{"id":31,"date":"2020-07-30T06:53:14","date_gmt":"2020-07-30T06:53:14","guid":{"rendered":"http:\/\/virtue.studio\/wrlp\/?page_id=31"},"modified":"2020-07-31T06:08:28","modified_gmt":"2020-07-31T06:08:28","slug":"employment-training-application","status":"publish","type":"page","link":"https:\/\/virtue.studio\/wrlp\/employment-training-application\/","title":{"rendered":"Employment Training Application"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\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_3' style='display:none'><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Employment Training Application<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/wrlp\/wp-json\/wp\/v2\/pages\/31#gf_3' data-formid='3' novalidate><input id=partial_entry_id_3 class=\"partial_entry_id\" type=hidden name=\"partial_entry_id\" value=\"pending\" data-form_id=\"3\"\/>\n        <div id='gf_progressbar_wrapper_3' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>8<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_12' style='width:12%;'><span>12%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_3_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_1\" class=\"gfield gfield--type-name 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 gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_3_1'>\n                            \n                            <span id='input_3_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_3_1_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.4' id='input_3_1_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_3_1_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_3_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_3_108\" class=\"gfield gfield--type-radio gfield--type-choice 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' >I am a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_108'>\n\t\t\t<li class='gchoice gchoice_3_108_0'>\n\t\t\t\t<input name='input_108' type='radio' value='Greensboro Resident'  id='choice_3_108_0'    \/>\n\t\t\t\t<label for='choice_3_108_0' id='label_3_108_0' class='gform-field-label gform-field-label--type-inline'>Greensboro Resident<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_108_1'>\n\t\t\t\t<input name='input_108' type='radio' value='High Point Resident'  id='choice_3_108_1'    \/>\n\t\t\t\t<label for='choice_3_108_1' id='label_3_108_1' class='gform-field-label gform-field-label--type-inline'>High Point Resident<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_108_2'>\n\t\t\t\t<input name='input_108' type='radio' value='Guilford County Resident'  id='choice_3_108_2'    \/>\n\t\t\t\t<label for='choice_3_108_2' id='label_3_108_2' class='gform-field-label gform-field-label--type-inline'>Guilford County Resident<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_108_3'>\n\t\t\t\t<input name='input_108' type='radio' value='gf_other_choice'  id='choice_3_108_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_3_108_other' name='input_108_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_2\" class=\"gfield gfield--type-address 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 gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_3_2_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_2_1' id='input_3_2_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_2_2_container' >\n                                        <input type='text' name='input_2.2' id='input_3_2_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_2_2' id='input_3_2_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_3_2_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_2_3' id='input_3_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_2_4_container' >\n                                        <select name='input_2.4' id='input_3_2_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' selected='selected'>North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_3_2_4' id='input_3_2_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_3_2_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_2_5' id='input_3_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_2.6' id='input_3_2_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_4\" class=\"gfield gfield--type-address 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 gfield_label_before_complex' >Mailing Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    <div id='input_3_4_copy_values_option_container' class='copy_values_option_container' >\n                                        <input type='checkbox' id='input_3_4_copy_values_activated' class='copy_values_activated' value='1' data-source_field_id='2' name='input_4_copy_values_activated'  \/>\n                                        <label for='input_3_4_copy_values_activated' id='input_3_4_copy_values_option_label' class='copy_values_option_label inline gform-field-label gform-field-label--type-inline'>Same as previous<\/label>\n                                    <\/div>\n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_3_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_4_1' id='input_3_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_4_2_container' >\n                                        <input type='text' name='input_4.2' id='input_3_4_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_4_2' id='input_3_4_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_3_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_4_3' id='input_3_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_4_4_container' >\n                                        <select name='input_4.4' id='input_3_4_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' selected='selected'>North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_3_4_4' id='input_3_4_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_3_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_4_5' id='input_3_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_3_4_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_5\" class=\"gfield gfield--type-phone gf_left_half 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_3_5'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_3_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_6\" class=\"gfield gfield--type-phone gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_6'>Alternate Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_3_6' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_7\" class=\"gfield gfield--type-email 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_3_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_3_7' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_3_54' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_2_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_2' class='gform_page' data-js='page-field-id-54' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_3_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_8\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gf_left_half 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_3_8'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_8' id='input_3_8' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_3_8_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_3_8_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_8' class='gform_hidden' value='https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_3_9\" class=\"gfield gfield--type-text gf_right_half 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_3_9'>Social Security Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_3_9' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_10\" class=\"gfield gfield--type-select gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_10'>Gender<\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_3_10' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select one<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Prefer Not to Answer' >Prefer Not to Answer<\/option><\/select><\/div><\/li><li id=\"field_3_11\" class=\"gfield gfield--type-select gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_11'>Race\/Ethnic Group<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_3_11' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select one<\/option><option value='American Indian or Alaska Native' >American Indian or Alaska Native<\/option><option value='Asian' >Asian<\/option><option value='Black or African American' >Black or African American<\/option><option value='Hispanic or Latino' >Hispanic or Latino<\/option><option value='Native Hawaiian or Other Pacific Islander' >Native Hawaiian or Other Pacific Islander<\/option><option value='White' >White<\/option><\/select><\/div><\/li><li id=\"field_3_12\" class=\"gfield gfield--type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Family\/Household Members<\/label><style type=\"text\/css\">\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_12_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_12_col_2' class='gfield_list_col_even' \/><col id='gfield_list_12_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_12_col_4' class='gfield_list_col_even' \/><col id='gfield_list_12_col_5' class='gfield_list_col_odd' \/><col id='gfield_list_12_col_6' class='gfield_list_col_even' \/><col id='gfield_list_12_col_7' class='gfield_list_col_odd' \/><col id='gfield_list_12_col_8' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Name<\/th><th scope=\"col\">Relation to the Head of Household<\/th><th scope=\"col\">DOB<\/th><th scope=\"col\">Last 4 digits of Social Security #<\/th><th scope=\"col\">Marital Status (Married, Divorced, Single, N\/A)<\/th><th scope=\"col\">Gender<\/th><th scope=\"col\">Education (Last Grade Completed)<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_12_cell1' data-label='Name'><input aria-invalid='false'   aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_12[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_12_cell2' data-label='Relation to the Head of Household'><input aria-invalid='false'   aria-label='Relation to the Head of Household, Row 1' data-aria-label-template='Relation to the Head of Household, Row {0}' type='text' name='input_12[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_12_cell3' data-label='DOB'><input aria-invalid='false'   aria-label='DOB, Row 1' data-aria-label-template='DOB, Row {0}' type='text' name='input_12[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_12_cell4' data-label='Last 4 digits of Social Security #'><input aria-invalid='false'   aria-label='Last 4 digits of Social Security #, Row 1' data-aria-label-template='Last 4 digits of Social Security #, Row {0}' type='text' name='input_12[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_12_cell5' data-label='Marital Status (Married, Divorced, Single, N\/A)'><input aria-invalid='false'   aria-label='Marital Status (Married, Divorced, Single, N\/A), Row 1' data-aria-label-template='Marital Status (Married, Divorced, Single, N\/A), Row {0}' type='text' name='input_12[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_12_cell6' data-label='Gender'><input aria-invalid='false'   aria-label='Gender, Row 1' data-aria-label-template='Gender, Row {0}' type='text' name='input_12[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_12_cell7' data-label='Education (Last Grade Completed)'><input aria-invalid='false'   aria-label='Education (Last Grade Completed), Row 1' data-aria-label-template='Education (Last Grade Completed), Row {0}' type='text' name='input_12[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img data-src='https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' src='data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==' class='lazyload' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img data-src='https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' src='data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==' class='lazyload' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_3_83\" class=\"gfield gfield--type-list 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 gfield_label_before_complex' >Emergency Contact Information<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_83_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_83_col_2' class='gfield_list_col_even' \/><col id='gfield_list_83_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_83_col_4' class='gfield_list_col_even' \/><col id='gfield_list_83_col_5' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\">Name<\/th><th scope=\"col\">Relationship<\/th><th scope=\"col\">Address<\/th><th scope=\"col\">Phone<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_83_cell1' data-label='Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_83[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_83_cell2' data-label='Relationship'><input aria-invalid='false' aria-required=\"true\"  aria-label='Relationship, Row 1' data-aria-label-template='Relationship, Row {0}' type='text' name='input_83[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_83_cell3' data-label='Address'><input aria-invalid='false' aria-required=\"true\"  aria-label='Address, Row 1' data-aria-label-template='Address, Row {0}' type='text' name='input_83[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_83_cell4' data-label='Phone'><input aria-invalid='false' aria-required=\"true\"  aria-label='Phone, Row 1' data-aria-label-template='Phone, Row {0}' type='text' name='input_83[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img data-src='https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' src='data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==' class='lazyload' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img data-src='https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' src='data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==' class='lazyload' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_3_84\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Do you have any medical conditions that require a medical or emergency plan?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_84'>\n\t\t\t<li class='gchoice gchoice_3_84_0'>\n\t\t\t\t<input name='input_84' type='radio' value='Yes'  id='choice_3_84_0'    \/>\n\t\t\t\t<label for='choice_3_84_0' id='label_3_84_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_3_84_1'>\n\t\t\t\t<input name='input_84' type='radio' value='No' checked='checked' id='choice_3_84_1'    \/>\n\t\t\t\t<label for='choice_3_84_1' id='label_3_84_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_85\" class=\"gfield gfield--type-textarea 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_3_85'>Please explain your medical condition and share the medical and emergency plan<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_85' id='input_3_85' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_82' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_82' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_3_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_3' class='gform_page' data-js='page-field-id-82' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_3_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_88\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Have you ever participated in a WRLP training program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_88'>\n\t\t\t<li class='gchoice gchoice_3_88_0'>\n\t\t\t\t<input name='input_88' type='radio' value='Yes'  id='choice_3_88_0'    \/>\n\t\t\t\t<label for='choice_3_88_0' id='label_3_88_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_3_88_1'>\n\t\t\t\t<input name='input_88' type='radio' value='No'  id='choice_3_88_1'    \/>\n\t\t\t\t<label for='choice_3_88_1' id='label_3_88_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_98\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Do you have a High School Diploma or a GED?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_98'>\n\t\t\t<li class='gchoice gchoice_3_98_0'>\n\t\t\t\t<input name='input_98' type='radio' value='Yes'  id='choice_3_98_0'    \/>\n\t\t\t\t<label for='choice_3_98_0' id='label_3_98_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_3_98_1'>\n\t\t\t\t<input name='input_98' type='radio' value='No'  id='choice_3_98_1'    \/>\n\t\t\t\t<label for='choice_3_98_1' id='label_3_98_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_97\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Do you have basic computer skills?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_97'>\n\t\t\t<li class='gchoice gchoice_3_97_0'>\n\t\t\t\t<input name='input_97' type='radio' value='Yes'  id='choice_3_97_0'    \/>\n\t\t\t\t<label for='choice_3_97_0' id='label_3_97_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_3_97_1'>\n\t\t\t\t<input name='input_97' type='radio' value='No'  id='choice_3_97_1'    \/>\n\t\t\t\t<label for='choice_3_97_1' id='label_3_97_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_96\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Can you pass a drug test?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_96'>\n\t\t\t<li class='gchoice gchoice_3_96_0'>\n\t\t\t\t<input name='input_96' type='radio' value='Yes'  id='choice_3_96_0'    \/>\n\t\t\t\t<label for='choice_3_96_0' id='label_3_96_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_3_96_1'>\n\t\t\t\t<input name='input_96' type='radio' value='No'  id='choice_3_96_1'    \/>\n\t\t\t\t<label for='choice_3_96_1' id='label_3_96_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_95\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Are you suicidal or homicidal today?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_95'>\n\t\t\t<li class='gchoice gchoice_3_95_0'>\n\t\t\t\t<input name='input_95' type='radio' value='Yes'  id='choice_3_95_0'    \/>\n\t\t\t\t<label for='choice_3_95_0' id='label_3_95_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_3_95_1'>\n\t\t\t\t<input name='input_95' type='radio' value='No'  id='choice_3_95_1'    \/>\n\t\t\t\t<label for='choice_3_95_1' id='label_3_95_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_94\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Have you been convicted of a felony within the last 7 years?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_94'>\n\t\t\t<li class='gchoice gchoice_3_94_0'>\n\t\t\t\t<input name='input_94' type='radio' value='Yes'  id='choice_3_94_0'    \/>\n\t\t\t\t<label for='choice_3_94_0' id='label_3_94_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_3_94_1'>\n\t\t\t\t<input name='input_94' type='radio' value='No'  id='choice_3_94_1'    \/>\n\t\t\t\t<label for='choice_3_94_1' id='label_3_94_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_93\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Are you employed?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_93'>\n\t\t\t<li class='gchoice gchoice_3_93_0'>\n\t\t\t\t<input name='input_93' type='radio' value='Yes'  id='choice_3_93_0'    \/>\n\t\t\t\t<label for='choice_3_93_0' id='label_3_93_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_3_93_1'>\n\t\t\t\t<input name='input_93' type='radio' value='No'  id='choice_3_93_1'    \/>\n\t\t\t\t<label for='choice_3_93_1' id='label_3_93_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_92\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Have you worked in the past 12 months?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_92'>\n\t\t\t<li class='gchoice gchoice_3_92_0'>\n\t\t\t\t<input name='input_92' type='radio' value='Yes'  id='choice_3_92_0'    \/>\n\t\t\t\t<label for='choice_3_92_0' id='label_3_92_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_3_92_1'>\n\t\t\t\t<input name='input_92' type='radio' value='No'  id='choice_3_92_1'    \/>\n\t\t\t\t<label for='choice_3_92_1' id='label_3_92_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_91\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Do you have transportation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_91'>\n\t\t\t<li class='gchoice gchoice_3_91_0'>\n\t\t\t\t<input name='input_91' type='radio' value='Yes'  id='choice_3_91_0'    \/>\n\t\t\t\t<label for='choice_3_91_0' id='label_3_91_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_3_91_1'>\n\t\t\t\t<input name='input_91' type='radio' value='No'  id='choice_3_91_1'    \/>\n\t\t\t\t<label for='choice_3_91_1' id='label_3_91_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_90\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Are you a veteran?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_90'>\n\t\t\t<li class='gchoice gchoice_3_90_0'>\n\t\t\t\t<input name='input_90' type='radio' value='Yes'  id='choice_3_90_0'    \/>\n\t\t\t\t<label for='choice_3_90_0' id='label_3_90_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_3_90_1'>\n\t\t\t\t<input name='input_90' type='radio' value='No'  id='choice_3_90_1'    \/>\n\t\t\t\t<label for='choice_3_90_1' id='label_3_90_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_89\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Are you disabled?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_89'>\n\t\t\t<li class='gchoice gchoice_3_89_0'>\n\t\t\t\t<input name='input_89' type='radio' value='Yes'  id='choice_3_89_0'    \/>\n\t\t\t\t<label for='choice_3_89_0' id='label_3_89_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_3_89_1'>\n\t\t\t\t<input name='input_89' type='radio' value='No'  id='choice_3_89_1'    \/>\n\t\t\t\t<label for='choice_3_89_1' id='label_3_89_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_99\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Do you have health insurance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_99'>\n\t\t\t<li class='gchoice gchoice_3_99_0'>\n\t\t\t\t<input name='input_99' type='radio' value='Yes'  id='choice_3_99_0'    \/>\n\t\t\t\t<label for='choice_3_99_0' id='label_3_99_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_3_99_1'>\n\t\t\t\t<input name='input_99' type='radio' value='No'  id='choice_3_99_1'    \/>\n\t\t\t\t<label for='choice_3_99_1' id='label_3_99_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_86' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_86' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_4_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_4' class='gform_page' data-js='page-field-id-86' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_3_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_100\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Do you have children who live with you?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_100'>\n\t\t\t<li class='gchoice gchoice_3_100_0'>\n\t\t\t\t<input name='input_100' type='radio' value='Yes'  id='choice_3_100_0'    \/>\n\t\t\t\t<label for='choice_3_100_0' id='label_3_100_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_3_100_1'>\n\t\t\t\t<input name='input_100' type='radio' value='No'  id='choice_3_100_1'    \/>\n\t\t\t\t<label for='choice_3_100_1' id='label_3_100_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_100_2'>\n\t\t\t\t<input name='input_100' type='radio' value='Not Applicable'  id='choice_3_100_2'    \/>\n\t\t\t\t<label for='choice_3_100_2' id='label_3_100_2' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_102\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Do you receive a childcare subsidy?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_102'>\n\t\t\t<li class='gchoice gchoice_3_102_0'>\n\t\t\t\t<input name='input_102' type='radio' value='Yes'  id='choice_3_102_0'    \/>\n\t\t\t\t<label for='choice_3_102_0' id='label_3_102_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_3_102_1'>\n\t\t\t\t<input name='input_102' type='radio' value='No'  id='choice_3_102_1'    \/>\n\t\t\t\t<label for='choice_3_102_1' id='label_3_102_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_102_2'>\n\t\t\t\t<input name='input_102' type='radio' value='Not Applicable'  id='choice_3_102_2'    \/>\n\t\t\t\t<label for='choice_3_102_2' id='label_3_102_2' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_103\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Does your child have health care insurance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_103'>\n\t\t\t<li class='gchoice gchoice_3_103_0'>\n\t\t\t\t<input name='input_103' type='radio' value='Yes'  id='choice_3_103_0'    \/>\n\t\t\t\t<label for='choice_3_103_0' id='label_3_103_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_3_103_1'>\n\t\t\t\t<input name='input_103' type='radio' value='No'  id='choice_3_103_1'    \/>\n\t\t\t\t<label for='choice_3_103_1' id='label_3_103_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_103_2'>\n\t\t\t\t<input name='input_103' type='radio' value='Not Applicable'  id='choice_3_103_2'    \/>\n\t\t\t\t<label for='choice_3_103_2' id='label_3_103_2' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_104\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Does your child receive Medicaid?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_104'>\n\t\t\t<li class='gchoice gchoice_3_104_0'>\n\t\t\t\t<input name='input_104' type='radio' value='Yes'  id='choice_3_104_0'    \/>\n\t\t\t\t<label for='choice_3_104_0' id='label_3_104_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_3_104_1'>\n\t\t\t\t<input name='input_104' type='radio' value='No'  id='choice_3_104_1'    \/>\n\t\t\t\t<label for='choice_3_104_1' id='label_3_104_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_104_2'>\n\t\t\t\t<input name='input_104' type='radio' value='Not Applicable'  id='choice_3_104_2'    \/>\n\t\t\t\t<label for='choice_3_104_2' id='label_3_104_2' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_105\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Does your child receive child support?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_105'>\n\t\t\t<li class='gchoice gchoice_3_105_0'>\n\t\t\t\t<input name='input_105' type='radio' value='Yes'  id='choice_3_105_0'    \/>\n\t\t\t\t<label for='choice_3_105_0' id='label_3_105_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_3_105_1'>\n\t\t\t\t<input name='input_105' type='radio' value='No'  id='choice_3_105_1'    \/>\n\t\t\t\t<label for='choice_3_105_1' id='label_3_105_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_105_2'>\n\t\t\t\t<input name='input_105' type='radio' value='Not Applicable'  id='choice_3_105_2'    \/>\n\t\t\t\t<label for='choice_3_105_2' id='label_3_105_2' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_106\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Does your child receive SSI?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_106'>\n\t\t\t<li class='gchoice gchoice_3_106_0'>\n\t\t\t\t<input name='input_106' type='radio' value='Yes'  id='choice_3_106_0'    \/>\n\t\t\t\t<label for='choice_3_106_0' id='label_3_106_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_3_106_1'>\n\t\t\t\t<input name='input_106' type='radio' value='No'  id='choice_3_106_1'    \/>\n\t\t\t\t<label for='choice_3_106_1' id='label_3_106_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_106_2'>\n\t\t\t\t<input name='input_106' type='radio' value='Not Applicable'  id='choice_3_106_2'    \/>\n\t\t\t\t<label for='choice_3_106_2' id='label_3_106_2' class='gform-field-label gform-field-label--type-inline'>Not Applicable<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_101' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_101' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_5_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_5' class='gform_page' data-js='page-field-id-101' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_3_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_13\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >Eligibility for emergency assistance is dependent upon the total gross income for you and your household members (relatives only).  Please list the total amount grossed in your household within the past 90 days (<strong>Do Not Include Non-relatives<\/strong>).<\/li><li id=\"field_3_60\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Employment Income in the Past 90 Days<\/h2><\/li><li id=\"field_3_38\" class=\"gfield gfield--type-number gf_left_third 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_3_38'>Employment Income 1st Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_38' id='input_3_38' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_69\" class=\"gfield gfield--type-number gf_middle_third 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_3_69'>Employment Income 2nd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_69' id='input_3_69' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_68\" class=\"gfield gfield--type-number gf_right_third 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_3_68'>Employment Income 3rd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_68' id='input_3_68' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_61\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Unemployment Benefits in the Past 90 Days<\/h2><\/li><li id=\"field_3_39\" class=\"gfield gfield--type-number gf_left_third 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_3_39'>Unemployment Benefits 1st Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_39' id='input_3_39' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_71\" class=\"gfield gfield--type-number gf_middle_third 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_3_71'>Unemployment Benefits 2nd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_71' id='input_3_71' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_70\" class=\"gfield gfield--type-number gf_right_third 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_3_70'>Unemployment Benefits 3rd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_70' id='input_3_70' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_62\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Social Security or SSI in the Past 90 Days<\/h2><\/li><li id=\"field_3_40\" class=\"gfield gfield--type-number gf_left_third 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_3_40'>Social Security or SSI 1st Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_40' id='input_3_40' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_73\" class=\"gfield gfield--type-number gf_middle_third 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_3_73'>Social Security or SSI 2nd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_73' id='input_3_73' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_72\" class=\"gfield gfield--type-number gf_right_third 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_3_72'>Social Security or SSI 3rd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_72' id='input_3_72' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_63\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Pension Income in the Past 90 Days<\/h2><\/li><li id=\"field_3_41\" class=\"gfield gfield--type-number gf_left_third 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_3_41'>Pension 1st Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_41' id='input_3_41' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_75\" class=\"gfield gfield--type-number gf_middle_third 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_3_75'>Pension 2nd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_75' id='input_3_75' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_74\" class=\"gfield gfield--type-number gf_right_third 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_3_74'>Pension 3rd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_74' id='input_3_74' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_64\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">TANF (Work First) in the Past 90 Days<\/h2><\/li><li id=\"field_3_43\" class=\"gfield gfield--type-number gf_left_third 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_3_43'>TANF (Work First) 1st Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_43' id='input_3_43' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_77\" class=\"gfield gfield--type-number gf_middle_third 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_3_77'>TANF (Work First) 2nd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_77' id='input_3_77' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_76\" class=\"gfield gfield--type-number gf_right_third 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_3_76'>TANF (Work First) 3rd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_76' id='input_3_76' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_65\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Child Support Received in the Past 90 Days<\/h2><\/li><li id=\"field_3_42\" class=\"gfield gfield--type-number gf_left_third 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_3_42'>Child Support 1st Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_42' id='input_3_42' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_79\" class=\"gfield gfield--type-number gf_middle_third 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_3_79'>Child Support 2nd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_79' id='input_3_79' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_78\" class=\"gfield gfield--type-number gf_right_third 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_3_78'>Child Support 3rd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_78' id='input_3_78' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_66\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Food &amp; Nutrition (Food Stamps) in the Past 90 Days<\/h2><\/li><li id=\"field_3_44\" class=\"gfield gfield--type-number gf_left_third 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_3_44'>Food &amp; Nutrition (Food Stamps) 1st Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_44' id='input_3_44' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_81\" class=\"gfield gfield--type-number gf_middle_third 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_3_81'>Food &amp; Nutrition (Food Stamps) 2nd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_81' id='input_3_81' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_80\" class=\"gfield gfield--type-number gf_right_third 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_3_80'>Food &amp; Nutrition (Food Stamps) 3rd Month<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_80' id='input_3_80' type='text' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_3_46\" class=\"gfield gfield--type-number gf_right_third gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_46'>90 Day Income<\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_3_46' type='text' step='any'   value='' class='medium gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_55' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_55' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_6_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_6' class='gform_page' data-js='page-field-id-55' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_3_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_107\" class=\"gfield gfield--type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Employment History<\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_107_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_107_col_2' class='gfield_list_col_even' \/><col id='gfield_list_107_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_107_col_4' class='gfield_list_col_even' \/><col id='gfield_list_107_col_5' class='gfield_list_col_odd' \/><col id='gfield_list_107_col_6' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\">Employer<\/th><th scope=\"col\">Address<\/th><th scope=\"col\">City<\/th><th scope=\"col\">State<\/th><th scope=\"col\">Zip Code<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_107_cell1' data-label='Employer'><input aria-invalid='false'   aria-label='Employer, Row 1' data-aria-label-template='Employer, Row {0}' type='text' name='input_107[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_107_cell2' data-label='Address'><input aria-invalid='false'   aria-label='Address, Row 1' data-aria-label-template='Address, Row {0}' type='text' name='input_107[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_107_cell3' data-label='City'><input aria-invalid='false'   aria-label='City, Row 1' data-aria-label-template='City, Row {0}' type='text' name='input_107[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_107_cell4' data-label='State'><input aria-invalid='false'   aria-label='State, Row 1' data-aria-label-template='State, Row {0}' type='text' name='input_107[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_107_cell5' data-label='Zip Code'><input aria-invalid='false'   aria-label='Zip Code, Row 1' data-aria-label-template='Zip Code, Row {0}' type='text' name='input_107[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img data-src='https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' src='data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==' class='lazyload' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img data-src='https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' src='data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==' class='lazyload' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><\/li><li id=\"field_3_30\" class=\"gfield gfield--type-radio gfield--type-choice 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' >Family Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_30'>\n\t\t\t<li class='gchoice gchoice_3_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='Single Person'  id='choice_3_30_0'    \/>\n\t\t\t\t<label for='choice_3_30_0' id='label_3_30_0' class='gform-field-label gform-field-label--type-inline'>Single Person<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='Single Parent'  id='choice_3_30_1'    \/>\n\t\t\t\t<label for='choice_3_30_1' id='label_3_30_1' class='gform-field-label gform-field-label--type-inline'>Single Parent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_30_2'>\n\t\t\t\t<input name='input_30' type='radio' value='Two-Parent'  id='choice_3_30_2'    \/>\n\t\t\t\t<label for='choice_3_30_2' id='label_3_30_2' class='gform-field-label gform-field-label--type-inline'>Two-Parent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_30_3'>\n\t\t\t\t<input name='input_30' type='radio' value='Two Adults-No Children'  id='choice_3_30_3'    \/>\n\t\t\t\t<label for='choice_3_30_3' id='label_3_30_3' class='gform-field-label gform-field-label--type-inline'>Two Adults-No Children<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_30_4'>\n\t\t\t\t<input name='input_30' type='radio' value='Grandparents'  id='choice_3_30_4'    \/>\n\t\t\t\t<label for='choice_3_30_4' id='label_3_30_4' class='gform-field-label gform-field-label--type-inline'>Grandparents<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Housing Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_31'>\n\t\t\t<li class='gchoice gchoice_3_31_0'>\n\t\t\t\t<input name='input_31' type='radio' value='Own'  id='choice_3_31_0'    \/>\n\t\t\t\t<label for='choice_3_31_0' id='label_3_31_0' class='gform-field-label gform-field-label--type-inline'>Own<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_31_1'>\n\t\t\t\t<input name='input_31' type='radio' value='Rent'  id='choice_3_31_1'    \/>\n\t\t\t\t<label for='choice_3_31_1' id='label_3_31_1' class='gform-field-label gform-field-label--type-inline'>Rent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_31_2'>\n\t\t\t\t<input name='input_31' type='radio' value='Public Housing'  id='choice_3_31_2'    \/>\n\t\t\t\t<label for='choice_3_31_2' id='label_3_31_2' class='gform-field-label gform-field-label--type-inline'>Public Housing<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_31_3'>\n\t\t\t\t<input name='input_31' type='radio' value='Section 8'  id='choice_3_31_3'    \/>\n\t\t\t\t<label for='choice_3_31_3' id='label_3_31_3' class='gform-field-label gform-field-label--type-inline'>Section 8<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_31_4'>\n\t\t\t\t<input name='input_31' type='radio' value='Living with family'  id='choice_3_31_4'    \/>\n\t\t\t\t<label for='choice_3_31_4' id='label_3_31_4' class='gform-field-label gform-field-label--type-inline'>Living with family<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_31_5'>\n\t\t\t\t<input name='input_31' type='radio' value='Homeless'  id='choice_3_31_5'    \/>\n\t\t\t\t<label for='choice_3_31_5' id='label_3_31_5' class='gform-field-label gform-field-label--type-inline'>Homeless<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_3_31'>Please insert a check beside the housing type that best represents your current living arrangements.<\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_56' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_56' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_7_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_7' class='gform_page' data-js='page-field-id-56' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_3_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_32\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent for Service Providers<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_32.1' id='input_3_32_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_3_32\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_3_32_1' >I Consent to the Release of Confidential Information for Multiple Service Providers<\/label><input type='hidden' name='input_32.2' value='I Consent to the Release of Confidential Information for Multiple Service Providers' class='gform_hidden' \/><input type='hidden' name='input_32.3' value='5' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_3_32' tabindex='0'>I hereby give my consent for the release of information contained on my application to be released or discussed with other agencies or service providers for the sole purpose of referrals and billing inquires only. By this consent, I shall hold Welfare Reform Liaison Project, Inc. harmless for any liability that I may incur as a result of any disclosure made within the bounds of my consent and authorization.<br \/>\n<p><br \/>\nI understand that my records are protected under <strong>10A NCAC 97B.0302 CONFIDENTIALITY AND DISCLOSURE OF INFORMATION<\/strong> and cannot be disclosed without my written consent unless otherwise provided for in the regulations.  The only exception to this requirement is if the disclosure is required by court order or for program monitoring by the Office, authorized federal, state, or local monitoring agencies.  I understand that this <strong>CONSENT<\/strong> is voluntary, and can be withdrawn\/revoked at any time except to the extent that action has been taken in reliance on it, and that in any event, this consent expires automatically as follows:<br \/>\n<\/p><br \/>\nOne year from the date of Consent, unless otherwise specified.<br \/>\n<\/div><\/li><li id=\"field_3_33\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Certification and Waiver<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_33.1' id='input_3_33_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_3_33\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_3_33_1' >I agree.<\/label><input type='hidden' name='input_33.2' value='I agree.' class='gform_hidden' \/><input type='hidden' name='input_33.3' value='5' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_3_33' tabindex='0'>I hereby grant permission and authorize any employer, utility company, fuel company, the Veteran\u2019s Administration, the Social Security Administration, and any other applicable public or private institution to share information regarding my past and present income verification in order to determine eligibility for CSBG services.  I allow the release of information contained herein for purposes of verification.<br \/>\n<p><br \/>\nI understand that any personal information I provide will be held in confidence to protect my privacy.<br \/>\n<\/p><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_57' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_57' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_8_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_8' class='gform_page' data-js='page-field-id-57' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_3_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_34\" class=\"gfield gfield--type-fileupload gf_left_half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_3_34'>Photo of ID Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_3_34' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_34&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_34&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_34&quot;,&quot;filelist&quot;:&quot;gform_preview_3_34&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/?gf_page=6c943cc26644d89&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,jpeg,gif,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;8388608b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:34,&quot;_gform_file_upload_nonce_3_34&quot;:&quot;79974f5c86&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_3_34&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_3_34' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_34' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_3_34 gfield_description_3_34\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_34'>Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 8 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_34'><\/ul> <div id='gform_preview_3_34' class='ginput_preview_list'><\/div><\/div><div class='gfield_description' id='gfield_description_3_34'>Please take a clear photo of your ID or driver&#8217;s license <\/div><\/li><li id=\"field_3_35\" class=\"gfield gfield--type-fileupload gf_left_half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_3_35'>Social Security Card<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_3_35' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_35&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_35&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_35&quot;,&quot;filelist&quot;:&quot;gform_preview_3_35&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/?gf_page=6c943cc26644d89&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,jpeg,gif,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;8388608b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:35,&quot;_gform_file_upload_nonce_3_35&quot;:&quot;2adb8f70bd&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;2&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_3_35&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_3_35' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_35' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_3_35 gfield_description_3_35\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_35'>Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 8 MB, Max. files: 2.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_35'><\/ul> <div id='gform_preview_3_35' class='ginput_preview_list'><\/div><\/div><div class='gfield_description' id='gfield_description_3_35'>Please take a clear photo of your Social Security Card <\/div><\/li><li id=\"field_3_36\" class=\"gfield gfield--type-fileupload gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_3_36'>Other<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_3_36' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_36&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_36&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_36&quot;,&quot;filelist&quot;:&quot;gform_preview_3_36&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/?gf_page=6c943cc26644d89&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/virtue.studio\\\/wrlp\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;jpg,jpeg,gif,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;8388608b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:36,&quot;_gform_file_upload_nonce_3_36&quot;:&quot;5dd3df4e88&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;4&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_3_36&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_3_36' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_36' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_3_36\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_36'>Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 8 MB, Max. files: 4.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_36'><\/ul> <div id='gform_preview_3_36' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_3_37\" class=\"gfield gfield--type-signature field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_37'>Signature<\/label><div ><div id='input_3_37_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_3_37_valid' id='input_3_37_valid' \/><canvas id='input_3_37' width='300' height='180'><\/canvas><\/div><\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_3' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <a type='button' href=\"javascript:void(0);\" id='gform_save_3_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_3' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_3' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='lo77a07pTwtPlHo5rYS6gxAqjsM4ePLAk9WP2acurXLKB2OSgmKbGJeZhnNaRMyDaLig7F1rhhRc3nZAVdb0bu\/3OJuW5VnDNC6P97InFC7OFb0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJ7XCIzMi4xXCI6XCJkYjRkYjExZjZlOWMxYjBhYzk2NmFhMTA4MTAyZGJhNlwiLFwiMzIuMlwiOlwiZjkzMTgyNWQ3ZTM5N2NhMmE4ZTU4NDA2YjllNDgyZjFcIixcIjMyLjNcIjpcImRkMDRkNDcxMWZiMDc2NzI3ZWQzODFmODYyZTA1NDM1XCIsXCIzMy4xXCI6XCJkYjRkYjExZjZlOWMxYjBhYzk2NmFhMTA4MTAyZGJhNlwiLFwiMzMuMlwiOlwiOThiMWQ5YTkwMzNlY2RmN2E5M2QyNzI3YTM3OWMyOTVcIixcIjMzLjNcIjpcImRkMDRkNDcxMWZiMDc2NzI3ZWQzODFmODYyZTA1NDM1XCJ9IiwiNWNhZTRkZjI5MzVhMTMzZWVhMjdjNzk3ZjRlYWZjNDEiXQ==' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_3' value='' \/>\n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_3').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_3').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_3').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_3').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_3').val();gformInitSpinner( 3, 'https:\/\/virtue.studio\/wrlp\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [3, current_page]);window['gf_submitting_3'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_3').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_3').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [3]);window['gf_submitting_3'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_3').text());}else{jQuery('#gform_3').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"3\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_3\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_3\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_3\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 3, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false,"footnotes":""},"class_list":["post-31","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/virtue.studio\/wrlp\/wp-json\/wp\/v2\/pages\/31","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/virtue.studio\/wrlp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/virtue.studio\/wrlp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/virtue.studio\/wrlp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/virtue.studio\/wrlp\/wp-json\/wp\/v2\/comments?post=31"}],"version-history":[{"count":0,"href":"https:\/\/virtue.studio\/wrlp\/wp-json\/wp\/v2\/pages\/31\/revisions"}],"wp:attachment":[{"href":"https:\/\/virtue.studio\/wrlp\/wp-json\/wp\/v2\/media?parent=31"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}