{"id":195,"date":"2022-05-03T10:18:45","date_gmt":"2022-05-03T17:18:45","guid":{"rendered":"https:\/\/beta2.swrforum.com\/?page_id=195"},"modified":"2022-10-10T13:58:05","modified_gmt":"2022-10-10T20:58:05","slug":"enrollment-application","status":"publish","type":"page","link":"https:\/\/yamhillheadstart.org\/es\/enrollment-application\/","title":{"rendered":"Aplicaci\u00f3n de Inscripci\u00f3n"},"content":{"rendered":"<div class=\"gb-container gb-container-af59ad55\"><div class=\"gb-inside-container\">\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h1 class=\"wp-block-heading\">Ready to Sign up?<\/h1>\n\n\n\t\t\t<link rel=\"stylesheet\" property=\"stylesheet\" href=\"https:\/\/yamhillheadstart.org\/wp-content\/plugins\/happyforms-upgrade\/bundles\/css\/frontend.css\" \/>\n\t\t\t\t\t<style type=\"text\/css\" id=\"happyforms-conditional-styles\">\n\t\t#happyforms-193_single_line_text_29-part { display: none; }\n#happyforms-193_single_line_text_30-part { display: none; }\n#happyforms-193_single_line_text_31-part { display: none; }\n#happyforms-193_single_line_text_32-part { display: none; }\n#happyforms-193_single_line_text_36-part { display: none; }\n#happyforms-193_radio_37-part { display: none; }\n#happyforms-193_radio_38-part { display: none; }\n#happyforms-193_single_line_text_39-part { display: none; }\n#happyforms-193_radio_40-part { display: none; }\n#happyforms-193_single_line_text_42-part { display: none; }\n#happyforms-193_radio_43-part { display: none; }\n#happyforms-193_single_line_text_44-part { display: none; }\n#happyforms-193_single_line_text_45-part { display: none; }\n#happyforms-193_single_line_text_46-part { display: none; }\n#happyforms-193_single_line_text_47-part { display: none; }\n#happyforms-193_checkbox_48-part { display: none; }\n#happyforms-193_single_line_text_52-part { display: none; }\n#happyforms-193_radio_54-part { display: none; }\n#happyforms-193_radio_55-part { display: none; }\n#happyforms-193_radio_56-part { display: none; }\n#happyforms-193_radio_57-part { display: none; }\n#happyforms-193_radio_58-part { display: none; }\n#happyforms-193_single_line_text_59-part { display: none; }\n#happyforms-193_radio_61-part { display: none; }\n#happyforms-193_radio_62-part { display: none; }\n#happyforms-193_radio_63-part { display: none; }\n#happyforms-193_radio_64-part { display: none; }\n#happyforms-193_date_73-part { display: none; }\n#happyforms-193_date_74-part { display: none; }\n#happyforms-193_single_line_text_41-part { display: none; }\n\t\t<\/style>\n\t\t\t<!-- HappyForms CSS variables -->\n\t<style>\n\t#happyforms-193 {\n\t\t--happyforms-part-title-font-size: 16px;\n--happyforms-part-description-font-size: 12px;\n--happyforms-part-value-font-size: 16px;\n--happyforms-submit-button-font-size: 16px;\n--happyforms-color-primary: #000000;\n--happyforms-color-success-notice: #ebf9f0;\n--happyforms-color-success-notice-text: #1eb452;\n--happyforms-color-error: #f23000;\n--happyforms-color-error-notice: #ffeeea;\n--happyforms-color-error-notice-text: #f23000;\n--happyforms-color-part-title: #000000;\n--happyforms-color-part-value: #000000;\n--happyforms-color-part-placeholder: #888888;\n--happyforms-color-part-description: #454545;\n--happyforms-color-part-border: #dbdbdb;\n--happyforms-color-part-border-focus: #7aa4ff;\n--happyforms-color-part-background: #ffffff;\n--happyforms-color-part-background-focus: #ffffff;\n--happyforms-color-submit-background: #000000;\n--happyforms-color-submit-background-hover: #000000;\n--happyforms-color-submit-border: ;\n--happyforms-color-submit-text: #ffffff;\n--happyforms-color-submit-text-hover: #ffffff;\n--happyforms-color-table-row-odd: #fcfcfc;\n--happyforms-color-table-row-even: #efefef;\n--happyforms-color-table-row-odd-text: #000000;\n--happyforms-color-table-row-even-text: #000000;\n--happyforms-color-dropdown-item-bg: #ffffff;\n--happyforms-color-dropdown-item-text: #000000;\n--happyforms-color-dropdown-item-bg-hover: #f4f4f5;\n--happyforms-color-dropdown-item-text-hover: #000000;\n--happyforms-color-divider-hr: #cccccc;\n--happyforms-color-choice-checkmark-bg: #ffffff;\n--happyforms-color-choice-checkmark-bg-focus: #000000;\n--happyforms-color-choice-checkmark-color: #ffffff;\n--happyforms-color-rating: #cccccc;\n--happyforms-color-rating-hover: #000000;\n--happyforms-color-multistep-info-text-color: #000000;\n--happyforms-color-multistep-info-back-color: #000000;\n--happyforms-color-multistep-info-back-color-hover: #000000;\n--happyforms-poll-bar-color: #e8e8e8;\n--happyforms-poll-link-color: #000000;\n--happyforms-poll-winner-color: #000000;\n\t}\n\t<\/style>\n\t<!-- End of HappyForms CSS variables -->\n\t\t<!-- HappyForms Additional CSS -->\n\t<style data-happyforms-additional-css>\n\t\t<\/style>\n\t<!-- End of HappyForms Additional CSS -->\n\t\t\t<link rel=\"stylesheet\" type=\"text\/css\" href=\"https:\/\/yamhillheadstart.org\/wp-content\/plugins\/happyforms-upgrade\/core\/assets\/css\/no-interaction.css\">\n\t\t<div class=\"happyforms-form happyforms-styles\" id=\"happyforms-193\">\n\t\t\n\t<form action=\"\" id=\"happyforms-form-193\" method=\"post\" novalidate=\"true\" autocomplete=\"off\" data-happyforms-conditionable=\"\">\n\t\t\t\t<input type=\"hidden\" name=\"happyforms_random_seed\" value=\"1506425275\" \/>\n\t\t\n\t\t\t<input type=\"hidden\" name=\"action\" value=\"happyforms_message\">\n\t\t\t\t<input type=\"hidden\" name=\"client_referer\" value=\"\">\n\t\t\t\t<input type=\"hidden\" name=\"current_post_id\" value=\"\">\n\t\t\t\t<input type=\"hidden\" name=\"happyforms_form_id\" value=\"193\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"happyforms_step\" value=\"0\" \/>\n\t\n\t\t<div class=\"happyforms-flex\">\n\t\t\t\t<label for=\"193-single_line_text\" class=\"screen-reader-text\">Leave this field blank<\/label>\n\t<input type=\"text\" id=\"193-single_line_text\" name=\"193-single_line_text\" style=\"display: none;\" tabindex=\"-1\" autocomplete=\"off\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_1-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_1\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_1\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Did an agency refer you to Head Start<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_1_option_1651524300168\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_1\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_1_option_1651524310640\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_1\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_single_line_text_39-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_39\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_39\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Agency Name &amp; Person who referred:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_39\" type=\"text\" name=\"193_single_line_text_39\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_40-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_40\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_40\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">If an agency didn&#039;t refer you, how did you hear about Head Start of Yamhill County?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_40_option_1665435632630\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_40\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">A friend or family member<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_40_option_1665435641773\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_40\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Website<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_40_option_1665435646973\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_40\" value=\"2\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Facebook<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_40_option_1665435652495\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_40\" value=\"3\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Instagram<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_40_option_1665435657790\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_40\" value=\"4\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Flyer<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_40_option_1665435663141\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_40\" value=\"5\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Other<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_single_line_text_41-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_41\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_41\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">If you answered &quot;Other&quot;, please share how you heard about us.<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_41\" type=\"text\" name=\"193_single_line_text_41\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_2-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_2\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_2\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is someone helping you complete this form?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_2_option_1651524391600\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_2\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_2_option_1651524397056\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_2\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_3-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_3\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_3\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Primary Parent\/Guardian First Name:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_3\" type=\"text\" name=\"193_single_line_text_3\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_4-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_4\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_4\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Primary Parent\/Guardian Last Name:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_4\" type=\"text\" name=\"193_single_line_text_4\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--date happyforms-part--width-half happyforms-part--label-show happyforms-part-date--required happyforms-part-date--date happyforms-part-date--12\" id=\"happyforms-193_date_75-part\" data-happyforms-type=\"date\" data-happyforms-id=\"date_75\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_date_75\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Primary Parent\/ Guardian Date of Birth:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\n<div class=\"happyforms-part-date__date-input happyforms-part--date__input-wrap happyforms-part-date-input--date\">\n\t<div class=\"happyforms-custom-date\" data-searchable=\"true\">\n\t\t<div class=\"happyforms-part__date-wrap\">\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t<input type=\"date\" min=\"1945-01-01\" max=\"2030-12-31\" value=\"\" name=\"193_date_75[date]\" data-serialize required class=\"happyforms-date-field\" \/>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_5-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_5\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_5\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Living in the home?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_5_option_1651524485312\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_5\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_5_option_1651524757920\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_5\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_6-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_6\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_6\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Secondary Parent\/Guardian First Name:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_6\" type=\"text\" name=\"193_single_line_text_6\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_7-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_7\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_7\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Secondary Parent\/Guardian Last Name:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_7\" type=\"text\" name=\"193_single_line_text_7\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--date happyforms-part--width-half happyforms-part--label-show happyforms-part-date--date happyforms-part-date--12\" id=\"happyforms-193_date_76-part\" data-happyforms-type=\"date\" data-happyforms-id=\"date_76\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_date_76\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Secondary Parent\/ Guardian Date of Birth:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\n<div class=\"happyforms-part-date__date-input happyforms-part--date__input-wrap happyforms-part-date-input--date\">\n\t<div class=\"happyforms-custom-date\" data-searchable=\"true\">\n\t\t<div class=\"happyforms-part__date-wrap\">\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t<input type=\"date\" min=\"1945-01-01\" max=\"2030-12-31\" value=\"\" name=\"193_date_76[date]\" data-serialize required class=\"happyforms-date-field\" \/>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_8-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_8\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_8\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Living in the home?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_5_option_1651524485312\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_8\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_5_option_1651524757920\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_8\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_single_line_text_9-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_9\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_9\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Living Address<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_9\" type=\"text\" name=\"193_single_line_text_9\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_10-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_10\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_10\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">City<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_10\" type=\"text\" name=\"193_single_line_text_10\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_11-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_11\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_11\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">State<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_11\" type=\"text\" name=\"193_single_line_text_11\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--number happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_number_12-part\" data-happyforms-type=\"number\" data-happyforms-id=\"number_12\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_number_12\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Zip Code<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\t\t\t\t<input id=\"happyforms-193_number_12\" type=\"number\" value=\"\" name=\"193_number_12\" placeholder=\"\" min=\"\" max=\"\" step=\"1\" autocomplete=\"off\" spellcheck=\"false\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_13-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_13\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_13\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is Mailing Address the Same as Living Address?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_13_option_1651525247082\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_13\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_13_option_1651525249890\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_13\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_single_line_text_29-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_29\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_29\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Mailing Address<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_29\" type=\"text\" name=\"193_single_line_text_29\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_30-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_30\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_30\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">City<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_30\" type=\"text\" name=\"193_single_line_text_30\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_31-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_31\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_31\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">State<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_31\" type=\"text\" name=\"193_single_line_text_31\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_32-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_32\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_32\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Zip Code<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_32\" type=\"text\" name=\"193_single_line_text_32\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_33-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_33\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_33\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Cell Phone<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_33\" type=\"text\" name=\"193_single_line_text_33\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_34-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_34\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_34\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Secondary Phone<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_34\" type=\"text\" name=\"193_single_line_text_34\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_35-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_35\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_35\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Message Phone<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_35\" type=\"text\" name=\"193_single_line_text_35\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--with-autocomplete happyforms-form__part happyforms-part happyforms-part--email happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_email_14-part\" data-happyforms-type=\"email\" data-happyforms-id=\"email_14\" data-happyforms-required=\"\">\n\t\t<div class=\"happyforms-part-wrap\">\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_email_14\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Email Address<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t<input type=\"email\" name=\"193_email_14\" id=\"happyforms-193_email_14\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_15-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_15\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_15\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Family Structure<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_15_option_1651525331850\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_15\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">2 Parent Household<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_15_option_1651525340194\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_15\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">1 Parent Household<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_15_option_1651525348962\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_15\" value=\"2\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">2 Grandparent Household<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_15_option_1651525356122\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_15\" value=\"3\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">1 Grandparent Household<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--number happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_number_17-part\" data-happyforms-type=\"number\" data-happyforms-id=\"number_17\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_number_17\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Number of people in the family:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\t\t\t\t<input id=\"happyforms-193_number_17\" type=\"number\" value=\"\" name=\"193_number_17\" placeholder=\"\" min=\"\" max=\"\" step=\"1\" autocomplete=\"off\" spellcheck=\"false\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--checkbox happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_checkbox_16-part\" data-happyforms-type=\"checkbox\" data-happyforms-id=\"checkbox_16\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_checkbox_16\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Do any of the following apply to your family<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525406505\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"0\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Parent(s)\/Guardian(s) work in agriculture<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525442450\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"1\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Family member has a disability<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525484458\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"2\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Parent\/Guardian is or was in recovery<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525498338\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"3\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Parent\/Guardian is or was incarcerated<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525522594\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"4\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Is or has experienced domestic violence<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525543890\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"5\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Parent\/Guardian is or was in foster care<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525565483\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"6\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Parent\/Guardian currently attends school<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_16_option_1651525587042\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_16[]\" value=\"7\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Parent\/Guardian does not have a high school diploma or GED<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_18-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_18\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_18\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Please mark the option that best describes your housing:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_18_option_1651525768827\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_18\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Homeowner<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_18_option_1651525775426\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_18\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Renting<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_18_option_1651525778930\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_18\" value=\"2\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Doubled up or living with others, friends, or family<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_18_option_1675268919805\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_18\" value=\"3\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">In a shelter, transitional housing, or without a home<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_19-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_19\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_19\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is parent or guardian expecting a child?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_19_option_1651525836619\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_19\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_19_option_1651525839019\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_19\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_42-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_42\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_42\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Due date:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_42\" type=\"text\" name=\"193_single_line_text_42\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_43-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_43\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_43\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Are you interested in signing up for Early Head Start for expecting parents?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_43_option_1665436046246\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_43\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_43_option_1665436051389\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_43\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_20-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_20\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_20\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is your family receiving WIC?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_20_option_1651525873498\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_20\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_20_option_1651525875602\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_20\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_21-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_21\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_21\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Primary Language<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_21_option_1651525910235\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_21\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">English<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_21_option_1651525913554\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_21\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Other<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_84-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_84\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_84\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is your family acquiring or learning another language in addition to English?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_84_option_1651525910235\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_84\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_84_option_1651525913554\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_84\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_36-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_36\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_36\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Please list primary language:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_36\" type=\"text\" name=\"193_single_line_text_36\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_37-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_37\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_37\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Does parent speak English?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_37_option_1661295553290\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_37\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_37_option_1661295560186\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_37\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_38-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_38\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_38\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Does child speak English?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_38_option_1661295595514\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_38\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_38_option_1661295599490\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_38\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_22-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_22\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_22\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is child in daycare?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_22_option_1661295662778\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_22\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_22_option_1661295667737\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_22\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_single_line_text_44-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_44\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_44\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Address of Childcare:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_44\" type=\"text\" name=\"193_single_line_text_44\" value=\"\" placeholder=\"Street\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_45-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_45\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_45\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">City:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_45\" type=\"text\" name=\"193_single_line_text_45\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_46-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_46\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_46\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">State:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_46\" type=\"text\" name=\"193_single_line_text_46\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-third happyforms-part--label-show\" id=\"happyforms-193_single_line_text_47-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_47\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_47\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Zip Code:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_47\" type=\"text\" name=\"193_single_line_text_47\" value=\"\" placeholder=\"\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--checkbox happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_checkbox_48-part\" data-happyforms-type=\"checkbox\" data-happyforms-id=\"checkbox_48\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_checkbox_48\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Days in childcare:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_48_option_1665436370070\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_48[]\" value=\"0\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Monday<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_48_option_1665436374309\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_48[]\" value=\"1\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Tuesday<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_48_option_1665436378094\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_48[]\" value=\"2\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Wednesday<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_48_option_1665436383340\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_48[]\" value=\"3\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Thursday<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_48_option_1740697160064\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_48[]\" value=\"4\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Friday<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--placeholder happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_placeholder_50-part\" data-happyforms-type=\"placeholder\" data-happyforms-id=\"placeholder_50\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t<p>Please list all children in your family ages birth to 5.<\/p>\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_single_line_text_24-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_24\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_24\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Child Information:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_24\" type=\"text\" name=\"193_single_line_text_24\" value=\"\" placeholder=\"Child&#039;s First and Last Name\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--date happyforms-part--width-full happyforms-part--label-show happyforms-part-date--required happyforms-part-date--date happyforms-part-date--12\" id=\"happyforms-193_date_72-part\" data-happyforms-type=\"date\" data-happyforms-id=\"date_72\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_date_72\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Date of Birth<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\n<div class=\"happyforms-part-date__date-input happyforms-part--date__input-wrap happyforms-part-date-input--date\">\n\t<div class=\"happyforms-custom-date\" data-searchable=\"true\">\n\t\t<div class=\"happyforms-part__date-wrap\">\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t<input type=\"date\" min=\"2015-01-01\" max=\"2030-12-31\" value=\"\" name=\"193_date_72[date]\" data-serialize required class=\"happyforms-date-field\" \/>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_25-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_25\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_25\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Sex of Child<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_25_option_1651526085010\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_25\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Male<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_25_option_1651526090090\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_25\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Female<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_26-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_26\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_26\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Does the child have a diagnosed disability?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_26_option_1651526128810\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_26\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_26_option_1651526134818\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_26\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_27-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_27\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_27\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is the child on an IFSP?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_27_option_1651526236099\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_27\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_27_option_1651526239675\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_27\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_28-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_28\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_28\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is the child a foster child or in DHS custody?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_28_option_1651526292786\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_28\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes (please submit placement letter in lieu of proof of income)<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_28_option_1651526295139\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_28\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_51-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_51\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_51\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Would you like to add a second child ages 0-5 years?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_51_option_1665436864478\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_51\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_51_option_1665436869798\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_51\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_single_line_text_52-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_52\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_52\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Child Information:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_52\" type=\"text\" name=\"193_single_line_text_52\" value=\"\" placeholder=\"Child&#039;s First and Last Name\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--date happyforms-part--width-full happyforms-part--label-show happyforms-part-date--required happyforms-part-date--date happyforms-part-date--12\" id=\"happyforms-193_date_73-part\" data-happyforms-type=\"date\" data-happyforms-id=\"date_73\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_date_73\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Date of Birth<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\n<div class=\"happyforms-part-date__date-input happyforms-part--date__input-wrap happyforms-part-date-input--date\">\n\t<div class=\"happyforms-custom-date\" data-searchable=\"true\">\n\t\t<div class=\"happyforms-part__date-wrap\">\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t<input type=\"date\" min=\"2015-01-01\" max=\"2030-12-31\" value=\"\" name=\"193_date_73[date]\" data-serialize required class=\"happyforms-date-field\" \/>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_54-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_54\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_54\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Sex of Child<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_54_option_1665436978325\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_54\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Male<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_54_option_1665436982376\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_54\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Female<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_55-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_55\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_55\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Does the child have a diagnosed disability?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_55_option_1665437019678\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_55\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_55_option_1665437025070\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_55\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_56-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_56\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_56\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is the child on an IFSP?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_56_option_1665437067460\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_56\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_56_option_1665437071110\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_56\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_57-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_57\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_57\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is the child a foster child or in DHS custody?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_57_option_1665437116145\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_57\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes (please submit placement letter in lieu of proof of income)<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_57_option_1665437135854\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_57\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_58-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_58\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_58\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Add a third child age 0-5 years?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_58_option_1665437175665\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_58\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_58_option_1665437181151\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_58\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--single_line_text happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_single_line_text_59-part\" data-happyforms-type=\"single_line_text\" data-happyforms-id=\"single_line_text_59\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\n\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_single_line_text_59\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Child Information<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_single_line_text_59\" type=\"text\" name=\"193_single_line_text_59\" value=\"\" placeholder=\"Child&#039;s First and Last Name\" autocomplete=\"off\" spellcheck=\"false\"  autocorrect=\"off\" \/>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--date happyforms-part--width-full happyforms-part--label-show happyforms-part-date--required happyforms-part-date--date happyforms-part-date--12\" id=\"happyforms-193_date_74-part\" data-happyforms-type=\"date\" data-happyforms-id=\"date_74\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_date_74\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Date of Birth<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\n<div class=\"happyforms-part-date__date-input happyforms-part--date__input-wrap happyforms-part-date-input--date\">\n\t<div class=\"happyforms-custom-date\" data-searchable=\"true\">\n\t\t<div class=\"happyforms-part__date-wrap\">\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t<input type=\"date\" min=\"2015-01-01\" max=\"2030-12-31\" value=\"\" name=\"193_date_74[date]\" data-serialize required class=\"happyforms-date-field\" \/>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_61-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_61\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_61\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Sex of Child<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_61_option_1665437284372\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_61\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Male<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_61_option_1665437287943\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_61\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Female<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_62-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_62\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_62\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Does the child have a diagnosed disability?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_62_option_1665437318159\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_62\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_62_option_1665437323649\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_62\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_63-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_63\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_63\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is the child on an IFSP?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_63_option_1665437353881\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_63\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_63_option_1665437357988\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_63\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-half happyforms-part--label-show\" id=\"happyforms-193_radio_64-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_64\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_64\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Is the child a foster child or in DHS custody?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_64_option_1665437404087\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_64\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes (please submit placement letter in lieu of proof of income)<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_64_option_1665437423579\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_64\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--checkbox happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_checkbox_81-part\" data-happyforms-type=\"checkbox\" data-happyforms-id=\"checkbox_81\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_checkbox_81\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Do you or someone in your family receive any of the following?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_81_option_1666125367598\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_81[]\" value=\"0\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">TANF<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_81_option_1666125372708\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_81[]\" value=\"1\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">SNAP<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_81_option_1666125376896\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_81[]\" value=\"2\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Supplemental Security Income (SSI)<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_81_option_1697055640446\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_81[]\" value=\"3\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Social Security Income<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_81_option_1786046855069\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_81[]\" value=\"4\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Social Security Disability Income<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_81_option_1697055673468\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_81[]\" value=\"5\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">VA Compensation<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"checkbox_81_option_1666125405590\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"checkbox\" class=\"happyforms-visuallyhidden happyforms-checkbox\" name=\"193_checkbox_81[]\" value=\"6\" data-serialize  autocomplete=\"off\" spellcheck=\"false\"  >\n\t\t\t\t\t<span class=\"checkmark\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" viewBox=\"0 0 24 24\"><path fill=\"currentColor\" d=\"M20.285 2l-11.285 11.567-5.286-5.011-3.714 3.716 9 8.728 15-15.285z\"\/><\/svg><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Not receiving benefits<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_83-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_83\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_83\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Do you give Head Start of Yamhill County permission to obtain TANF &amp; SNAP information from the Department of Human Services?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_83_option_1667329992958\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_83\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_83_option_1667330007179\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_83\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-part--choice display-type--block happyforms-form__part happyforms-part happyforms-part--radio happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_radio_85-part\" data-happyforms-type=\"radio\" data-happyforms-id=\"radio_85\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_radio_85\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Do you give permission for Head Start of Yamhill County to share your name and contact information with your local school district, Yamhill County Public Health, A Family Place Relief Nursery, Preschool Promise, Migrant and Tribal Early Head Start &amp; Head Start programs to refer your family to parenting, child health, and preschool services?<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_85_option_1667329992958\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_85\" value=\"0\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">Yes<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-part__option happyforms-part-option\" id=\"radio_85_option_1667330007179\">\n\t\t\t\t<label class=\"option-label\">\n\t\t\t\t\t<input type=\"radio\" class=\"happyforms-visuallyhidden\" name=\"193_radio_85\" value=\"1\"  autocomplete=\"off\" spellcheck=\"false\" >\n\t\t\t\t\t<span class=\"checkmark\"><span class=\"happyforms-radio-circle\"><\/span><\/span>\n\t\t\t\t\t<span class=\"label-wrap\">\n\t\t\t\t\t\t<span class=\"label\">No<\/span>\t\t\t\t\t<\/span>\n\t\t\t\t<\/label>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--attachment happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_attachment_69-part\" data-happyforms-type=\"attachment\" data-happyforms-id=\"attachment_69\" data-happyforms-part-id=\"attachment_69\" data-happyforms-max-file-size=\"8\" data-happyforms-max-file-count=\"0\" data-happyforms-allowed-file-extensions=\"csv,txt,pdf,zip,jpg,jpeg,gif,png,bmp,mp3,mp4\">\n\t<div class=\"happyforms-attachment happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_attachment_69\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">INCLUDE PROOF OF INCOME FROM ALL SOURCES, such as your previous year&#039;s IRS Form 1040, W-2(s), or your most recent pay stub. Also include documentation of unearned income, including TANF, SSI, child support, Social Security, VA benefits, unemployment benefits, retirement, tribal payments, etc. If applicable, include proof of current SNAP benefits.<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t<div class=\"happyforms-upload-area happyforms-input-group with-suffix\">\n\t\t\t\t<input type=\"text\" class=\"happyforms-visuallyhidden\" tabindex=\"-1\" aria-disabled=\"true\">\n\t\t\t\t<div class=\"happyforms-attachment-box\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-attachment-progress\" data-type=\"default\">Choose file<\/div>\n\t\t\t\t\t<div class=\"happyforms-attachment-progress\" data-type=\"uploading\">Uploading\u2026 (<span>0<\/span>%)<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"happyforms-input-group__suffix happyforms-input-group__suffix--button\">\n\t\t\t\t\t<button type=\"button\" class=\"happyforms-plain-button\" tabindex=\"-1\">Browse<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t\n\t\t\t<div class=\"happyforms-file-notices\">\n\t\t\t\t<div class=\"happyforms-part-error-notice\" data-error-type=\"duplicate\">\n\t\t\t\t\t<p><svg role=\"img\" aria-hidden=\"true\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path fill=\"currentColor\" d=\"M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zm-248 50c-25.405 0-46 20.595-46 46s20.595 46 46 46 46-20.595 46-46-20.595-46-46-46zm-43.673-165.346l7.418 136c.347 6.364 5.609 11.346 11.982 11.346h48.546c6.373 0 11.635-4.982 11.982-11.346l7.418-136c.375-6.874-5.098-12.654-11.982-12.654h-63.383c-6.884 0-12.356 5.78-11.981 12.654z\" class=\"\"><\/path><\/svg> A file with this name has already been uploaded.<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"happyforms-part-error-notice\" data-error-type=\"invalid\">\n\t\t\t\t\t<p><svg role=\"img\" aria-hidden=\"true\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path fill=\"currentColor\" d=\"M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zm-248 50c-25.405 0-46 20.595-46 46s20.595 46 46 46 46-20.595 46-46-20.595-46-46-46zm-43.673-165.346l7.418 136c.347 6.364 5.609 11.346 11.982 11.346h48.546c6.373 0 11.635-4.982 11.982-11.346l7.418-136c.375-6.874-5.098-12.654-11.982-12.654h-63.383c-6.884 0-12.356 5.78-11.981 12.654z\" class=\"\"><\/path><\/svg> This file type isn\u2019t allowed.<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"happyforms-part-error-notice\" data-error-type=\"size\">\n\t\t\t\t\t<p><svg role=\"img\" aria-hidden=\"true\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path fill=\"currentColor\" d=\"M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zm-248 50c-25.405 0-46 20.595-46 46s20.595 46 46 46 46-20.595 46-46-20.595-46-46-46zm-43.673-165.346l7.418 136c.347 6.364 5.609 11.346 11.982 11.346h48.546c6.373 0 11.635-4.982 11.982-11.346l7.418-136c.375-6.874-5.098-12.654-11.982-12.654h-63.383c-6.884 0-12.356 5.78-11.981 12.654z\" class=\"\"><\/path><\/svg> This file size is too big.<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<ul class=\"happyforms-attachment__list\">\n\t\t\t\t\t\t\t<\/ul>\n\n\t\t\t<script type=\"text\/template\" class=\"item-template\">\n\t\t\t\t<li class=\"happyforms-attachment-item\" data-attachment-id=\"\">\n\t<div class=\"happyforms-attachment-item__col happyforms-attachment-item__col--main\">\n\t\t<span class=\"happyforms-attachment-item__name\"><\/span>\n\t\t<span class=\"happyforms-attachment-item__size\"><\/span>\n\t<\/div>\n\t<div class=\"happyforms-attachment-item__col\">\n\t\t<button type=\"button\" class=\"happyforms-text-button happyforms-attachment-link happyforms-delete-attachment\">Delete<\/button>\n\t<\/div>\n\t<div>\n\t\t<input type=\"hidden\" name=\"193_attachment_69[#][id]\" value=\"\" class=\"happyforms-attachment-input__id\" \/>\n\t\t<input type=\"hidden\" name=\"193_attachment_69[#][name]\" value=\"\" class=\"happyforms-attachment-input__name\" \/>\n\t\t<input type=\"hidden\" name=\"193_attachment_69[#][size]\" value=\"\" class=\"happyforms-attachment-input__size\" \/>\n\t<\/div>\n<\/li>\t\t\t<\/script>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--attachment happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_attachment_70-part\" data-happyforms-type=\"attachment\" data-happyforms-id=\"attachment_70\" data-happyforms-part-id=\"attachment_70\" data-happyforms-max-file-size=\"8\" data-happyforms-max-file-count=\"0\" data-happyforms-allowed-file-extensions=\"csv,txt,pdf,zip,jpg,jpeg,gif,png,bmp,mp3,mp4\">\n\t<div class=\"happyforms-attachment happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_attachment_70\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Proof of Income (2)<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t<div class=\"happyforms-upload-area happyforms-input-group with-suffix\">\n\t\t\t\t<input type=\"text\" class=\"happyforms-visuallyhidden\" tabindex=\"-1\" aria-disabled=\"true\">\n\t\t\t\t<div class=\"happyforms-attachment-box\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"happyforms-attachment-progress\" data-type=\"default\">Choose file<\/div>\n\t\t\t\t\t<div class=\"happyforms-attachment-progress\" data-type=\"uploading\">Uploading\u2026 (<span>0<\/span>%)<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"happyforms-input-group__suffix happyforms-input-group__suffix--button\">\n\t\t\t\t\t<button type=\"button\" class=\"happyforms-plain-button\" tabindex=\"-1\">Browse<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t\n\t\t\t<div class=\"happyforms-file-notices\">\n\t\t\t\t<div class=\"happyforms-part-error-notice\" data-error-type=\"duplicate\">\n\t\t\t\t\t<p><svg role=\"img\" aria-hidden=\"true\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path fill=\"currentColor\" d=\"M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zm-248 50c-25.405 0-46 20.595-46 46s20.595 46 46 46 46-20.595 46-46-20.595-46-46-46zm-43.673-165.346l7.418 136c.347 6.364 5.609 11.346 11.982 11.346h48.546c6.373 0 11.635-4.982 11.982-11.346l7.418-136c.375-6.874-5.098-12.654-11.982-12.654h-63.383c-6.884 0-12.356 5.78-11.981 12.654z\" class=\"\"><\/path><\/svg> A file with this name has already been uploaded.<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"happyforms-part-error-notice\" data-error-type=\"invalid\">\n\t\t\t\t\t<p><svg role=\"img\" aria-hidden=\"true\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path fill=\"currentColor\" d=\"M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zm-248 50c-25.405 0-46 20.595-46 46s20.595 46 46 46 46-20.595 46-46-20.595-46-46-46zm-43.673-165.346l7.418 136c.347 6.364 5.609 11.346 11.982 11.346h48.546c6.373 0 11.635-4.982 11.982-11.346l7.418-136c.375-6.874-5.098-12.654-11.982-12.654h-63.383c-6.884 0-12.356 5.78-11.981 12.654z\" class=\"\"><\/path><\/svg> This file type isn\u2019t allowed.<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"happyforms-part-error-notice\" data-error-type=\"size\">\n\t\t\t\t\t<p><svg role=\"img\" aria-hidden=\"true\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\"><path fill=\"currentColor\" d=\"M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zm-248 50c-25.405 0-46 20.595-46 46s20.595 46 46 46 46-20.595 46-46-20.595-46-46-46zm-43.673-165.346l7.418 136c.347 6.364 5.609 11.346 11.982 11.346h48.546c6.373 0 11.635-4.982 11.982-11.346l7.418-136c.375-6.874-5.098-12.654-11.982-12.654h-63.383c-6.884 0-12.356 5.78-11.981 12.654z\" class=\"\"><\/path><\/svg> This file size is too big.<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t\t<ul class=\"happyforms-attachment__list\">\n\t\t\t\t\t\t\t<\/ul>\n\n\t\t\t<script type=\"text\/template\" class=\"item-template\">\n\t\t\t\t<li class=\"happyforms-attachment-item\" data-attachment-id=\"\">\n\t<div class=\"happyforms-attachment-item__col happyforms-attachment-item__col--main\">\n\t\t<span class=\"happyforms-attachment-item__name\"><\/span>\n\t\t<span class=\"happyforms-attachment-item__size\"><\/span>\n\t<\/div>\n\t<div class=\"happyforms-attachment-item__col\">\n\t\t<button type=\"button\" class=\"happyforms-text-button happyforms-attachment-link happyforms-delete-attachment\">Delete<\/button>\n\t<\/div>\n\t<div>\n\t\t<input type=\"hidden\" name=\"193_attachment_70[#][id]\" value=\"\" class=\"happyforms-attachment-input__id\" \/>\n\t\t<input type=\"hidden\" name=\"193_attachment_70[#][name]\" value=\"\" class=\"happyforms-attachment-input__name\" \/>\n\t\t<input type=\"hidden\" name=\"193_attachment_70[#][size]\" value=\"\" class=\"happyforms-attachment-input__size\" \/>\n\t<\/div>\n<\/li>\t\t\t<\/script>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--signature happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_signature_67-part\" data-happyforms-type=\"signature\" data-happyforms-id=\"signature_67\" data-happyforms-required=\"\" data-happyforms-signature-type=\"draw\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_signature_67\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">I certify that the information above is true and complete and that misrepresentation may be considered fraud. I understand that acceptance is not guaranteed due to limited space.<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t<input id=\"happyforms-193_signature_67_signature_path_data\" type=\"hidden\" name=\"193_signature_67[signature_path_data]\" value=\"\" data-happyforms-path-data \/>\n\t\t\t\t<input id=\"happyforms-193_signature_67_signature_raster_data\" type=\"hidden\" name=\"193_signature_67[signature_raster_data]\" value=\"\" data-happyforms-raster-data \/>\n\n\t\t\t\t<div class=\"happyforms--signature-area--container \">\n\t\t\t\t\t<div class=\"happyforms--signature-area\">\n\t\t\t\t\t\t<svg viewBox=\"0 0 0 0\" data-happyforms-name=\"193_signature_67[signature_viewbox]\" preserveAspectRatio=\"xMidYMid meet\">\n\t\t\t\t\t\t\t<path d=\"\" \/>\n\t\t\t\t\t\t<\/svg>\n\t\t\t\t\t\t<img \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<button class=\"happyforms-button happyforms--signature-area--start-drawing\">Start drawing<\/button>\n\t\t\t\t\t<div class=\"happyforms--signature-area--toolbar\">\n\t\t\t\t\t\t<button class=\"happyforms-button happyforms--signature-area--clear-drawing\">Clear<\/button>\n\t\t\t\t\t\t<button class=\"happyforms-button happyforms--signature-area--done-drawing\">Done<\/button>\n\t\t\t\t\t\t<button class=\"happyforms-button happyforms--signature-area--edit-drawing\">Start over<\/button>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t\n\t\t\t\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"happyforms-form__part happyforms-part happyforms-part--date happyforms-part--width-full happyforms-part--label-show happyforms-part-date--required happyforms-part-date--date happyforms-part-date--12\" id=\"happyforms-193_date_71-part\" data-happyforms-type=\"date\" data-happyforms-id=\"date_71\" data-happyforms-required=\"\">\n\t<div class=\"happyforms-part-wrap\">\n\t\t\t\t\t\t\t\t<div class=\"happyforms-part__label-container\">\n\t\t\t\t<label for=\"happyforms-193_date_71\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Date Signed:<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-required\"><\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"happyforms-optional\">(optional)<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t<\/div>\n\t\t\t\n\t\t\n\t\t<div class=\"happyforms-part__el\">\n\t\t\t\t\t\t\n<div class=\"happyforms-part-date__date-input happyforms-part--date__input-wrap happyforms-part-date-input--date\">\n\t<div class=\"happyforms-custom-date\" data-searchable=\"true\">\n\t\t<div class=\"happyforms-part__date-wrap\">\n\t\t\t<div class=\"happyforms-input\">\n\t\t\t\t<input type=\"date\" min=\"2022-01-01\" max=\"2029-12-31\" value=\"\" name=\"193_date_71[date]\" data-serialize required class=\"happyforms-date-field\" \/>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>\n\t\t\t\t<div class=\"happyforms-form__part happyforms-part happyforms-part--recaptcha happyforms-recaptcha-v3\" data-sitekey=\"6LdeHYwgAAAAAA9yn_mGhUz9vW5qfGDYKcdQHo2E\" data-happyforms-type=\"recaptcha_v3\" data-theme=\"\">\n\t\t\t\t<div class=\"happyforms-part-wrap\" id=\"happyforms-193-recaptcha\"><\/div>\n\n\t\t\t<\/div>\n\t\t\t\t<div class=\"happyforms-form__part happyforms-part happyforms-part--submit\">\n\t\t<button type=\"submit\" class=\"happyforms-submit happyforms-button--submit \">Send<\/button>\n\t<\/div>\t\t<\/div>\n\n\t\t\t<\/form>\n\n\t<\/div>\n\n\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>\u00bfListo para aplicar?<\/p>","protected":false},"author":1,"featured_media":2649,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-195","page","type-page","status-publish","has-post-thumbnail"],"featured_image_src":"https:\/\/yamhillheadstart.org\/wp-content\/uploads\/2022\/09\/Banner-11.1-2-scaled.jpg","_links":{"self":[{"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/pages\/195","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/comments?post=195"}],"version-history":[{"count":7,"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/pages\/195\/revisions"}],"predecessor-version":[{"id":2159,"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/pages\/195\/revisions\/2159"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/media\/2649"}],"wp:attachment":[{"href":"https:\/\/yamhillheadstart.org\/es\/wp-json\/wp\/v2\/media?parent=195"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}