{"id":37465,"date":"2024-03-20T15:53:32","date_gmt":"2024-03-20T19:53:32","guid":{"rendered":"https:\/\/www.leecountylegalaid.org\/?page_id=37465"},"modified":"2024-10-15T12:59:28","modified_gmt":"2024-10-15T16:59:28","slug":"housing-law-apply-online","status":"publish","type":"page","link":"https:\/\/www.leecountylegalaid.org\/es\/housing-law-apply-online\/","title":{"rendered":"Ley de Vivienda \u2013 Solicite en l\u00ednea"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><div class=\"vc_row-full-width-before\"><\/div><div id=\"prm-custom\" data-vc-full-width=\"true\" data-vc-full-width-init=\"false\" class=\"vc_row wpb_row vc_row-fluid vc_custom_1702392971838 thegem-custom-6add7423cf22f9383 vc_row-has-fill\"><script type=\"text\/javascript\">if (typeof(gem_fix_fullwidth_position) == \"function\") { gem_fix_fullwidth_position(document.getElementById(\"prm-custom\")); }<\/script><div class=\"wpb_column vc_column_container vc_col-sm-6 thegem-custom-6add7423cf4392725\" ><div class=\"vc_column-inner thegem-custom-inner-6add7423cf43b vc_custom_1701962863119\"><div class=\"wpb_wrapper thegem-custom-6add7423cf4392725\"><h2 style=\"color: #6d6e71;text-align: left\" class=\"vc_custom_heading vc_custom_1702393004270\" >Before You Begin<\/h2>\r\n\t\r\n\t\t<div class=\"wpb_text_column wpb_content_element  vc_custom_1702392993613 subheader thegem-vc-text thegem-custom-6add7423cfd595095\"  >\r\n\t\t\t<div class=\"wpb_wrapper\">\r\n\t\t\t\t<p><span style=\"color: #6d6e71;\">Please do not submit multiple applications as it may delay the processing of your application. If you applied more than 3 weeks ago, you may contact the office for a status.<\/span><\/p>\n\r\n\t\t\t<\/div>\r\n\t\t\t<style>@media screen and (max-width: 1023px) {.thegem-vc-text.thegem-custom-6add7423cfd595095{display: block!important;}}@media screen and (max-width: 767px) {.thegem-vc-text.thegem-custom-6add7423cfd595095{display: block!important;}}@media screen and (max-width: 1023px) {.thegem-vc-text.thegem-custom-6add7423cfd595095{position: relative !important;}}@media screen and (max-width: 767px) {.thegem-vc-text.thegem-custom-6add7423cfd595095{position: relative !important;}}<\/style>\r\n\t\t<\/div>\r\n\t\r\n<\/div><\/div><\/div><\/div><div class=\"vc_row-full-width vc_clearfix\"><\/div><div class=\"vc_row-full-width-before\"><\/div><div id=\"prm-custom\" data-vc-full-width=\"true\" data-vc-full-width-init=\"false\" class=\"vc_row wpb_row vc_row-fluid vc_custom_1701962844348 thegem-custom-6add7423cff267566\"><script type=\"text\/javascript\">if (typeof(gem_fix_fullwidth_position) == \"function\") { gem_fix_fullwidth_position(document.getElementById(\"prm-custom\")); }<\/script><div class=\"wpb_column vc_column_container vc_col-sm-12 thegem-custom-6add7423d00884325\" ><div class=\"vc_column-inner thegem-custom-inner-6add7423d008a vc_custom_1701962598073\"><div class=\"wpb_wrapper thegem-custom-6add7423d00884325\"><h2 style=\"text-align: left\" class=\"vc_custom_heading vc_custom_1701962623122\" >Online Application<\/h2><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_7' style='display:none'><div id='gf_7' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/es\/wp-json\/wp\/v2\/pages\/37465#gf_7' data-formid='7' novalidate>\n        <div id='gf_progressbar_wrapper_7' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>9<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_11' style='width:11%;'><span>11%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_7_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_5\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a3490d2e\" data-field-span=\"12\"><h2 class=\"gsection_title\">HOUSING LAW APPLICATION FOR ASSISTANCE<\/h2><\/li><li id=\"field_7_1\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"226d8456\" data-field-span=\"12\"><label id='gfield_label_7_1' class='gfield_label gform-field-label' for='input_7_1'><span class='gform-field-label__text'>Date of Application:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_7_1'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_1'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_7_1' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_1' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_7_1' aria-label='Date of Application:: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_7_156\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"4aae552b\" data-field-span=\"12\"><label id='gfield_label_7_156' class='gfield_label gform-field-label' for='input_7_156'><span class='gform-field-label__text'>What are you seeking assistance with?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_7_156'>250 word limit<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_156' id='input_7_156' class='textarea medium'  aria-describedby=\"gfield_description_7_156\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_7_20' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_2' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_2' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_6\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ebe80c0f\" data-field-span=\"12\"><h2 class=\"gsection_title\">Information About You<\/h2><\/li><li id=\"field_7_120\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7f1b5dee\" data-field-span=\"12\"><label id='gfield_label_7_120' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Current Full Legal Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_120'>\n                            \n                            <span id='input_7_120_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_120.3' id='input_7_120_3' value=''   aria-required='true'     aria-labelledby=\"input_7_120_3_label gfield_label_7_120\"\/>\n                                                    <label for='input_7_120_3' id='input_7_120_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_7_120_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_120.4' id='input_7_120_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_120_4' id='input_7_120_4_label' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_7_120_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_120.6' id='input_7_120_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_120_6' id='input_7_120_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_7\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7e2f85bb\" data-field-span=\"12\"><label id='gfield_label_7_7' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Home Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_7_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_7_7_1' value=''    aria-required='true'    aria-labelledby=\"input_7_7_1_label gfield_label_7_7\"\/>\n                                        <label for='input_7_7_1' id='input_7_7_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_7_7_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_7_3' id='input_7_7_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_7_7_4_container' >\n                                        <input type='text' name='input_7.4' id='input_7_7_4' value=''      aria-required='true'    \/>\n                                        <label for='input_7_7_4' id='input_7_7_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_7_7_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_7_5' id='input_7_7_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_7_7_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_7_8\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c06f1a94\" data-field-span=\"12\"><label id='gfield_label_7_8' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Mailing Address<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_7_8' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_8_1_container' >\n                                        <input type='text' name='input_8.1' id='input_7_8_1' value=''    aria-required='false'    aria-labelledby=\"input_7_8_1_label gfield_label_7_8\"\/>\n                                        <label for='input_7_8_1' id='input_7_8_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_8_3_container' >\n                                    <input type='text' name='input_8.3' id='input_7_8_3' value=''    aria-required='false'    \/>\n                                    <label for='input_7_8_3' id='input_7_8_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_7_8_4_container' >\n                                        <input type='text' name='input_8.4' id='input_7_8_4' value=''      aria-required='false'    \/>\n                                        <label for='input_7_8_4' id='input_7_8_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_8_5_container' >\n                                    <input type='text' name='input_8.5' id='input_7_8_5' value=''    aria-required='false'    \/>\n                                    <label for='input_7_8_5' id='input_7_8_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_8.6' id='input_7_8_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_7_10\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"2843c84c\" data-field-span=\"12\"><label id='gfield_label_7_10' class='gfield_label gform-field-label' for='input_7_10'><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_7_10'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_10'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_7_10' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_10' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_7_10' aria-label='Date of Birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_7_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a0aaf80e\" data-field-span=\"12\"><label id='gfield_label_7_11' class='gfield_label gform-field-label' for='input_7_11'><span class='gform-field-label__text'>County of Residence (Not Country\/USA)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_7_11' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_143\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"1ef3a6b1\" data-field-span=\"12\">If your county of residence is outside of Lee county, we may not be able to provide any services without a referral from another Legal Aid organization.<\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_3' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_3' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7e8d8d8e\" data-field-span=\"12\"><h2 class=\"gsection_title\">Contact Information<\/h2><\/li><li id=\"field_7_15\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ad4c1f0d\" data-field-span=\"12\"><label id='gfield_label_7_15' class='gfield_label gform-field-label' for='input_7_15'><span class='gform-field-label__text'>Home Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_15' id='input_7_15' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_7_16\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0e8e83e1\" data-field-span=\"12\"><label id='gfield_label_7_16' class='gfield_label gform-field-label' for='input_7_16'><span class='gform-field-label__text'>Cell Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_7_16' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_7_18\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"1d4692eb\" data-field-span=\"12\"><label id='gfield_label_7_18' class='gfield_label gform-field-label' for='input_7_18'><span class='gform-field-label__text'>Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_18' id='input_7_18' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_7_122\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"9158365b\" data-field-span=\"12\">Correspondence from this agency will be either phone or email address so make sure you can receive correspondence at submitted email address and phone number.<\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_22' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_22' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_4' class='gform_page' data-js='page-field-id-22' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_4' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"01171ce4\" data-field-span=\"12\"><h2 class=\"gsection_title\">Household Income<\/h2><div class='gsection_description' id='gfield_description_7_25'>Please list the name, relationship AND all income in the section below: (You must provide name and income for all adults living in the household.  Otherwise application will be rejected.  If you provide false information your application will be rejected.)\n<\/div><\/li><li id=\"field_7_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fdb1f545\" data-field-span=\"12\"><label id='gfield_label_7_33' class='gfield_label gform-field-label' for='input_7_33'><span class='gform-field-label__text'>How many adults live in your household?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_7_33' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_24\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0ed5ae1b\" data-field-span=\"12\"><label id='gfield_label_7_24' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>List all household members (including yourself) and income<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_24'>\n                            \n                            <span id='input_7_24_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.3' id='input_7_24_3' value=''   aria-required='true'   placeholder='Applicant name'  aria-labelledby=\"input_7_24_3_label gfield_label_7_24\"\/>\n                                                    <label for='input_7_24_3' id='input_7_24_3_label' class='gform-field-label gform-field-label--type-sub '>Your name<\/label>\n                                                <\/span>\n                            <span id='input_7_24_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.4' id='input_7_24_4' value='Self'   aria-required='false'     \/>\n                                                    <label for='input_7_24_4' id='input_7_24_4_label' class='gform-field-label gform-field-label--type-sub '>Relationship to you<\/label>\n                                                <\/span>\n                            <span id='input_7_24_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.6' id='input_7_24_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_24_6' id='input_7_24_6_label' class='gform-field-label gform-field-label--type-sub '>Income Amount Annually<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_29\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"de95ff18\" data-field-span=\"12\"><label id='gfield_label_7_29' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name of adult in household<\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_29'>\n                            \n                            <span id='input_7_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.3' id='input_7_29_3' value=''   aria-required='false'     aria-labelledby=\"input_7_29_3_label gfield_label_7_29\"\/>\n                                                    <label for='input_7_29_3' id='input_7_29_3_label' class='gform-field-label gform-field-label--type-sub '>Name of Adult in Household<\/label>\n                                                <\/span>\n                            <span id='input_7_29_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.4' id='input_7_29_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_29_4' id='input_7_29_4_label' class='gform-field-label gform-field-label--type-sub '>Relationship to you<\/label>\n                                                <\/span>\n                            <span id='input_7_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.6' id='input_7_29_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_29_6' id='input_7_29_6_label' class='gform-field-label gform-field-label--type-sub '>Income Amount Annually<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_28\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"02d80f99\" data-field-span=\"12\"><label id='gfield_label_7_28' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name of adult in household<\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_28'>\n                            \n                            <span id='input_7_28_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_28.3' id='input_7_28_3' value=''   aria-required='false'     aria-labelledby=\"input_7_28_3_label gfield_label_7_28\"\/>\n                                                    <label for='input_7_28_3' id='input_7_28_3_label' class='gform-field-label gform-field-label--type-sub '>Name of Adult in Household<\/label>\n                                                <\/span>\n                            <span id='input_7_28_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_28.4' id='input_7_28_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_28_4' id='input_7_28_4_label' class='gform-field-label gform-field-label--type-sub '>Relationship to you<\/label>\n                                                <\/span>\n                            <span id='input_7_28_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_28.6' id='input_7_28_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_28_6' id='input_7_28_6_label' class='gform-field-label gform-field-label--type-sub '>Income Amount Annually<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_27\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"cd4ac42a\" data-field-span=\"12\"><label id='gfield_label_7_27' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name of adult in household<\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_27'>\n                            \n                            <span id='input_7_27_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.3' id='input_7_27_3' value=''   aria-required='false'     aria-labelledby=\"input_7_27_3_label gfield_label_7_27\"\/>\n                                                    <label for='input_7_27_3' id='input_7_27_3_label' class='gform-field-label gform-field-label--type-sub '>Name of Adult in Household<\/label>\n                                                <\/span>\n                            <span id='input_7_27_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.4' id='input_7_27_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_27_4' id='input_7_27_4_label' class='gform-field-label gform-field-label--type-sub '>Relationship to you<\/label>\n                                                <\/span>\n                            <span id='input_7_27_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_27.6' id='input_7_27_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_27_6' id='input_7_27_6_label' class='gform-field-label gform-field-label--type-sub '>Income Amount Annually<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_26\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"82c5eec0\" data-field-span=\"12\"><label id='gfield_label_7_26' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name of adult in household<\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_26'>\n                            \n                            <span id='input_7_26_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_26.3' id='input_7_26_3' value=''   aria-required='false'     aria-labelledby=\"input_7_26_3_label gfield_label_7_26\"\/>\n                                                    <label for='input_7_26_3' id='input_7_26_3_label' class='gform-field-label gform-field-label--type-sub '>Name of Adult in Household<\/label>\n                                                <\/span>\n                            <span id='input_7_26_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_26.4' id='input_7_26_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_26_4' id='input_7_26_4_label' class='gform-field-label gform-field-label--type-sub '>Relationship to you<\/label>\n                                                <\/span>\n                            <span id='input_7_26_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_26.6' id='input_7_26_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_26_6' id='input_7_26_6_label' class='gform-field-label gform-field-label--type-sub '>Income Amount Annually<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7e13a7d3\" data-field-span=\"12\"><label id='gfield_label_7_32' class='gfield_label gform-field-label' for='input_7_32'><span class='gform-field-label__text'>How many children live in your household?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_7_32' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_30' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_30' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_5' class='gform_page' data-js='page-field-id-30' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_5' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"9b761734\" data-field-span=\"12\"><h2 class=\"gsection_title\">Work Information<\/h2><div class='gsection_description' id='gfield_description_7_31'>Please provide an accurate rate of pay and how many hours. (We will not be able to accept your application without this Information.) <\/div><\/li><li id=\"field_7_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"bef8e0fc\" data-field-span=\"12\"><label id='gfield_label_7_39' class='gfield_label gform-field-label' for='input_7_39'><span class='gform-field-label__text'>Name of Employer<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_7_39' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"79072d18\" data-field-span=\"12\"><label id='gfield_label_7_44' class='gfield_label gform-field-label' for='input_7_44'><span class='gform-field-label__text'>Rate of pay<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_7_44' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c027ade0\" data-field-span=\"12\"><label id='gfield_label_7_45' class='gfield_label gform-field-label' for='input_7_45'><span class='gform-field-label__text'>How many hours per week do you work?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_7_45' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_46\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"03cf9827\" data-field-span=\"12\"><label id='gfield_label_7_46' class='gfield_label gform-field-label' for='input_7_46'><span class='gform-field-label__text'>Total income per week<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_7_46' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_47' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_47' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_6' class='gform_page' data-js='page-field-id-47' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_6' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5cb9fbc9\" data-field-span=\"12\"><h2 class=\"gsection_title\">Other Sources of Income<\/h2><\/li><li id=\"field_7_117\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"8a12389a\" data-field-span=\"12\"><label id='gfield_label_7_117' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have any other source of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_117'>\n\t\t\t<li class='gchoice gchoice_7_117_0'>\n\t\t\t\t<input name='input_117' type='radio' value='Yes'  id='choice_7_117_0'    \/>\n\t\t\t\t<label for='choice_7_117_0' id='label_7_117_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_117_1'>\n\t\t\t\t<input name='input_117' type='radio' value='No'  id='choice_7_117_1'    \/>\n\t\t\t\t<label for='choice_7_117_1' id='label_7_117_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_7_117'>If yes, what type of income do you receive, who receives said income and how much?<br><br><i> Examples of types of income: Additional job(s), Child Support, Disability, Social Security, Unemployment Compensation, Worker\u2019s comp, etc. (This includes income for Children and other person\u2019s in household)<\/div><\/li><li id=\"field_7_129\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"69c02aad\" data-field-span=\"12\"><label id='gfield_label_7_129' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Other \/ Additional Jobs<\/span><\/label><style type=\"text\/css\">\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_129_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_129_col_2' class='gfield_list_col_even' \/><col id='gfield_list_129_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\" id=\"gfield_list_7_129_header_1\">Name of person receiving income<\/th><th scope=\"col\" id=\"gfield_list_7_129_header_2\">Amount of income received<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_129_cell1' data-label='Name of person receiving income'><input aria-invalid='false'  aria-describedby=\"gfield_description_7_129\" aria-labelledby=\"gfield_list_7_129_header_1 gfield_label_7_129\" data-aria-label-template='Name of person receiving income, Row {0}' type='text' name='input_129[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_129_cell2' data-label='Amount of income received'><input aria-invalid='false'   aria-label='Amount of income received, Row 1' data-aria-label-template='Amount of income received, Row {0}' type='text' name='input_129[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_7_129'>Click + to enter additional jobs<\/div><\/li><li id=\"field_7_146\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0bdcac30\" data-field-span=\"12\"><label id='gfield_label_7_146' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Child Support<\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_146_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_146_col_2' class='gfield_list_col_even' \/><col id='gfield_list_146_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\" id=\"gfield_list_7_146_header_1\">Name of Child<\/th><th scope=\"col\" id=\"gfield_list_7_146_header_2\">Amount of child support received<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_146_cell1' data-label='Name of Child'><input aria-invalid='false'  aria-describedby=\"gfield_description_7_146\" aria-labelledby=\"gfield_list_7_146_header_1 gfield_label_7_146\" data-aria-label-template='Name of Child, Row {0}' type='text' name='input_146[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_146_cell2' data-label='Amount of child support received'><input aria-invalid='false'   aria-label='Amount of child support received, Row 1' data-aria-label-template='Amount of child support received, Row {0}' type='text' name='input_146[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_7_146'>Click + to enter additional sources of child support<\/div><\/li><li id=\"field_7_130\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ab13c5a5\" data-field-span=\"12\"><label id='gfield_label_7_130' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Disability<\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_130_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_130_col_2' class='gfield_list_col_even' \/><col id='gfield_list_130_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\" id=\"gfield_list_7_130_header_1\">Name of person receiving disability<\/th><th scope=\"col\" id=\"gfield_list_7_130_header_2\">Amount of disability received<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_130_cell1' data-label='Name of person receiving disability'><input aria-invalid='false'  aria-describedby=\"gfield_description_7_130\" aria-labelledby=\"gfield_list_7_130_header_1 gfield_label_7_130\" data-aria-label-template='Name of person receiving disability, Row {0}' type='text' name='input_130[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_130_cell2' data-label='Amount of disability received'><input aria-invalid='false'   aria-label='Amount of disability received, Row 1' data-aria-label-template='Amount of disability received, Row {0}' type='text' name='input_130[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_7_130'>Click + to enter additional sources of disability<\/div><\/li><li id=\"field_7_131\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b398b2d7\" data-field-span=\"12\"><label id='gfield_label_7_131' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Social Security<\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_131_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_131_col_2' class='gfield_list_col_even' \/><col id='gfield_list_131_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\" id=\"gfield_list_7_131_header_1\">Name of person receiving Social Security<\/th><th scope=\"col\" id=\"gfield_list_7_131_header_2\">Amount of Social Security received<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_131_cell1' data-label='Name of person receiving Social Security'><input aria-invalid='false'  aria-describedby=\"gfield_description_7_131\" aria-labelledby=\"gfield_list_7_131_header_1 gfield_label_7_131\" data-aria-label-template='Name of person receiving Social Security, Row {0}' type='text' name='input_131[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_131_cell2' data-label='Amount of Social Security received'><input aria-invalid='false'   aria-label='Amount of Social Security received, Row 1' data-aria-label-template='Amount of Social Security received, Row {0}' type='text' name='input_131[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_7_131'>Click + to enter additional sources of Social Security<\/div><\/li><li id=\"field_7_132\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0c9e86ba\" data-field-span=\"12\"><label id='gfield_label_7_132' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Unemployment<\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_132_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_132_col_2' class='gfield_list_col_even' \/><col id='gfield_list_132_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\" id=\"gfield_list_7_132_header_1\">Name of person receiving unemployment<\/th><th scope=\"col\" id=\"gfield_list_7_132_header_2\">Amount of unemployment received<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_132_cell1' data-label='Name of person receiving unemployment'><input aria-invalid='false'  aria-describedby=\"gfield_description_7_132\" aria-labelledby=\"gfield_list_7_132_header_1 gfield_label_7_132\" data-aria-label-template='Name of person receiving unemployment, Row {0}' type='text' name='input_132[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_132_cell2' data-label='Amount of unemployment received'><input aria-invalid='false'   aria-label='Amount of unemployment received, Row 1' data-aria-label-template='Amount of unemployment received, Row {0}' type='text' name='input_132[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_7_132'>Click + to enter additional sources of unemployment<\/div><\/li><li id=\"field_7_133\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"9351d03a\" data-field-span=\"12\"><label id='gfield_label_7_133' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Workers Comp<\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_133_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_133_col_2' class='gfield_list_col_even' \/><col id='gfield_list_133_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\" id=\"gfield_list_7_133_header_1\">Name of person receiving Workers&#039; Comp<\/th><th scope=\"col\" id=\"gfield_list_7_133_header_2\">Amount of Workers Comp received<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_133_cell1' data-label='Name of person receiving Workers&#039; Comp'><input aria-invalid='false'  aria-describedby=\"gfield_description_7_133\" aria-labelledby=\"gfield_list_7_133_header_1 gfield_label_7_133\" data-aria-label-template='Name of person receiving Workers&#039; Comp, Row {0}' type='text' name='input_133[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_133_cell2' data-label='Amount of Workers Comp received'><input aria-invalid='false'   aria-label='Amount of Workers Comp received, Row 1' data-aria-label-template='Amount of Workers Comp received, Row {0}' type='text' name='input_133[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_7_133'>Click + to enter additional sources of Workers' Comp<\/div><\/li><li id=\"field_7_134\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"21a24b15\" data-field-span=\"12\"><label id='gfield_label_7_134' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Other sources of income<\/span><\/label><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_134_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_134_col_2' class='gfield_list_col_even' \/><col id='gfield_list_134_col_3' class='gfield_list_col_odd' \/><col id='gfield_list_134_col_4' class='gfield_list_col_even' \/><\/colgroup><thead><tr><th scope=\"col\" id=\"gfield_list_7_134_header_1\">Type of Income<\/th><th scope=\"col\" id=\"gfield_list_7_134_header_2\">Name of person receiving other income<\/th><th scope=\"col\" id=\"gfield_list_7_134_header_3\">Amount of other income received<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_134_cell1' data-label='Type of Income'><input aria-invalid='false'  aria-describedby=\"gfield_description_7_134\" aria-labelledby=\"gfield_list_7_134_header_1 gfield_label_7_134\" data-aria-label-template='Type of Income, Row {0}' type='text' name='input_134[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_134_cell2' data-label='Name of person receiving other income'><input aria-invalid='false'   aria-label='Name of person receiving other income, Row 1' data-aria-label-template='Name of person receiving other income, Row {0}' type='text' name='input_134[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_134_cell3' data-label='Amount of other income received'><input aria-invalid='false'   aria-label='Amount of other income received, Row 1' data-aria-label-template='Amount of other income received, Row {0}' type='text' name='input_134[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)' onkeypress='gformAddListItem(this, 0)'><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 0)' onkeypress='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\"><img src='https:\/\/www.leecountylegalaid.org\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_7_134'>Click + to enter additional sources of other income<\/div><\/li><li id=\"field_7_57\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"ea1abbb8\" data-field-span=\"12\"><label id='gfield_label_7_57' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you own a house?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_57'>\n\t\t\t<li class='gchoice gchoice_7_57_0'>\n\t\t\t\t<input name='input_57' type='radio' value='Yes'  id='choice_7_57_0'    \/>\n\t\t\t\t<label for='choice_7_57_0' id='label_7_57_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_57_1'>\n\t\t\t\t<input name='input_57' type='radio' value='No'  id='choice_7_57_1'    \/>\n\t\t\t\t<label for='choice_7_57_1' id='label_7_57_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fa95613c\" data-field-span=\"12\"><label id='gfield_label_7_58' class='gfield_label gform-field-label' for='input_7_58'><span class='gform-field-label__text'>If yes, value<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_7_58' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_62' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_62' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_7' class='gform_page' data-js='page-field-id-62' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_7' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3a848e6a\" data-field-span=\"12\"><h2 class=\"gsection_title\">Additional Information<\/h2><\/li><li id=\"field_7_135\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c8e510a4\" data-field-span=\"12\">All questions must be answered honestly and completely to the best of your ability. We may not be able to help if false, fraudulent or incomplete information is submitted.<\/li><li id=\"field_7_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8f4930ed\" data-field-span=\"12\"><label id='gfield_label_7_64' class='gfield_label gform-field-label' for='input_7_64'><span class='gform-field-label__text'>How long have you lived in Florida before today?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_7_64' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_67\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"f0c0deb5\" data-field-span=\"12\"><label id='gfield_label_7_67' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Have you ever been charged with a crime?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_67'>\n\t\t\t<li class='gchoice gchoice_7_67_0'>\n\t\t\t\t<input name='input_67' type='radio' value='Yes'  id='choice_7_67_0'    \/>\n\t\t\t\t<label for='choice_7_67_0' id='label_7_67_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_67_1'>\n\t\t\t\t<input name='input_67' type='radio' value='No'  id='choice_7_67_1'    \/>\n\t\t\t\t<label for='choice_7_67_1' id='label_7_67_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"242685c4\" data-field-span=\"12\"><label id='gfield_label_7_66' class='gfield_label gform-field-label' for='input_7_66'><span class='gform-field-label__text'>What were you charged for and when?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_7_66' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_136\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b7d111a9\" data-field-span=\"12\"><label id='gfield_label_7_136' class='gfield_label gform-field-label' for='input_7_136'><span class='gform-field-label__text'>Where were you charged?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_136' id='input_7_136' type='text' value='' class='medium'  aria-describedby=\"gfield_description_7_136\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_136'>Enter city \/ county \/ state\/ jurisdiction<\/div><\/li><li id=\"field_7_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"17638da0\" data-field-span=\"12\"><label id='gfield_label_7_65' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Have you been served with legal documents?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_65'>\n\t\t\t<li class='gchoice gchoice_7_65_0'>\n\t\t\t\t<input name='input_65' type='radio' value='Yes'  id='choice_7_65_0'    \/>\n\t\t\t\t<label for='choice_7_65_0' id='label_7_65_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_65_1'>\n\t\t\t\t<input name='input_65' type='radio' value='No'  id='choice_7_65_1'    \/>\n\t\t\t\t<label for='choice_7_65_1' id='label_7_65_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6d43ae09\" data-field-span=\"12\"><label id='gfield_label_7_68' class='gfield_label gform-field-label' for='input_7_68'><span class='gform-field-label__text'>For what were you served legal documents?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_7_68' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_70\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b834a36d\" data-field-span=\"12\"><label id='gfield_label_7_70' class='gfield_label gform-field-label' for='input_7_70'><span class='gform-field-label__text'>What date were you served legal documents?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_7_70'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_70'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_7_70' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_70' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_7_70' aria-label='What date were you served legal documents?: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_7_147\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"606d7ae5\" data-field-span=\"12\"><label id='gfield_label_7_147' class='gfield_label gform-field-label' for='input_7_147'><span class='gform-field-label__text'>Case number for legal documents served<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_7_147' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_148\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c829ceea\" data-field-span=\"12\"><label id='gfield_label_7_148' class='gfield_label gform-field-label' for='input_7_148'><span class='gform-field-label__text'>For which county\/state were you served legal documents?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_7_148' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_157\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ae83ea80\" data-field-span=\"12\"><label id='gfield_label_7_157' class='gfield_label gform-field-label' for='input_7_157'><span class='gform-field-label__text'>Do you currently have a case pending in Lee County? If so, what is the case #?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_157' id='input_7_157' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_69\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"057f2765\" data-field-span=\"12\"><label id='gfield_label_7_69' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you currently represented by an attorney in this matter?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_69'>\n\t\t\t<li class='gchoice gchoice_7_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='Yes'  id='choice_7_69_0'    \/>\n\t\t\t\t<label for='choice_7_69_0' id='label_7_69_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='No'  id='choice_7_69_1'    \/>\n\t\t\t\t<label for='choice_7_69_1' id='label_7_69_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c7bc8bab\" data-field-span=\"12\"><label id='gfield_label_7_71' class='gfield_label gform-field-label' for='input_7_71'><span class='gform-field-label__text'>Who is representing you?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_7_71' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_72\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8526730b\" data-field-span=\"12\"><label id='gfield_label_7_72' class='gfield_label gform-field-label' for='input_7_72'><span class='gform-field-label__text'>Please give a brief description of what you want us to help you with<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea' data-text-counter-max='600' data-text-counter-template='{current} of {max} max characters'><textarea name='input_72' id='input_7_72' class='textarea medium'   maxlength='600'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_73' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_73' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_8' class='gform_page' data-js='page-field-id-73' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_8' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_74\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ccaa6e0c\" data-field-span=\"12\"><h2 class=\"gsection_title\">INFORMATION ABOUT THE OTHER PARTY<\/h2><div class='gsection_description' id='gfield_description_7_74'>Your application WILL NOT be accepted if you do not provide a valid address for the other party.  PLEASE PROVIDE A VALID ADDRESS. NO PO BOXES.<\/div><\/li><li id=\"field_7_75\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"16fed3f9\" data-field-span=\"12\"><label id='gfield_label_7_75' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Opposing Party Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_7_75'>\n                            \n                            <span id='input_7_75_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_75.3' id='input_7_75_3' value=''   aria-required='true'     aria-labelledby=\"input_7_75_3_label gfield_label_7_75\"\/>\n                                                    <label for='input_7_75_3' id='input_7_75_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_7_75_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_75.4' id='input_7_75_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_75_4' id='input_7_75_4_label' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_7_75_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_75.6' id='input_7_75_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_75_6' id='input_7_75_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_158\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"10c363da\" data-field-span=\"12\"><label id='gfield_label_7_158' class='gfield_label gform-field-label' for='input_7_158'><span class='gform-field-label__text'>Company or Landlord Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_158' id='input_7_158' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_77\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"d040c829\" data-field-span=\"12\"><label id='gfield_label_7_77' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Opposing Party Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_7_77' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_77_1_container' >\n                                        <input type='text' name='input_77.1' id='input_7_77_1' value=''    aria-required='true'    aria-labelledby=\"input_7_77_1_label gfield_label_7_77\"\/>\n                                        <label for='input_7_77_1' id='input_7_77_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_7_77_2_container' >\n                                        <input type='text' name='input_77.2' id='input_7_77_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_77_2' id='input_7_77_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_7_77_3_container' >\n                                    <input type='text' name='input_77.3' id='input_7_77_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_77_3' id='input_7_77_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_7_77_4_container' >\n                                        <input type='text' name='input_77.4' id='input_7_77_4' value=''      aria-required='true'    \/>\n                                        <label for='input_7_77_4' id='input_7_77_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_77_5_container' >\n                                    <input type='text' name='input_77.5' id='input_7_77_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_77_5' id='input_7_77_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_77.6' id='input_7_77_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_7_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"27785337\" data-field-span=\"12\"><label id='gfield_label_7_81' class='gfield_label gform-field-label' for='input_7_81'><span class='gform-field-label__text'>Opposing Party County of Residence<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_7_81' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_82\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0cac32c8\" data-field-span=\"12\"><h2 class=\"gsection_title\">Contact Information<\/h2><\/li><li id=\"field_7_83\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a5657f0e\" data-field-span=\"12\"><label id='gfield_label_7_83' class='gfield_label gform-field-label' for='input_7_83'><span class='gform-field-label__text'>Opposing Party Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_83' id='input_7_83' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_7_87\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"b8828527\" data-field-span=\"12\"><label id='gfield_label_7_87' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Does the opposing party have an attorney?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_87'>\n\t\t\t<li class='gchoice gchoice_7_87_0'>\n\t\t\t\t<input name='input_87' type='radio' value='Yes'  id='choice_7_87_0'    \/>\n\t\t\t\t<label for='choice_7_87_0' id='label_7_87_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_87_1'>\n\t\t\t\t<input name='input_87' type='radio' value='No'  id='choice_7_87_1'    \/>\n\t\t\t\t<label for='choice_7_87_1' id='label_7_87_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_87_2'>\n\t\t\t\t<input name='input_87' type='radio' value='Don&#039;t Know'  id='choice_7_87_2'    \/>\n\t\t\t\t<label for='choice_7_87_2' id='label_7_87_2' class='gform-field-label gform-field-label--type-inline'>Don't Know<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6cc4fdd5\" data-field-span=\"12\"><label id='gfield_label_7_88' class='gfield_label gform-field-label' for='input_7_88'><span class='gform-field-label__text'>Who is the opposing party&#039;s attorney?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_7_88' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_104\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"042c215a\" data-field-span=\"12\"><h2 class=\"gsection_title\">YOUR DEMOGRAPHIC INFORMATION<\/h2><div class='gsection_description' id='gfield_description_7_104'>Please provide YOUR demographic information. <\/div><\/li><li id=\"field_7_105\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"e34c85df\" data-field-span=\"12\"><label id='gfield_label_7_105' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Gender<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_105'>\n\t\t\t<li class='gchoice gchoice_7_105_0'>\n\t\t\t\t<input name='input_105' type='radio' value='Male'  id='choice_7_105_0'    \/>\n\t\t\t\t<label for='choice_7_105_0' id='label_7_105_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_105_1'>\n\t\t\t\t<input name='input_105' type='radio' value='Female'  id='choice_7_105_1'    \/>\n\t\t\t\t<label for='choice_7_105_1' id='label_7_105_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_106\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"8bf49de8\" data-field-span=\"12\"><label id='gfield_label_7_106' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Race<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_106'>\n\t\t\t<li class='gchoice gchoice_7_106_0'>\n\t\t\t\t<input name='input_106' type='radio' value='White'  id='choice_7_106_0'    \/>\n\t\t\t\t<label for='choice_7_106_0' id='label_7_106_0' class='gform-field-label gform-field-label--type-inline'>White<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_106_1'>\n\t\t\t\t<input name='input_106' type='radio' value='Black'  id='choice_7_106_1'    \/>\n\t\t\t\t<label for='choice_7_106_1' id='label_7_106_1' class='gform-field-label gform-field-label--type-inline'>Black<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_106_2'>\n\t\t\t\t<input name='input_106' type='radio' value='Asian'  id='choice_7_106_2'    \/>\n\t\t\t\t<label for='choice_7_106_2' id='label_7_106_2' class='gform-field-label gform-field-label--type-inline'>Asian<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_106_3'>\n\t\t\t\t<input name='input_106' type='radio' value='Native American'  id='choice_7_106_3'    \/>\n\t\t\t\t<label for='choice_7_106_3' id='label_7_106_3' class='gform-field-label gform-field-label--type-inline'>Native American<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_106_4'>\n\t\t\t\t<input name='input_106' type='radio' value='gf_other_choice'  id='choice_7_106_4'   onfocus=\"jQuery(this).next('input').focus();\" \/ aria-label=\"Race\">\n\t\t\t\t<input class='small' id='input_7_106_other' name='input_106_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_107\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"904ecb66\" data-field-span=\"12\"><label id='gfield_label_7_107' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Ethnicity<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_107'>\n\t\t\t<li class='gchoice gchoice_7_107_0'>\n\t\t\t\t<input name='input_107' type='radio' value='Hispanic'  id='choice_7_107_0'    \/>\n\t\t\t\t<label for='choice_7_107_0' id='label_7_107_0' class='gform-field-label gform-field-label--type-inline'>Hispanic<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_107_1'>\n\t\t\t\t<input name='input_107' type='radio' value='Non-Hispanic'  id='choice_7_107_1'    \/>\n\t\t\t\t<label for='choice_7_107_1' id='label_7_107_1' class='gform-field-label gform-field-label--type-inline'>Non-Hispanic<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_108\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"aeaa991b\" data-field-span=\"12\"><label id='gfield_label_7_108' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Language<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_108'>\n\t\t\t<li class='gchoice gchoice_7_108_0'>\n\t\t\t\t<input name='input_108' type='radio' value='English'  id='choice_7_108_0'    \/>\n\t\t\t\t<label for='choice_7_108_0' id='label_7_108_0' class='gform-field-label gform-field-label--type-inline'>English<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_108_1'>\n\t\t\t\t<input name='input_108' type='radio' value='Spanish'  id='choice_7_108_1'    \/>\n\t\t\t\t<label for='choice_7_108_1' id='label_7_108_1' class='gform-field-label gform-field-label--type-inline'>Spanish<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_108_2'>\n\t\t\t\t<input name='input_108' type='radio' value='gf_other_choice'  id='choice_7_108_2'   onfocus=\"jQuery(this).next('input').focus();\" \/ aria-label=\"Language\">\n\t\t\t\t<input class='small' id='input_7_108_other' name='input_108_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_109\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"658c00ff\" data-field-span=\"12\"><label id='gfield_label_7_109' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you a Veteran?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_109'>\n\t\t\t<li class='gchoice gchoice_7_109_0'>\n\t\t\t\t<input name='input_109' type='radio' value='Yes'  id='choice_7_109_0'    \/>\n\t\t\t\t<label for='choice_7_109_0' id='label_7_109_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_109_1'>\n\t\t\t\t<input name='input_109' type='radio' value='No'  id='choice_7_109_1'    \/>\n\t\t\t\t<label for='choice_7_109_1' id='label_7_109_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_137\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"bd86bb18\" data-field-span=\"12\"><label id='gfield_label_7_137' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you Disabled?<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_137'>\n\t\t\t<li class='gchoice gchoice_7_137_0'>\n\t\t\t\t<input name='input_137' type='radio' value='Yes'  id='choice_7_137_0'    \/>\n\t\t\t\t<label for='choice_7_137_0' id='label_7_137_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_137_1'>\n\t\t\t\t<input name='input_137' type='radio' value='No'  id='choice_7_137_1'    \/>\n\t\t\t\t<label for='choice_7_137_1' id='label_7_137_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_138\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"925aeda3\" data-field-span=\"12\"><label id='gfield_label_7_138' class='gfield_label gform-field-label' for='input_7_138'><span class='gform-field-label__text'>If yes, state your disability<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_138' id='input_7_138' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_110\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"611b4d59\" data-field-span=\"12\"><label id='gfield_label_7_110' class='gfield_label gform-field-label' for='input_7_110'><span class='gform-field-label__text'>How did you hear about our office?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_110' id='input_7_110' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_7_111' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_7_111' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_9' class='gform_page' data-js='page-field-id-111' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_7_9' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_112\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"11eb0627\" data-field-span=\"12\"><h2 class=\"gsection_title\">Lee County Legal Aid Society, Inc.<\/h2><\/li><li id=\"field_7_113\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"187df4b4\" data-field-span=\"12\"><label id='gfield_label_7_113' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Application for Assistance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_113'><li class='gchoice gchoice_7_113_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_113.1' type='checkbox'  value='Accept'  id='choice_7_113_1'   aria-describedby=\"gfield_description_7_113\" aria-labelledby=\"label_7_113_1 gfield_label_7_113\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_7_113_1' id='label_7_113_1' class='gform-field-label gform-field-label--type-inline'>Accept<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_7_113'>\tI understand that I am completing this application for the purpose of determining my eligibility to receive legal assistance from Lee County Legal Aid Society. My completion of this application in no way creates an attorney-client relationship or privilege. I also understand that should my application not be completed fully, including household income and opposing party\u2019s physical address, this application for assistance will be denied. No application is denied for reasons of race, sex, creed, color, religion, age, national origin, marital status, disability, or sexual orientation.<\/div><\/li><li id=\"field_7_139\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"465167c7\" data-field-span=\"12\"><label id='gfield_label_7_139' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Privacy<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_139'><li class='gchoice gchoice_7_139_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_139.1' type='checkbox'  value='Accept'  id='choice_7_139_1'   aria-describedby=\"gfield_description_7_139\" aria-labelledby=\"label_7_139_1 gfield_label_7_139\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_7_139_1' id='label_7_139_1' class='gform-field-label gform-field-label--type-inline'>Accept<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_7_139'>I understand the information provided in this application will be treated as confidential. I understand the information I provide in the application will only be used to determine eligibility for services.<\/div><\/li><li id=\"field_7_140\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"40d92f09\" data-field-span=\"12\"><label id='gfield_label_7_140' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Eligibility<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_140'><li class='gchoice gchoice_7_140_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.1' type='checkbox'  value='Accept'  id='choice_7_140_1'   aria-describedby=\"gfield_description_7_140\" aria-labelledby=\"label_7_140_1 gfield_label_7_140\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_7_140_1' id='label_7_140_1' class='gform-field-label gform-field-label--type-inline'>Accept<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_7_140'>I understand this application is only a preliminary screening and eligibility is not guaranteed. Completing the application does not make me a client of Lee County Legal Aid Society and does not create an attorney-client relationship. <br>\n<br>\nI understand that I may not qualify for services.  Some applicants may get an attorney to represent them, while others may get legal advice, a referral, or some other assistance. Decisions about what service can be given are based the nature of the individual case. <br>\n<br>\nI understand that it may take up to 3 weeks for final determination to be made.<\/div><\/li><li id=\"field_7_155\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"601578fb\" data-field-span=\"12\"><label id='gfield_label_7_155' class='gfield_label gform-field-label' for='input_7_155'><span class='gform-field-label__text'>Signature<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_7_155' type='text' value='' class='medium'  aria-describedby=\"gfield_description_7_155\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_155'>Type your name as your signature<\/div><\/li><li id=\"field_7_154\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"55618d46\" data-field-span=\"12\"><label id='gfield_label_7_154' class='gfield_label gform-field-label' for='input_7_154'><span class='gform-field-label__text'>Date of signature<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_7_154'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_154'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t 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