty member'  id='choice_6_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_13_1' id='label_6_13_1' class='gform-field-label gform-field-label--type-inline'>Nominated by a staff or faculty member<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='UWM Events Calendar'  id='choice_6_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_13_2' id='label_6_13_2' class='gform-field-label gform-field-label--type-inline'>UWM Events Calendar<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Social Media'  id='choice_6_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_13_3' id='label_6_13_3' class='gform-field-label gform-field-label--type-inline'>Social Media<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='Print Material (fliers, banners, window clings)'  id='choice_6_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_13_4' id='label_6_13_4' class='gform-field-label gform-field-label--type-inline'>Print Material (fliers, banners, window clings)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.5' type='checkbox'  value='Student Leadership Program Newsletter'  id='choice_6_13_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_13_5' id='label_6_13_5' class='gform-field-label gform-field-label--type-inline'>Student Leadership Program Newsletter<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.6' type='checkbox'  value='Word of mouth'  id='choice_6_13_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_13_6' id='label_6_13_6' class='gform-field-label gform-field-label--type-inline'>Word of mouth<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_13_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.7' type='checkbox'  value='Mentioned in another Leadership program I attended'  id='choice_6_13_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_13_7' id='label_6_13_7' class='gform-field-label gform-field-label--type-inline'>Mentioned in another Leadership program I attended<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_13_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' 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