{"id":617,"date":"2020-01-07T20:37:07","date_gmt":"2020-01-07T20:37:07","guid":{"rendered":"https:\/\/www.qorrn.com\/?page_id=617"},"modified":"2022-08-31T23:58:38","modified_gmt":"2022-08-31T23:58:38","slug":"submit-a-resource","status":"publish","type":"page","link":"https:\/\/www.qorrn.com\/submit-a-resource\/","title":{"rendered":"Submit a Resource"},"content":{"rendered":"\n<p>Thank you so much for submitting to QORRN. We&#8217;re very grateful for your support in helping us grow our network across the country.<\/p>\n\n\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_2_container\" data-token=\"25a83620460489692c75765060b674b1\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_ajax_submit  frm_pro_form \" id=\"form_submitaresource\"  data-token=\"25a83620460489692c75765060b674b1\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Submit a Resource<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"2\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_2\" id=\"frm_hide_fields_2\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"submitaresource\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_2\" name=\"frm_submit_entry_2\" value=\"4176561d42\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/617\" \/><div id=\"frm_field_46_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Please tell us a bit about yourself<\/h3>\r\n\r\n\r\n<div id=\"frm_field_40_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n    <label for=\"field_6isnf\" id=\"field_6isnf_label\" class=\"frm_primary_label\">Your Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6isnf\" name=\"item_meta[40]\" value=\"\"  data-sectionid=\"46\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_41_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_2c8a7\" id=\"field_2c8a7_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_2c8a7\" name=\"item_meta[41]\" value=\"\"  data-sectionid=\"46\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_91fjd\" id=\"field_91fjd_label\" class=\"frm_primary_label\">State of Residence\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_91fjd\" name=\"item_meta[42]\" value=\"\"  data-sectionid=\"46\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_43_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2xkam\" id=\"field_2xkam_label\" class=\"frm_primary_label\">May we list your name as a contributor on our About Us page?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\t\t\t<span class=\"frm_off_label frm_switch_opt\">No<\/span>\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[43][]\" id=\"field_2xkam\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t\tdata-off=\"No\"\n\t\t\t\t\t\t data-invmsg=\"May we list your name as a contributor on our About Us page? is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_2xkam\"\t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_2xkam_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t<span class=\"frm_on_label frm_switch_opt\">Yes<\/span>\n\t\t\t<\/label>\n<\/div>\n\r\n    <div class=\"frm_description\" id=\"frm_desc_field_2xkam\">If you choose &#8220;no&#8221;, we&#8217;ll list Anonymous instead of your name.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_12_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Basics<\/h3>\r\n\r\n\r\n<div id=\"frm_field_7_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_zc5de\" id=\"field_zc5de_label\" class=\"frm_primary_label\">Resource Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zc5de\" name=\"item_meta[7]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_8_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_sgw4i\" id=\"field_sgw4i_label\" class=\"frm_primary_label\">Target Geography\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    \t\t<select name=\"item_meta[8]\" id=\"field_sgw4i\"  data-sectionid=\"12\" data-placeholder=\"Select an option\"  placeholder=\"Select an option\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Target Geography is invalid\" aria-invalid=\"false\"  >\n\t\t\t\t\t<option class=\"frm-select-placeholder\" value=\"\">\n\t\t\t\tSelect an option\t\t\t<\/option>\n\t\t\t<option  value=\"Local\">Local (Has a brick-and-mortar location in a rural county)<\/option><option  value=\"Statewide\">Statewide (Can be accessed online or by phone from anywhere)<\/option><option  value=\"National\">National (Can be accessed online or by phone from anywhere)<\/option>\t<\/select>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <div  id=\"field_vwk2g_label\" class=\"frm_primary_label\">Where is this resource located?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_vwk2g_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_44-12-0\"><label for=\"field_vwk2g-0\">\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_vwk2g-0\" value=\"Illinois\"\n\t\t   data-sectionid=\"12\" data-invmsg=\"Where is this resource located? is invalid\" aria-invalid=\"false\"  \/> Illinois<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_44-12-1\"><label for=\"field_vwk2g-1\">\t\t<input type=\"radio\" name=\"item_meta[44]\" id=\"field_vwk2g-1\" value=\"North Carolina\"\n\t\t   data-sectionid=\"12\" data-invmsg=\"Where is this resource located? is invalid\" aria-invalid=\"false\"  \/> North Carolina<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_boxl9\" id=\"field_boxl9_label\" class=\"frm_primary_label\">Does this resource focus specifically on LGBTQ+ clients and issues?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    \n<div >\n    <label class=\"frm_switch_block\">\n\t\t\t\t\t<span class=\"frm_off_label frm_switch_opt\">No<\/span>\n\t\t\n\t\t<input type=\"checkbox\" name=\"item_meta[31][]\" id=\"field_boxl9\" value=\"Yes\"\n\t\t\t\t\t\t\t\t\t\tdata-off=\"No\"\n\t\t\t\t\t\t data-sectionid=\"12\" data-invmsg=\"Does this resource focus specifically on LGBTQ+ clients and issues? is invalid\" aria-invalid=\"false\"  \t\t\/>\n\n\t\t<span class=\"frm_switch\" tabindex=\"0\" role=\"switch\" aria-labelledby=\"field_boxl9_label\" aria-checked=\"false\">\n\t\t\t<span class=\"frm_slider\"><\/span>\n\t\t<\/span>\n\n\t\t\t\t\t<span class=\"frm_on_label frm_switch_opt\">Yes<\/span>\n\t\t\t<\/label>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_10_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Contact Info<\/h3>\r\n\r\n\r\n<div id=\"frm_field_14_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_esmcg\" id=\"field_esmcg_label\" class=\"frm_primary_label\">Website\/URL\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"url\" id=\"field_esmcg\" name=\"item_meta[14]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Website\/URL is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_9jvmh\" id=\"field_9jvmh_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_9jvmh\" name=\"item_meta[30]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_yhk27\" id=\"field_yhk27_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_yhk27\" name=\"item_meta[17]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_15_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ld5y1\" id=\"field_ld5y1_label\" class=\"frm_primary_label\">Address 1\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ld5y1\" name=\"item_meta[15]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_2449c\" id=\"field_2449c_label\" class=\"frm_primary_label\">Address 2\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2449c\" name=\"item_meta[16]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_first\">\r\n    <label for=\"field_tgkfz\" id=\"field_tgkfz_label\" class=\"frm_primary_label\">City\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_tgkfz\" name=\"item_meta[18]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_nf3xr\" id=\"field_nf3xr_label\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nf3xr\" name=\"item_meta[21]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_20_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_5sbtu\" id=\"field_5sbtu_label\" class=\"frm_primary_label\">Zip\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5sbtu\" name=\"item_meta[20]\" value=\"\"  data-sectionid=\"10\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_top_container frm_dynamic_select_container\">\r\n    <label for=\"field_w6kqq\" id=\"field_w6kqq_label\" class=\"frm_primary_label\">County &#8211; Illinois\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_data_container\" aria-labelledby=\"field_w6kqq_label\" role=\"group\"><select name=\"item_meta[33]\" id=\"field_w6kqq\"  data-sectionid=\"10\" data-invmsg=\"County - Illinois is invalid\" aria-invalid=\"false\"  >\n<option value=\"\"> <\/option>\n<option value=\"152\">Adams County, IL<\/option>\n<option value=\"223\">Alexander County, IL<\/option>\n<option value=\"193\">Bond County, IL<\/option>\n<option value=\"155\">Boone County, IL<\/option>\n<option value=\"221\">Brown County, IL<\/option>\n<option value=\"174\">Bureau County, IL<\/option>\n<option value=\"229\">Calhoun County, IL<\/option>\n<option value=\"203\">Carroll County, IL<\/option>\n<option value=\"213\">Cass County, IL<\/option>\n<option value=\"139\">Champaign County, IL<\/option>\n<option value=\"175\">Christian County, IL<\/option>\n<option value=\"201\">Clark County, IL<\/option>\n<option value=\"209\">Clay County, IL<\/option>\n<option value=\"166\">Clinton County, IL<\/option>\n<option value=\"158\">Coles County, IL<\/option>\n<option value=\"130\">Cook County, IL<\/option>\n<option value=\"188\">Crawford County, IL<\/option>\n<option value=\"216\">Cumberland County, IL<\/option>\n<option value=\"196\">De Witt County, IL<\/option>\n<option value=\"149\">DeKalb County, IL<\/option>\n<option value=\"187\">Douglas County, IL<\/option>\n<option value=\"131\">DuPage County, IL<\/option>\n<option value=\"190\">Edgar County, IL<\/option>\n<option value=\"222\">Edwards County, IL<\/option>\n<option value=\"172\">Effingham County, IL<\/option>\n<option value=\"184\">Fayette County, IL<\/option>\n<option value=\"208\">Ford County, IL<\/option>\n<option value=\"163\">Franklin County, IL<\/option>\n<option value=\"169\">Fulton County, IL<\/option>\n<option value=\"227\">Gallatin County, IL<\/option>\n<option value=\"210\">Greene County, IL<\/option>\n<option value=\"156\">Grundy County, IL<\/option>\n<option value=\"218\">Hamilton County, IL<\/option>\n<option value=\"189\">Hancock County, IL<\/option>\n<option value=\"231\">Hardin County, IL<\/option>\n<option value=\"220\">Henderson County, IL<\/option>\n<option value=\"160\">Henry County, IL<\/option>\n<option value=\"129\">Illinois<\/option>\n<option value=\"180\">Iroquois County, IL<\/option>\n<option value=\"153\">Jackson County, IL<\/option>\n<option value=\"217\">Jasper County, IL<\/option>\n<option value=\"165\">Jefferson County, IL<\/option>\n<option value=\"182\">Jersey County, IL<\/option>\n<option value=\"185\">Jo Daviess County, IL<\/option>\n<option value=\"211\">Johnson County, IL<\/option>\n<option value=\"134\">Kane County, IL<\/option>\n<option value=\"146\">Kankakee County, IL<\/option>\n<option value=\"145\">Kendall County, IL<\/option>\n<option value=\"159\">Knox County, IL<\/option>\n<option value=\"132\">Lake County, IL<\/option>\n<option value=\"147\">LaSalle County, IL<\/option>\n<option value=\"197\">Lawrence County, IL<\/option>\n<option value=\"171\">Lee County, IL<\/option>\n<option value=\"168\">Livingston County, IL<\/option>\n<option value=\"178\">Logan County, IL<\/option>\n<option value=\"148\">Macon County, IL<\/option>\n<option value=\"161\">Macoupin County, IL<\/option>\n<option value=\"137\">Madison County, IL<\/option>\n<option value=\"167\">Marion County, IL<\/option>\n<option value=\"215\">Marshall County, IL<\/option>\n<option value=\"207\">Mason County, IL<\/option>\n<option value=\"204\">Massac County, IL<\/option>\n<option value=\"177\">McDonough County, IL<\/option>\n<option value=\"135\">McHenry County, IL<\/option>\n<option value=\"142\">McLean County, IL<\/option>\n<option value=\"212\">Menard County, IL<\/option>\n<option value=\"200\">Mercer County, IL<\/option>\n<option value=\"170\">Monroe County, IL<\/option>\n<option value=\"179\">Montgomery County, IL<\/option>\n<option value=\"173\">Morgan County, IL<\/option>\n<option value=\"202\">Moultrie County, IL<\/option>\n<option value=\"157\">Ogle County, IL<\/option>\n<option value=\"141\">Peoria County, IL<\/option>\n<option value=\"186\">Perry County, IL<\/option>\n<option value=\"194\">Piatt County, IL<\/option>\n<option value=\"199\">Pike County, IL<\/option>\n<option value=\"230\">Pope County, IL<\/option>\n<option value=\"225\">Pulaski County, IL<\/option>\n<option value=\"224\">Putnam County, IL<\/option>\n<option value=\"176\">Randolph County, IL<\/option>\n<option value=\"198\">Richland County, IL<\/option>\n<option value=\"143\">Rock Island County, IL<\/option>\n<option value=\"181\">Saline County, IL<\/option>\n<option value=\"140\">Sangamon County, IL<\/option>\n<option value=\"219\">Schuyler County, IL<\/option>\n<option value=\"228\">Scott County, IL<\/option>\n<option value=\"183\">Shelby County, IL<\/option>\n<option value=\"138\">St. Clair County, IL<\/option>\n<option value=\"226\">Stark County, IL<\/option>\n<option value=\"162\">Stephenson County, IL<\/option>\n<option value=\"144\">Tazewell County, IL<\/option>\n<option value=\"192\">Union County, IL<\/option>\n<option value=\"150\">Vermilion County, IL<\/option>\n<option value=\"214\">Wabash County, IL<\/option>\n<option value=\"191\">Warren County, IL<\/option>\n<option value=\"205\">Washington County, IL<\/option>\n<option value=\"195\">Wayne County, IL<\/option>\n<option value=\"206\">White County, IL<\/option>\n<option value=\"154\">Whiteside County, IL<\/option>\n<option value=\"133\">Will County, IL<\/option>\n<option value=\"151\">Williamson County, IL<\/option>\n<option value=\"136\">Winnebago County, IL<\/option>\n<option value=\"164\">Woodford County, IL<\/option>\n<\/select>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_45_container\" class=\"frm_form_field form-field  frm_top_container frm_dynamic_select_container\">\r\n    <label for=\"field_oylj2\" id=\"field_oylj2_label\" class=\"frm_primary_label\">County &#8211; North Carolina\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_data_container\" aria-labelledby=\"field_oylj2_label\" role=\"group\"><select name=\"item_meta[45]\" id=\"field_oylj2\"  data-sectionid=\"10\" data-invmsg=\"County - North Carolina is invalid\" aria-invalid=\"false\"  >\n<option value=\"\"> <\/option>\n<option value=\"369\">Alamance County, NC<\/option>\n<option value=\"323\">Alexander County, NC<\/option>\n<option value=\"324\">Alleghany County, NC<\/option>\n<option value=\"310\">Anson County, NC<\/option>\n<option value=\"325\">Ashe County, NC<\/option>\n<option value=\"326\">Avery County, NC<\/option>\n<option value=\"311\">Beaufort County, NC<\/option>\n<option value=\"312\">Bertie County, NC<\/option>\n<option value=\"313\">Bladen County, NC<\/option>\n<option value=\"370\">Brunswick County, NC<\/option>\n<option value=\"371\">Buncombe County, NC<\/option>\n<option value=\"327\">Burke County, NC<\/option>\n<option value=\"372\">Cabarrus County, NC<\/option>\n<option value=\"328\">Caldwell County, NC<\/option>\n<option value=\"329\">Camden County, NC<\/option>\n<option value=\"330\">Carteret County, NC<\/option>\n<option value=\"331\">Caswell County, NC<\/option>\n<option value=\"373\">Catawba County, NC<\/option>\n<option value=\"314\">Chatham County, NC<\/option>\n<option value=\"332\">Cherokee County, NC<\/option>\n<option value=\"333\">Chowan County, NC<\/option>\n<option value=\"334\">Clay County, NC<\/option>\n<option value=\"296\">Cleveland County, NC<\/option>\n<option value=\"297\">Columbus County, NC<\/option>\n<option value=\"374\">Craven County, NC<\/option>\n<option value=\"375\">Cumberland County, NC<\/option>\n<option value=\"335\">Currituck County, NC<\/option>\n<option value=\"336\">Dare County, NC<\/option>\n<option value=\"376\">Davidson County, NC<\/option>\n<option value=\"337\">Davie County, NC<\/option>\n<option value=\"298\">Duplin County, NC<\/option>\n<option value=\"377\">Durham County, NC<\/option>\n<option value=\"299\">Edgecombe County, NC<\/option>\n<option value=\"378\">Forsyth County, NC<\/option>\n<option value=\"300\">Franklin County, NC<\/option>\n<option value=\"379\">Gaston County, NC<\/option>\n<option value=\"338\">Gates County, NC<\/option>\n<option value=\"339\">Graham County, NC<\/option>\n<option value=\"301\">Granville County, NC<\/option>\n<option value=\"340\">Greene County, NC<\/option>\n<option value=\"380\">Guilford County, NC<\/option>\n<option value=\"302\">Halifax County, NC<\/option>\n<option value=\"381\">Harnett County, NC<\/option>\n<option value=\"341\">Haywood County, NC<\/option>\n<option value=\"382\">Henderson County, NC<\/option>\n<option value=\"315\">Hertford County, NC<\/option>\n<option value=\"316\">Hoke County, NC<\/option>\n<option value=\"342\">Hyde County, NC<\/option>\n<option value=\"383\">Iredell County, NC<\/option>\n<option value=\"343\">Jackson County, NC<\/option>\n<option value=\"384\">Johnston County, NC<\/option>\n<option value=\"344\">Jones County, NC<\/option>\n<option value=\"317\">Lee County, NC<\/option>\n<option value=\"303\">Lenoir County, NC<\/option>\n<option value=\"345\">Lincoln County, NC<\/option>\n<option value=\"346\">Macon County, NC<\/option>\n<option value=\"347\">Madison County, NC<\/option>\n<option value=\"318\">Martin County, NC<\/option>\n<option value=\"348\">McDowell County, NC<\/option>\n<option value=\"385\">Mecklenburg County, NC<\/option>\n<option value=\"349\">Mitchell County, NC<\/option>\n<option value=\"350\">Montgomery County, NC<\/option>\n<option value=\"319\">Moore County, NC<\/option>\n<option value=\"304\">Nash County, NC<\/option>\n<option value=\"386\">New Hanover County, NC<\/option>\n<option value=\"320\">Northampton County, NC<\/option>\n<option value=\"387\">Onslow County, NC<\/option>\n<option value=\"388\">Orange County, NC<\/option>\n<option value=\"351\">Pamlico County, NC<\/option>\n<option value=\"305\">Pasquotank County, NC<\/option>\n<option value=\"352\">Pender County, NC<\/option>\n<option value=\"353\">Perquimans County, NC<\/option>\n<option value=\"354\">Person County, NC<\/option>\n<option value=\"389\">Pitt County, NC<\/option>\n<option value=\"355\">Polk County, NC<\/option>\n<option value=\"390\">Randolph County, NC<\/option>\n<option value=\"321\">Richmond County, NC<\/option>\n<option value=\"391\">Robeson County, NC<\/option>\n<option value=\"306\">Rockingham County, NC<\/option>\n<option value=\"392\">Rowan County, NC<\/option>\n<option value=\"356\">Rutherford County, NC<\/option>\n<option value=\"307\">Sampson County, NC<\/option>\n<option value=\"322\">Scotland County, NC<\/option>\n<option value=\"357\">Stanly County, NC<\/option>\n<option value=\"358\">Stokes County, NC<\/option>\n<option value=\"359\">Surry County, NC<\/option>\n<option value=\"360\">Swain County, NC<\/option>\n<option value=\"361\">Transylvania County, NC<\/option>\n<option value=\"362\">Tyrrell County, NC<\/option>\n<option value=\"393\">Union County, NC<\/option>\n<option value=\"308\">Vance County, NC<\/option>\n<option value=\"394\">Wake County, NC<\/option>\n<option value=\"363\">Warren County, NC<\/option>\n<option value=\"364\">Washington County, NC<\/option>\n<option value=\"365\">Watauga County, NC<\/option>\n<option value=\"395\">Wayne County, NC<\/option>\n<option value=\"366\">Wilkes County, NC<\/option>\n<option value=\"309\">Wilson County, NC<\/option>\n<option value=\"367\">Yadkin County, NC<\/option>\n<option value=\"368\">Yancey County, NC<\/option>\n<\/select>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field frm_section_heading form-field \">\r\n<h3 class=\"frm_pos_top\">Details<\/h3>\r\n<div id=\"frm_desc_field_bzejk\" class=\"frm_description frm_section_spacing\">Check all that apply.<\/div>\r\n\r\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <label for=\"field_6jq6t\" id=\"field_6jq6t_label\" class=\"frm_primary_label\">Service Categories\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    \t\t<div class=\"frm_catlevel_1\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-6\">\n\t\t\t<label for=\"field_28-6\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-6\" value=\"6\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Community and Support<\/label>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-241\">\n\t\t\t<label for=\"field_28-241\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-241\" value=\"241\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Adults Questioning Their Sexuality\/Gender Identity<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-234\">\n\t\t\t<label for=\"field_28-234\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-234\" value=\"234\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Ally Training and Education<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-403\">\n\t\t\t<label for=\"field_28-403\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-403\" value=\"403\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Black\/African Diaspora<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-251\">\n\t\t\t<label for=\"field_28-251\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-251\" value=\"251\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Housing\/Homelessness<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-235\">\n\t\t\t<label for=\"field_28-235\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-235\" value=\"235\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Immigration<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-398\">\n\t\t\t<label for=\"field_28-398\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-398\" value=\"398\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Indigenous\/Native Communities<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-253\">\n\t\t\t<label for=\"field_28-253\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-253\" value=\"253\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Marriage and Couples Counseling<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-407\">\n\t\t\t<label for=\"field_28-407\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-407\" value=\"407\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Mutual Aid\/Direct Giving\/Fundraising<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-236\">\n\t\t\t<label for=\"field_28-236\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-236\" value=\"236\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Other (Community and Support)<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-397\">\n\t\t\t<label for=\"field_28-397\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-397\" value=\"397\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>People with Disabilities<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-242\">\n\t\t\t<label for=\"field_28-242\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-242\" value=\"242\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Persons of Color\/P.O.C.<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-408\">\n\t\t\t<label for=\"field_28-408\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-408\" value=\"408\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Pride March\/Festival\/Parade<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-237\">\n\t\t\t<label for=\"field_28-237\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-237\" value=\"237\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Professional Development\/Scholarships\/Higher Education<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-399\">\n\t\t\t<label for=\"field_28-399\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-399\" value=\"399\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Seniors\/Elderly\/Aging<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-409\">\n\t\t\t<label for=\"field_28-409\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-409\" value=\"409\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Sex Work<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-238\">\n\t\t\t<label for=\"field_28-238\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-238\" value=\"238\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Sexual Trauma\/Violence\/Rape<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-294\">\n\t\t\t<label for=\"field_28-294\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-294\" value=\"294\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Spanish Speaking Community and Support<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-243\">\n\t\t\t<label for=\"field_28-243\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-243\" value=\"243\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Substance Abuse\/Addiction<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-244\">\n\t\t\t<label for=\"field_28-244\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-244\" value=\"244\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Trans and Gender-Non-Conforming<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-239\">\n\t\t\t<label for=\"field_28-239\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-239\" value=\"239\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Youth Services<\/label>\n<\/div><\/div>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_1\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-5\">\n\t\t\t<label for=\"field_28-5\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-5\" value=\"5\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Legal Services<\/label>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-252\">\n\t\t\t<label for=\"field_28-252\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-252\" value=\"252\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Adoption and Foster Care<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-259\">\n\t\t\t<label for=\"field_28-259\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-259\" value=\"259\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Anti-Discrimination (Workplace\/Housing\/Etc.)<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-254\">\n\t\t\t<label for=\"field_28-254\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-254\" value=\"254\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Immigration\/Asylum<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-258\">\n\t\t\t<label for=\"field_28-258\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-258\" value=\"258\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Marriage<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-292\">\n\t\t\t<label for=\"field_28-292\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-292\" value=\"292\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Other (Legal)<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-287\">\n\t\t\t<label for=\"field_28-287\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-287\" value=\"287\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Spanish Speaking Legal Services<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-261\">\n\t\t\t<label for=\"field_28-261\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-261\" value=\"261\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Trans Legal Aid (Change of Name\/Gender Marker)<\/label>\n<\/div><\/div>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_1\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-4\">\n\t\t\t<label for=\"field_28-4\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-4\" value=\"4\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Medical Treatment<\/label>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-402\">\n\t\t\t<label for=\"field_28-402\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-402\" value=\"402\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Family Planning (Birth control, Abortion)<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-256\">\n\t\t\t<label for=\"field_28-256\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-256\" value=\"256\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Fertility\/Conception (IVF\/Surrogacy\/etc.)<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-245\">\n\t\t\t<label for=\"field_28-245\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-245\" value=\"245\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Gender-Affirmation Services (Hormones\/Surgery)<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-246\">\n\t\t\t<label for=\"field_28-246\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-246\" value=\"246\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>HIV\/AIDS<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-247\">\n\t\t\t<label for=\"field_28-247\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-247\" value=\"247\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Mental Health<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-250\">\n\t\t\t<label for=\"field_28-250\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-250\" value=\"250\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Obstetrics, Gynecology, Breast Health<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-248\">\n\t\t\t<label for=\"field_28-248\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-248\" value=\"248\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Other (Medical)<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-401\">\n\t\t\t<label for=\"field_28-401\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-401\" value=\"401\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>People with Disabilities<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-257\">\n\t\t\t<label for=\"field_28-257\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-257\" value=\"257\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Pregnancy\/Pre-Natal Care<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-249\">\n\t\t\t<label for=\"field_28-249\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-249\" value=\"249\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>S.T.D.\/S.T.I.<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-400\">\n\t\t\t<label for=\"field_28-400\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-400\" value=\"400\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Seniors\/Elderly\/Aging<\/label>\n<\/div><\/div>\n\t\t<div class=\"frm_catlevel_2\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_28-293\">\n\t\t\t<label for=\"field_28-293\"><input type=\"checkbox\" name=\"item_meta[28][]\" id=\"field_28-293\" value=\"293\"  data-sectionid=\"26\" data-invmsg=\"Service Categories is invalid\" aria-invalid=\"false\"   \/>Spanish Speaking Medical Treatment<\/label>\n<\/div><\/div>\n<\/div><\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_5hoh4\" id=\"field_5hoh4_label\" class=\"frm_primary_label\">Special Notes\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[29]\" id=\"field_5hoh4\" rows=\"5\"  data-sectionid=\"26\" placeholder=\"Any details, information that would be useful for folks to know.\" data-invmsg=\"Special Notes is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__6596f22dd95d3\">\n\t\t\t\t<label for=\"frm_email_2\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_2\" type=\"text\" class=\"frm_verify\" name=\"frm__6596f22dd95d3\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"vp3AfcZdvO+v\/L+WblsOSIl6rsIrtT35y+5hUY\/IGVrrdWmgEScB3TrS8MRwiVxFm733lzIoe8P75yHiPbUSgS7oa4Pwy1thWeJ1NWsWnY4=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p class=\"excerpt\">Thank you so much for submitting to QORRN. We&#8217;re very grateful for your support in helping us grow our network across the country.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"folder":[406],"acf":[],"_links":{"self":[{"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/pages\/617"}],"collection":[{"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/comments?post=617"}],"version-history":[{"count":1,"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/pages\/617\/revisions"}],"predecessor-version":[{"id":1644,"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/pages\/617\/revisions\/1644"}],"wp:attachment":[{"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/media?parent=617"}],"wp:term":[{"taxonomy":"folder","embeddable":true,"href":"https:\/\/www.qorrn.com\/wp-json\/wp\/v2\/folder?post=617"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}