<h2 class="block-title">For More Program Information</h2>
<div class="contact-form block-content">
<form action="https://webto.salesforce.com/servlet/servlet.WebToCase?encoding=UTF-8" method="POST">
<!-- Recaptcha Settings --> <input keyname="" name="captcha_settings" type="hidden" value='{"keyname":"reCaptchaProd","fallback":"true","orgId":"00D390000005Z6D","ts":"1592323524595"}' />
<!-- Org ID --> <input name="orgid" type="hidden" value="00D390000005Z6D" />
<!-- Type and Subtype -->
<input type="hidden" id="type" name="type" value="Recruitment" />
<input type="hidden" id="00N39000004WhxV" name="00N39000004WhxV" value="Recruitment" />
<!-- Case Record Type --> <input type="hidden" id="recordType" name="recordType" value="0120z000000UPl8" />
<!-- Return URL --> <input name="retURL" type="hidden" value="https://professional.charlotte.edu/programs/bs-professional-studies" />
<!-- Event Tag --> <input type="hidden" id="00N0z000003O0Xj" name="00N0z000003O0Xj" size="20" value="programs/bs-professional-studies" />
<!-- Campaign --> <input id="00N0z000003GGtU" type="hidden" name="00N0z000003GGtU" data-defaultvalue="ys67-b.s.%20in%20professional%20studies" value="ys67-b.s.%20in%20professional%20studies" />
<!-- Description --> <input name="description" type="hidden" value="Web Form Completed - Online B.S. in Professional Studies" />
<!-- Academic Interest --> <input id="00N4X00000AuWxv" name="00N4X00000AuWxv" type="hidden" value="a0n4X00000GC1Bk" />
<!-- Form Elements -->
<label class="hidden" for="name">Name</label>
<br><input class="form-control" id="name" maxlength="80" name="name" placeholder="Name *" required="required" size="20" type="text" />
<label class="hidden" for="email">Email</label>
<br><input class="form-control" id="email" maxlength="80" name="email" placeholder="Email *" required="required" size="20" type="email" />
<label class="hidden" for="phone">Phone</label>
<br><input class="form-control" id="phone" maxlength="40" name="phone" placeholder="Phone *" required="required" size="20" type="text" />
<!-- Recaptcha -->
<div class="row top-pad">
<div class="col">
<div class="g-recaptcha" style="display:inline-block;transform:scale(0.88);transform-origin:0 0;" data-sitekey="6LdxMe0UAAAAAAzSI7W9-qppSQcJz6mw9huvDcYU" data-callback="recaptchaCallback" data-expired-callback="recaptchaExpiredCallback" data-error-callback="recaptchaErrorCallback"> </div>
</div>
<div class="col">
<div id="errAlert" class="alert alert-danger" hidden>
There was an error submitting your request. If this issue persists, please contact us at <a href="mailto:distanceed@uncc.edu">distanceed@uncc.edu</a> or <a href="tel:704-687-1283">704-687-1283</a>.
</div>
</div>
</div>
<label class="hidden" for="submitBtn">Submit</label><br />
<input class="button button-gold" id="submitBtn" name="submit" type="submit" />
</form>
</div>