{"id":3566,"date":"2026-07-28T11:41:49","date_gmt":"2026-07-28T16:41:49","guid":{"rendered":"https:\/\/dev-hope-council-2026.pantheonsite.io\/?page_id=3566"},"modified":"2026-07-29T08:41:49","modified_gmt":"2026-07-29T13:41:49","slug":"referral-form","status":"publish","type":"page","link":"https:\/\/www.hopecouncil.org\/es\/contact\/make-a-referral\/referral-form\/","title":{"rendered":"Formulario de derivaci\u00f3n"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-color:var(--awb-color5);--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:40px;--awb-padding-bottom:20px;--awb-background-image:radial-gradient(circle at center center, var(--awb-custom_color_4) 0%,rgba(203,211,209,0.6) 100%);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1456px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_3_4 3_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:75%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.56%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.56%;--awb-width-medium:75%;--awb-order-medium:0;--awb-spacing-right-medium:2.56%;--awb-spacing-left-medium:2.56%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-six\" style=\"--awb-text-color:var(--awb-color5);--awb-margin-top-small:10px;--awb-margin-right-small:0px;--awb-margin-bottom-small:10px;--awb-margin-left-small:0px;\"><h6 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Contact<\/h6><\/div><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-text-color:var(--awb-color1);--awb-margin-top-small:10px;--awb-margin-right-small:0px;--awb-margin-bottom-small:10px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"font-family:&quot;Poppins&quot;;font-style:normal;font-weight:700;margin:0;\">Referral Form<\/h3><\/div><\/div><\/div><\/div><\/div><div id=\"form\" class=\"fusion-container-anchor\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1456px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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 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var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_9' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_9' id='gform_9'  action='\/es\/wp-json\/wp\/v2\/pages\/3566#gf_9' data-formid='9' novalidate>\n        <div id='gf_progressbar_wrapper_9' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_9_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_9_24\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_24'><span class='gform-field-label__text'>Name<\/span><\/label><div class='ginput_container'><input name='input_24' id='input_9_24' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_9_24'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_9_20\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Referrer details<\/h3><\/div><div id=\"field_9_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-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_9_13'><span class='gform-field-label__text'>Your name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_9_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-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_9_14'><span class='gform-field-label__text'>Organization<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_9_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-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_9_15'><span class='gform-field-label__text'>Role<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_9_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_17\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-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_9_17'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_9_17' type='tel' value='' class='large'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_9_18\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_18'><span class='gform-field-label__text'>Email<\/span><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_18' id='input_9_18' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_9_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_19'><span class='gform-field-label__text'>Relationship to the person being referred<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_9_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_9_11' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_9_2' class='gform_page' data-js='page-field-id-11' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_9_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_9_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Referral details<\/h3><\/div><div id=\"field_9_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-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_9_1'><span class='gform-field-label__text'>Person&#039;s name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_9_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_9_3\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-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_9_3'><span class='gform-field-label__text'>Date of birth (if required for the service)<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_9_3'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_3'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_9_3' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_9_3' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_9_3' aria-label='Date of birth (if required for the service): Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_9_4\" class=\"gfield gfield--type-textarea gfield--input-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_9_4'><span class='gform-field-label__text'>Safe contact information (and any contact restrictions)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_4' id='input_9_4' class='textarea small'    placeholder='Phone, voicemail okay or not, email, best times\u2026' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_9_5\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_5'><span class='gform-field-label__text'>Reason for referral<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_9_5' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_9_6\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-columns\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Requested services<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_6'><div class='gchoice gchoice_9_6_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='Assessment'  id='choice_9_6_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_1' id='label_9_6_1' class='gform-field-label gform-field-label--type-inline'>Assessment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_6_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.2' type='checkbox'  value='Diversion'  id='choice_9_6_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_2' id='label_9_6_2' class='gform-field-label gform-field-label--type-inline'>Diversion<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_6_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.3' type='checkbox'  value='Peer support'  id='choice_9_6_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_3' id='label_9_6_3' class='gform-field-label gform-field-label--type-inline'>Peer support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_6_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.4' type='checkbox'  value='Family services'  id='choice_9_6_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_4' id='label_9_6_4' class='gform-field-label gform-field-label--type-inline'>Family services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_6_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.5' type='checkbox'  value='Testing'  id='choice_9_6_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_5' id='label_9_6_5' class='gform-field-label gform-field-label--type-inline'>Testing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_6_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.6' type='checkbox'  value='Navigation'  id='choice_9_6_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_6' id='label_9_6_6' class='gform-field-label gform-field-label--type-inline'>Navigation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_6_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.7' type='checkbox'  value='Outpatient Treatment'  id='choice_9_6_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_7' id='label_9_6_7' class='gform-field-label gform-field-label--type-inline'>Outpatient Treatment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_9_6_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.8' type='checkbox'  value='Not sure'  id='choice_9_6_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_6_8' id='label_9_6_8' class='gform-field-label gform-field-label--type-inline'>Not sure<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_9_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_3col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-columns\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Consent and release status<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_9_8'>\n\t\t\t<div class='gchoice gchoice_9_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Release of Information in place'  id='choice_9_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_8_0' id='label_9_8_0' class='gform-field-label gform-field-label--type-inline'>Release of Information in place<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Release needed'  id='choice_9_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_8_1' id='label_9_8_1' class='gform-field-label gform-field-label--type-inline'>Release needed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_9_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Not sure'  id='choice_9_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_9_8_2' id='label_9_8_2' class='gform-field-label gform-field-label--type-inline'>Not sure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_9\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_9'><span class='gform-field-label__text'>Brief notes<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_9_9' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_9_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I understand<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_9_10'><div class='gchoice gchoice_9_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='I understand this form is not monitored 24\/7 and is not for emergencies.'  id='choice_9_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_10_1' id='label_9_10_1' class='gform-field-label gform-field-label--type-inline'>I understand this form is not monitored 24\/7 and is not for emergencies.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_9_23\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_9_23'><span class='gform-field-label__text'>Upload release of information or other relevant reports\/documentation<\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_9_23' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_9_23&quot;,&quot;container&quot;:&quot;gform_multifile_upload_9_23&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_9_23&quot;,&quot;filelist&quot;:&quot;gform_preview_9_23&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.hopecouncil.org\\\/?gf_page=35dd6b39a05bf44&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.hopecouncil.org\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.hopecouncil.org\\\/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,png,pdf&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:9,&quot;field_id&quot;:23,&quot;_gform_file_upload_nonce_9_23&quot;:&quot;b1136635bd&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_9_23&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_9_23' 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_9_23' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_9_23\"  >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_9_23'>Accepted file types: jpg, jpeg, png, pdf, Max. file size: 10 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_9_23'><\/ul> <div id='gform_preview_9_23' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_9_22\" class=\"gfield gfield--type-turnstile gfield--input-type-turnstile gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_turnstile'><div class=\"cf-turnstile\" id=\"cf-turnstile_9\" data-js-turnstile data-response-field-name=\"cf-turnstile-response_9\" data-theme=\"auto\" data-size=\"normal\" data-sitekey=\"0x4AAAAAAECOGzwMyx9iFJAJ\"><\/div><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_9' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button class=\"gform_button button fusion-button\" id=\"gform_submit_button_9\" type=\"submit\" onclick=\"gform.submission.handleButtonClick(this);\"><span class=\"fusion-button-text\">Submit<\/span><i class=\"glyphicon fa-long-arrow-alt-right fas\" aria-hidden=\"true\"><\/i><\/button> <input type='hidden' name='gform_ajax' value='form_id=9&amp;title=&amp;description=&amp;tabindex=0&amp;theme=orbital&amp;styles=[]&amp;hash=012bae40d1ddbd1f39e56644cbdd0e56' \/><input type='hidden' class='gform_hidden' name='gform_submission_speeds' value='{&quot;pages&quot;:[]}' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_9' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_9' id='gform_theme_9' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_9' id='gform_style_settings_9' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='9' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='j2spGTMuaqxj77+WLoP2HRvrNfRGPW8sz1VTUJKfUVIk4Rfzzzpd12dbBoILPwYwJYlS\/n7YIFCpOUsl0C+y+gp\/qBUnVq8orPQqHfR78ES5veo=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_9' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_9' value='' \/>\n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_9' id='gform_ajax_frame_9' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {jQuery('#gform_ajax_frame_9').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_9');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_9').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){jQuery('#gform_wrapper_9').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_9').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_9').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_9').offset().top - mt); }, 50 );var current_page = 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