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class="js-form-item form-item form-group js-form-type-textfield form-item-last-name js-form-item-last-name"> <label for="edit-last-name" class="js-form-required form-required">Last Name</label> <input data-drupal-selector="edit-last-name" type="text" id="edit-last-name" name="last_name" value="" size="60" maxlength="255" class="form-text required" required="required" aria-required="true" /> </div> <div class="js-form-item form-item form-group js-form-type-email form-item-email js-form-item-email"> <label for="edit-email" class="js-form-required form-required">Email</label> <input data-drupal-selector="edit-email" type="email" id="edit-email" name="email" value="" size="60" maxlength="254" class="form-email required" required="required" aria-required="true" /> </div> <div class="js-form-item form-item form-group js-form-type-tel form-item-phone-number js-form-item-phone-number"> <label for="edit-phone-number">Phone Number</label> <input data-drupal-selector="edit-phone-number" type="tel" id="edit-phone-number" name="phone_number" value="" size="30" maxlength="128" placeholder="(123) 456-7890" class="form-tel" /> </div> <div class="js-form-item form-item form-group js-form-type-select form-item-ucsf-school js-form-item-ucsf-school"> <label for="edit-ucsf-school">UCSF School</label> <select data-drupal-selector="edit-ucsf-school" id="edit-ucsf-school" name="ucsf_school" class="form-select"><option value="" selected="selected">- Select -</option><option value="dentistry">School of Dentistry</option><option value="nursing">School of Nursing</option><option value="pharmacy">School of Pharmacy</option><option value="medicine">School of Medicine</option><option value="graduate">Graduate Division</option></select> </div> <div class="js-form-item form-item form-group js-form-type-textfield form-item-ucsf-degree-or-affiliation js-form-item-ucsf-degree-or-affiliation"> <label for="edit-ucsf-degree-or-affiliation">UCSF Degree or Affiliation</label> <input data-drupal-selector="edit-ucsf-degree-or-affiliation" type="text" id="edit-ucsf-degree-or-affiliation" name="ucsf_degree_or_affiliation" value="" size="60" maxlength="255" class="form-text" /> </div> <div class="js-form-item form-item form-group js-form-type-number form-item-ucsf-graduation-year js-form-item-ucsf-graduation-year"> <label for="edit-ucsf-graduation-year">UCSF Graduation Year</label> <input data-drupal-selector="edit-ucsf-graduation-year" type="number" id="edit-ucsf-graduation-year" name="ucsf_graduation_year" value="" step="any" placeholder="Example: 1999" class="form-number" /> </div> <div class="js-form-item form-item form-group js-form-type-textarea form-item-share-your-story js-form-item-share-your-story"> <label for="edit-share-your-story">Share Your Story</label> <div> <textarea data-drupal-selector="edit-share-your-story" id="edit-share-your-story" name="share_your_story" rows="5" cols="60" maxlength="650" class="form-textarea"></textarea> </div> </div> <div id="ajax-wrapper"><div class="js-form-item form-item form-group js-form-type-webform-image-file form-item-attach-a-photo-optional- js-form-item-attach-a-photo-optional-"> <label for="edit-attach-a-photo-optional-upload" id="edit-attach-a-photo-optional---label">Attach a photo (optional)</label> <div id="edit-attach-a-photo-optional-" class="js-webform-image-file webform-image-file js-form-managed-file form-managed-file"> <input data-drupal-selector="edit-attach-a-photo-optional-upload" accept="image/*" type="file" id="edit-attach-a-photo-optional-upload" name="files[attach_a_photo_optional_]" size="22" class="js-form-file form-file" /> <input class="js-hide button js-form-submit form-submit" data-drupal-selector="edit-attach-a-photo-optional-upload-button" formnovalidate="formnovalidate" type="submit" id="edit-attach-a-photo-optional-upload-button" name="attach_a_photo_optional__upload_button" value="Upload" /> <input data-drupal-selector="edit-attach-a-photo-optional-fids" type="hidden" name="attach_a_photo_optional_[fids]" /> </div> <div class="description"> <div id="edit-attach-a-photo-optional---description" class="webform-element-description">One file only.<br />2 MB limit.<br />Allowed types: gif, jpg, png, svg.<br />50 MB limit per form. </div> </div> </div> </div> <fieldset data-drupal-selector="edit-captcha" class="captcha captcha-type-challenge--hcaptcha"> <legend class="captcha__title js-form-required form-required"> CAPTCHA </legend> <div class="captcha__element"> <input data-drupal-selector="edit-captcha-sid" type="hidden" name="captcha_sid" value="64431" /> <input data-drupal-selector="edit-captcha-token" type="hidden" name="captcha_token" value="Da5Wz5euXyY6xsoWDNN6wVC18RVM_TXbgLa-mqI0TiY" /> <input data-drupal-selector="edit-captcha-response" type="hidden" name="captcha_response" value="hCaptcha no captcha" /> <div class="h-captcha" data-sitekey="c9d4c00f-d881-46ab-8bb2-935cdef2cb6a"></div><input 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