{"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=\"2780462014\" \/>\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-multi_line_text\" class=\"screen-reader-text\">Leave this field blank<\/label>\n\t<input type=\"text\" id=\"193-multi_line_text\" name=\"193-multi_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-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\">Eligibility Information (Check all that apply)<\/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 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_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\">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_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\">Parent\/Guardian is\/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\">Member of the child&#039;s family is medically fragile<\/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 is currently attending 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-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--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\">Housing 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\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\">Own 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\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\">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 Early 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_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\">Does anyone in your household receive 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-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--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\">Applicant 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-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-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\">Please indicate with of the following DHS benefits you are receiving:<\/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\">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<\/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=\"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\">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=\"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\">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-form__part happyforms-part happyforms-part--signature happyforms-part--width-full happyforms-part--label-show\" id=\"happyforms-193_signature_82-part\" data-happyforms-type=\"signature\" data-happyforms-id=\"signature_82\" 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_82\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">If you are obtaining TANF, SNAP, or SSI benefits, your signature below authorizes us to contact the Department of Human Services to obtain those records.<\/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_82_signature_path_data\" type=\"hidden\" name=\"193_signature_82[signature_path_data]\" value=\"\" data-happyforms-path-data \/>\n\t\t\t\t<input id=\"happyforms-193_signature_82_signature_raster_data\" type=\"hidden\" name=\"193_signature_82[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_82[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-half happyforms-part--label-show happyforms-part-date--date happyforms-part-date--12\" id=\"happyforms-193_date_78-part\" data-happyforms-type=\"date\" data-happyforms-id=\"date_78\">\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_78\" class=\"happyforms-part__label\">\n\t\t\t<span class=\"label\">Date of Signature<\/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=\"2035-12-31\" value=\"\" name=\"193_date_78[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_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\">I give my permission for HSYC to share my name and contact information with the school district, Yamhill County Public Health, A Family Place Relief Nursery, and\/or Migrant\/Tribal EHS and HS Programs for referrals to their parenting and child health\/ preschool programs.<\/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-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\">The above information is true and complete, and I understand misrepresentation is considered fraud.<\/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<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\">Attach proof of income such as form 1040 from previous tax year, W-2 forms from previous tax year, or copy of most recent pay stub. For families with foster children, please submit their placement letter. (If you have any of these documents available now, please submit otherwise we will contact you to provide them to 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\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\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}]}}