{"id":9472,"date":"2017-04-18T10:33:13","date_gmt":"2017-04-18T14:33:13","guid":{"rendered":"https:\/\/www.bu.edu\/familymed\/?page_id=9472"},"modified":"2026-03-13T10:52:39","modified_gmt":"2026-03-13T14:52:39","slug":"9472-2","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/familymed\/9472-2\/","title":{"rendered":""},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_39' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Family Medicine Site Preference Form 2026-2027<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_39'  action='\/familymed\/wp-json\/wp\/v2\/pages\/9472' data-formid='39' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_39' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_39_1\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_1\"><label class='gfield_label gform-field-label' for='input_39_1' >Your BUID:<\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_39_1' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_39_2\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_2\"><label class='gfield_label gform-field-label' for='input_39_2' >Name:<\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_39_2' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_39_3\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_3\"><label class='gfield_label gform-field-label' for='input_39_3' >BU Email Address<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_39_3' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_39_4\"  class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_4\"><label class='gfield_label gform-field-label' for='input_39_4' >Block #:<\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_39_4' class='medium gfield_select'     aria-invalid=\"false\" ><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><\/select><\/div><\/li><li id=\"field_39_5\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_5\"><label class='gfield_label gform-field-label'  >Are you fluent or medically competent in a language other than English?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_39_5'>\n\t\t\t<li class='gchoice gchoice_39_5_0'>\n\t\t\t\t<input name='input_5' type='radio' value='Yes'  id='choice_39_5_0'    \/>\n\t\t\t\t<label for='choice_39_5_0' id='label_39_5_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_5_1'>\n\t\t\t\t<input name='input_5' type='radio' value='No'  id='choice_39_5_1'    \/>\n\t\t\t\t<label for='choice_39_5_1' id='label_39_5_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_39_6\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_6\"><label class='gfield_label gform-field-label' for='input_39_6' >If yes, what language?<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_39_6' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_39_7\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_7\"><label class='gfield_label gform-field-label'  >Would you prefer a site where language other than English are used primarily?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_39_7'>\n\t\t\t<li class='gchoice gchoice_39_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='Yes'  id='choice_39_7_0'    \/>\n\t\t\t\t<label for='choice_39_7_0' id='label_39_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='No'  id='choice_39_7_1'    \/>\n\t\t\t\t<label for='choice_39_7_1' id='label_39_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_39_8\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_8\"><label class='gfield_label gform-field-label'  >Are you an active member of AMP?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_39_8'>\n\t\t\t<li class='gchoice gchoice_39_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Yes'  id='choice_39_8_0'    \/>\n\t\t\t\t<label for='choice_39_8_0' id='label_39_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='No'  id='choice_39_8_1'    \/>\n\t\t\t\t<label for='choice_39_8_1' id='label_39_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_39_9\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_9\"><label class='gfield_label gform-field-label'  >Will you have transportation available other than public transit for 3rd yr? (A car is required for Family Medicine rotation)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_39_9'>\n\t\t\t<li class='gchoice gchoice_39_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='Yes'  id='choice_39_9_0'    \/>\n\t\t\t\t<label for='choice_39_9_0' id='label_39_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='No'  id='choice_39_9_1'    \/>\n\t\t\t\t<label for='choice_39_9_1' id='label_39_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_39_10\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_10\"><label class='gfield_label gform-field-label'  >Please choose the best response to describe where you are commuting from to get to BMC for your classes:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_39_10'>\n\t\t\t<li class='gchoice gchoice_39_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='North of Boston'  id='choice_39_10_0'    \/>\n\t\t\t\t<label for='choice_39_10_0' id='label_39_10_0' class='gform-field-label gform-field-label--type-inline'>North of Boston<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='West of Boston'  id='choice_39_10_1'    \/>\n\t\t\t\t<label for='choice_39_10_1' id='label_39_10_1' class='gform-field-label gform-field-label--type-inline'>West of Boston<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_10_2'>\n\t\t\t\t<input name='input_10' type='radio' value='South of Boston'  id='choice_39_10_2'    \/>\n\t\t\t\t<label for='choice_39_10_2' id='label_39_10_2' class='gform-field-label gform-field-label--type-inline'>South of Boston<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_10_3'>\n\t\t\t\t<input name='input_10' type='radio' value='In the City'  id='choice_39_10_3'    \/>\n\t\t\t\t<label for='choice_39_10_3' id='label_39_10_3' class='gform-field-label gform-field-label--type-inline'>In the City<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_39_11\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_11\"><label class='gfield_label gform-field-label'  >Do you have strong preferences as far as the type of site you would like to be placed with?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_39_11'>\n\t\t\t<li class='gchoice gchoice_39_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='Yes'  id='choice_39_11_0'    \/>\n\t\t\t\t<label for='choice_39_11_0' id='label_39_11_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_39_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='No'  id='choice_39_11_1'    \/>\n\t\t\t\t<label for='choice_39_11_1' id='label_39_11_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_39_15\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_39_15\"><label class='gfield_label gform-field-label' for='input_39_15' >If yes, please provide details in the box below:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_39_15' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_39_13\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below 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