{"id":1671,"date":"2026-02-05T11:25:16","date_gmt":"2026-02-05T19:25:16","guid":{"rendered":"https:\/\/oregonyouthresourcemap.org\/?page_id=1671"},"modified":"2026-05-15T13:19:48","modified_gmt":"2026-05-15T20:19:48","slug":"submit-a-resource","status":"publish","type":"page","link":"https:\/\/oregonyouthresourcemap.org\/es\/submit-a-resource\/","title":{"rendered":"Enviar un recurso"},"content":{"rendered":"\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\" style=\"font-size:1.75rem\">Instructions<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Check to see if the resource or opportunity is already on the map! This is REALLY important because it helps us avoid duplicates which make the map harder to use. You can do this by using the search bar on the site.<\/li>\n\n\n\n<li>If the resource or opportunity is on the map, please check the information that is listed! Is the contact information, address, and description of services correct? If there are any errors or missing info, please let us know here:<\/li>\n\n\n\n<li>If the resource or opportunity is NOT on the map, please fill out this form once for each program you want to enter on the map. Each entry will create one new listing on the map! Please note that the resource will not automatically update the map and it may take some time for us to review listings.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Message <a href=\"mailto:mapinfo@directionservice.org\" target=\"_blank\" rel=\"noreferrer noopener\">mapinfo@directionservice.org<\/a> if you have questions, need assistance, or would like to submit information in an alternate format.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Thank you for helping us build this free resource map for Oregon Youth!<\/p>\n\n\n<style id=\"wpforms-css-vars-1669-block-31fd5499-c7fb-4d30-be9b-30449bfd9a64\">\n\t\t\t\t#wpforms-1669.wpforms-block-31fd5499-c7fb-4d30-be9b-30449bfd9a64 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-31fd5499-c7fb-4d30-be9b-30449bfd9a64 wpforms-render-modern\" id=\"wpforms-1669\"><form id=\"wpforms-form-1669\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1669\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/1671\" data-token=\"8df34ba3cea767f6eda46fb6d09b472a\" data-token-time=\"1784845916\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1669-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">Your Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1669-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" aria-errormessage=\"wpforms-1669-field_2-error\" aria-describedby=\"wpforms-1669-field_2-description\" required><label for=\"wpforms-1669-field_2\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1669-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" aria-errormessage=\"wpforms-1669-field_2-last-error\" aria-describedby=\"wpforms-1669-field_2-description\" required><label for=\"wpforms-1669-field_2-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-1669-field_2-description\" class=\"wpforms-field-description\">We will not share this information. We just need to who know who to contact for follow up questions<\/div><\/fieldset><\/div><div id=\"wpforms-1669-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_3\">Title \/ Agency Affiliation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1669-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-1669-field_3-error\" required><\/div><div id=\"wpforms-1669-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_4\">Contact Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1669-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1669-field_4-error\" aria-describedby=\"wpforms-1669-field_4-description\" required><div id=\"wpforms-1669-field_4-description\" class=\"wpforms-field-description\">We will email you occasionally to make sure the listing it up-to-date. We don&#8217;t share your information.<\/div><\/div>\t\t<div id=\"wpforms-1669-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1669-field_1\" >Layout Minimum Main<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1669-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1669-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_5\">Parent Organization<\/label><input type=\"text\" id=\"wpforms-1669-field_5\" class=\"wpforms-field-large\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-1669-field_5-error\" ><\/div><div id=\"wpforms-1669-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_6\">Category (Choose One) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1669-field_6\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][6]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>&#8212; Select Choice &#8212;<\/option><option value=\"Basic Needs: Clothing &amp; Goods\"  class=\"choice-4 depth-1\"  >Basic Needs: Clothing &amp; Goods<\/option><option value=\"Basic Needs: Cooking Classes\"  class=\"choice-5 depth-1\"  >Basic Needs: Cooking Classes<\/option><option value=\"Basic Needs: Food\"  class=\"choice-6 depth-1\"  >Basic Needs: Food<\/option><option value=\"Basic Needs: Food Pantries &amp; Boxes\"  class=\"choice-7 depth-1\"  >Basic Needs: Food Pantries &amp; Boxes<\/option><option value=\"Basic Needs: Fresh Produce\"  class=\"choice-8 depth-1\"  >Basic Needs: Fresh Produce<\/option><option value=\"Basic Needs: Hot Meals\"  class=\"choice-9 depth-1\"  >Basic Needs: Hot Meals<\/option><option value=\"Basic Needs: Hygiene Products\"  class=\"choice-10 depth-1\"  >Basic Needs: Hygiene Products<\/option><option value=\"Basic Needs: Medical Transportation\"  class=\"choice-11 depth-1\"  >Basic Needs: Medical Transportation<\/option><option value=\"Basic Needs: Public Transit\"  class=\"choice-12 depth-1\"  >Basic Needs: Public Transit<\/option><option value=\"Basic Needs: Transportation\"  class=\"choice-13 depth-1\"  >Basic Needs: Transportation<\/option><option value=\"Care &amp; Safety: Child Care\"  class=\"choice-14 depth-1\"  >Care &amp; Safety: Child Care<\/option><option value=\"Care &amp; Safety: Domestic Violence &amp; Sexual Assault\"  class=\"choice-15 depth-1\"  >Care &amp; Safety: Domestic Violence &amp; Sexual Assault<\/option><option value=\"Care &amp; Safety: Foster Care &amp; Youth Services\"  class=\"choice-16 depth-1\"  >Care &amp; Safety: Foster Care &amp; Youth Services<\/option><option value=\"Care &amp; Safety: Immigrants &amp; Refugees\"  class=\"choice-17 depth-1\"  >Care &amp; Safety: Immigrants &amp; Refugees<\/option><option value=\"Care &amp; Safety: Information &amp; Referrals\"  class=\"choice-18 depth-1\"  >Care &amp; Safety: Information &amp; Referrals<\/option><option value=\"Care &amp; Safety: Pet Care\"  class=\"choice-19 depth-1\"  >Care &amp; Safety: Pet Care<\/option><option value=\"Care &amp; Safety: Pregnancy &amp; Parenting\"  class=\"choice-20 depth-1\"  >Care &amp; Safety: Pregnancy &amp; Parenting<\/option><option value=\"Care &amp; Safety: Social Services\"  class=\"choice-21 depth-1\"  >Care &amp; Safety: Social Services<\/option><option value=\"Community Resources: Advocacy &amp; Mutual Aid\"  class=\"choice-22 depth-1\"  >Community Resources: Advocacy &amp; Mutual Aid<\/option><option value=\"Community Resources: BIPOC Resources\"  class=\"choice-23 depth-1\"  >Community Resources: BIPOC Resources<\/option><option value=\"Community Resources: Cultural Centers\"  class=\"choice-24 depth-1\"  >Community Resources: Cultural Centers<\/option><option value=\"Community Resources: Disability Resources\"  class=\"choice-25 depth-1\"  >Community Resources: Disability Resources<\/option><option value=\"Community Resources: Faith Based Services\"  class=\"choice-26 depth-1\"  >Community Resources: Faith Based Services<\/option><option value=\"Community Resources: LGBTQ+ Resources\"  class=\"choice-27 depth-1\"  >Community Resources: LGBTQ+ Resources<\/option><option value=\"Community Resources: Veteran Services\"  class=\"choice-28 depth-1\"  >Community Resources: Veteran Services<\/option><option value=\"Day Services &amp; Drop-in: Drop-In\"  class=\"choice-29 depth-1\"  >Day Services &amp; Drop-in: Drop-In<\/option><option value=\"Day Services &amp; Drop-in: Libraries\"  class=\"choice-30 depth-1\"  >Day Services &amp; Drop-in: Libraries<\/option><option value=\"Day Services &amp; Drop-in: Mail, Laundry, &amp; Showers\"  class=\"choice-31 depth-1\"  >Day Services &amp; Drop-in: Mail, Laundry, &amp; Showers<\/option><option value=\"Day Services &amp; Drop-in: Mental Health Drop-In\"  class=\"choice-32 depth-1\"  >Day Services &amp; Drop-in: Mental Health Drop-In<\/option><option value=\"Day Services &amp; Drop-in: Restrooms\"  class=\"choice-33 depth-1\"  >Day Services &amp; Drop-in: Restrooms<\/option><option value=\"Day Services &amp; Drop-in: Youth Drop-in\"  class=\"choice-34 depth-1\"  >Day Services &amp; Drop-in: Youth Drop-in<\/option><option value=\"Education: After School Programs\"  class=\"choice-35 depth-1\"  >Education: After School Programs<\/option><option value=\"Education: Alternative &amp; Specialized Education\"  class=\"choice-36 depth-1\"  >Education: Alternative &amp; Specialized Education<\/option><option value=\"Education: Education Access\"  class=\"choice-37 depth-1\"  >Education: Education Access<\/option><option value=\"Education: High School &amp; College\"  class=\"choice-38 depth-1\"  >Education: High School &amp; College<\/option><option value=\"Education: Student Clubs\"  class=\"choice-39 depth-1\"  >Education: Student Clubs<\/option><option value=\"Education: Wrap Around Support\"  class=\"choice-40 depth-1\"  >Education: Wrap Around Support<\/option><option value=\"Health &amp; Wellness: Dental\"  class=\"choice-41 depth-1\"  >Health &amp; Wellness: Dental<\/option><option value=\"Health &amp; Wellness: Healthcare Access\"  class=\"choice-42 depth-1\"  >Health &amp; Wellness: Healthcare Access<\/option><option value=\"Health &amp; Wellness: HIV \/ AIDS\"  class=\"choice-43 depth-1\"  >Health &amp; Wellness: HIV \/ AIDS<\/option><option value=\"Health &amp; Wellness: Holistic &amp; Alternative Medicine\"  class=\"choice-44 depth-1\"  >Health &amp; Wellness: Holistic &amp; Alternative Medicine<\/option><option value=\"Health &amp; Wellness: Hospitals &amp; Clinics\"  class=\"choice-45 depth-1\"  >Health &amp; Wellness: Hospitals &amp; Clinics<\/option><option value=\"Health &amp; Wellness: Reproductive Health\"  class=\"choice-46 depth-1\"  >Health &amp; Wellness: Reproductive Health<\/option><option value=\"Health &amp; Wellness: Student Health Centers\"  class=\"choice-47 depth-1\"  >Health &amp; Wellness: Student Health Centers<\/option><option value=\"Health &amp; Wellness: Syringe Exchange\"  class=\"choice-48 depth-1\"  >Health &amp; Wellness: Syringe Exchange<\/option><option value=\"Health &amp; Wellness: Transgender healthcare\"  class=\"choice-49 depth-1\"  >Health &amp; Wellness: Transgender healthcare<\/option><option value=\"Housing &amp; Shelter: Camps &amp; Villages\"  class=\"choice-50 depth-1\"  >Housing &amp; Shelter: Camps &amp; Villages<\/option><option value=\"Housing &amp; Shelter: Emergency Cold Weather Shelters\"  class=\"choice-51 depth-1\"  >Housing &amp; Shelter: Emergency Cold Weather Shelters<\/option><option value=\"Housing &amp; Shelter: Homeless Youth\"  class=\"choice-52 depth-1\"  >Housing &amp; Shelter: Homeless Youth<\/option><option value=\"Housing &amp; Shelter: Homeless Services\"  class=\"choice-53 depth-1\"  >Housing &amp; Shelter: Homeless Services<\/option><option value=\"Housing &amp; Shelter: Housing Services\"  class=\"choice-54 depth-1\"  >Housing &amp; Shelter: Housing Services<\/option><option value=\"Housing &amp; Shelter: Shelters &amp; Emergency Shelters\"  class=\"choice-55 depth-1\"  >Housing &amp; Shelter: Shelters &amp; Emergency Shelters<\/option><option value=\"Housing &amp; Shelter: Transitional Housing\"  class=\"choice-56 depth-1\"  >Housing &amp; Shelter: Transitional Housing<\/option><option value=\"Legal: Advocacy &amp; Know Your Rights\"  class=\"choice-57 depth-1\"  >Legal: Advocacy &amp; Know Your Rights<\/option><option value=\"Legal: Domestic Violence and Sexual Assault\"  class=\"choice-58 depth-1\"  >Legal: Domestic Violence and Sexual Assault<\/option><option value=\"Legal: Housing &amp; Renter&#039;s Rights\"  class=\"choice-59 depth-1\"  >Legal: Housing &amp; Renter&#8217;s Rights<\/option><option value=\"Legal: Immigration\"  class=\"choice-60 depth-1\"  >Legal: Immigration<\/option><option value=\"Legal: Legal Services\"  class=\"choice-61 depth-1\"  >Legal: Legal Services<\/option><option value=\"Legal: Rehabilitation\"  class=\"choice-62 depth-1\"  >Legal: Rehabilitation<\/option><option value=\"Mental Health: Addiction Recovery\"  class=\"choice-63 depth-1\"  >Mental Health: Addiction Recovery<\/option><option value=\"Mental Health: BIPOC Mental Health\"  class=\"choice-64 depth-1\"  >Mental Health: BIPOC Mental Health<\/option><option value=\"Mental Health: Counseling\"  class=\"choice-65 depth-1\"  >Mental Health: Counseling<\/option><option value=\"Mental Health: Crisis Hotlines &amp; Services\"  class=\"choice-66 depth-1\"  >Mental Health: Crisis Hotlines &amp; Services<\/option><option value=\"Mental Health: Mobile Crisis Services\"  class=\"choice-67 depth-1\"  >Mental Health: Mobile Crisis Services<\/option><option value=\"Mental Health: Residential Programs\"  class=\"choice-68 depth-1\"  >Mental Health: Residential Programs<\/option><option value=\"Mental Health: Resources &amp; Advocacy\"  class=\"choice-69 depth-1\"  >Mental Health: Resources &amp; Advocacy<\/option><option value=\"Mental Health: Support Groups\"  class=\"choice-70 depth-1\"  >Mental Health: Support Groups<\/option><option value=\"Money: Financial Assistance\"  class=\"choice-71 depth-1\"  >Money: Financial Assistance<\/option><option value=\"Money: Phone &amp; Internet\"  class=\"choice-72 depth-1\"  >Money: Phone &amp; Internet<\/option><option value=\"Money: Public Benefit Application &amp; OHP Assistance\"  class=\"choice-73 depth-1\"  >Money: Public Benefit Application &amp; OHP Assistance<\/option><option value=\"Money: Rent &amp; Utility Assistance\"  class=\"choice-74 depth-1\"  >Money: Rent &amp; Utility Assistance<\/option><option value=\"Work: Internships\"  class=\"choice-75 depth-1\"  >Work: Internships<\/option><option value=\"Work: Job Search Help\"  class=\"choice-76 depth-1\"  >Work: Job Search Help<\/option><option value=\"Work: Youth Job Search\"  class=\"choice-77 depth-1\"  >Work: Youth Job Search<\/option><option value=\"Work: Training &amp; Work Experience\"  class=\"choice-78 depth-1\"  >Work: Training &amp; Work Experience<\/option><option value=\"Work: Worker&#039;&#039;s Rights\"  class=\"choice-79 depth-1\"  >Work: Worker&#8221;s Rights<\/option><option value=\"Youth Leadership: Committees, Councils, &amp; Boards\"  class=\"choice-80 depth-1\"  >Youth Leadership: Committees, Councils, &amp; Boards<\/option><option value=\"Youth Leadership: Community Development &amp; Improvement\"  class=\"choice-81 depth-1\"  >Youth Leadership: Community Development &amp; Improvement<\/option><option value=\"Youth Leadership: Culturally Specific\"  class=\"choice-82 depth-1\"  >Youth Leadership: Culturally Specific<\/option><option value=\"Youth Leadership: Education &amp; Academic\"  class=\"choice-83 depth-1\"  >Youth Leadership: Education &amp; Academic<\/option><option value=\"Youth Leadership: Internship\"  class=\"choice-84 depth-1\"  >Youth Leadership: Internship<\/option><option value=\"Youth Leadership: Leadership Development Training\"  class=\"choice-85 depth-1\"  >Youth Leadership: Leadership Development Training<\/option><option value=\"Youth Leadership: Paid Opportunity\"  class=\"choice-86 depth-1\"  >Youth Leadership: Paid Opportunity<\/option><option value=\"Youth Leadership: Political Action &amp; Social Justice\"  class=\"choice-87 depth-1\"  >Youth Leadership: Political Action &amp; Social Justice<\/option><option value=\"Youth Leadership: Rural Community\"  class=\"choice-88 depth-1\"  >Youth Leadership: Rural Community<\/option><option value=\"Youth Leadership: Summer-based Opportunity\"  class=\"choice-89 depth-1\"  >Youth Leadership: Summer-based Opportunity<\/option><option value=\"Youth Leadership: Volunteer Opportunity\"  class=\"choice-90 depth-1\"  >Youth Leadership: Volunteer Opportunity<\/option><\/select><\/div><div id=\"wpforms-1669-field_7-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Checkboxes<\/legend><ul id=\"wpforms-1669-field_7\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1669-field_7_1\" name=\"wpforms[fields][7][]\" value=\"We offer services at a physical location, and that address should be displayed on the map\" aria-errormessage=\"wpforms-1669-field_7_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1669-field_7_1\">We offer services at a physical location, and that address should be displayed on the map<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1669-field_7_4\" name=\"wpforms[fields][7][]\" value=\"This program provides services at more than one physical address\" aria-errormessage=\"wpforms-1669-field_7_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1669-field_7_4\">This program provides services at more than one physical address<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1669-field_9-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"9\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Main Address<\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1669-field_9\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][9][address1]\" aria-errormessage=\"wpforms-1669-field_9-error\" ><label for=\"wpforms-1669-field_9\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1669-field_9-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][9][address2]\" aria-errormessage=\"wpforms-1669-field_9-address2-error\" ><label for=\"wpforms-1669-field_9-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1669-field_9-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][9][city]\" aria-errormessage=\"wpforms-1669-field_9-city-error\" ><label for=\"wpforms-1669-field_9-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1669-field_9-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][9][state]\" aria-errormessage=\"wpforms-1669-field_9-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-1669-field_9-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1669-field_9-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][9][postal]\" aria-errormessage=\"wpforms-1669-field_9-postal-error\" ><label for=\"wpforms-1669-field_9-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1669-field_10-container\" class=\"wpforms-field wpforms-field-repeater wpforms-conditional-field wpforms-conditional-show wpforms-field-repeater-display-rows\" data-rows-min=\"1\" data-rows-max=\"10\" data-clone-num=\"2\" data-field-type=\"repeater\" data-field-id=\"10\" style=\"display:none;\"><input type=\"hidden\" class=\"wpforms-field-repeater-clone-list\" name=\"wpforms[fields][10][clone_list]\" value=\"[]\"><script type=\"text\/html\" class=\"tmpl-wpforms-field-repeater-template-10-1669\"><div id=\"wpforms-1669-repeater-field_10-clone_{CLONE}\" class=\"wpforms-field-repeater-clone-wrap\" data-clone=\"{CLONE}\">\n\t\t\t\t<div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-rows wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1669-field_11_{CLONE}-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"11_{CLONE}\"><fieldset><legend class=\"wpforms-field-label\">Additional Address(es)<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1669-field_11_{CLONE}\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][11_{CLONE}][address1]\" aria-errormessage=\"wpforms-1669-field_11_{CLONE}-error\" ><label for=\"wpforms-1669-field_11_{CLONE}\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1669-field_11_{CLONE}-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][11_{CLONE}][address2]\" aria-errormessage=\"wpforms-1669-field_11_{CLONE}-address2-error\" ><label for=\"wpforms-1669-field_11_{CLONE}-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1669-field_11_{CLONE}-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][11_{CLONE}][city]\" aria-errormessage=\"wpforms-1669-field_11_{CLONE}-city-error\" ><label for=\"wpforms-1669-field_11_{CLONE}-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1669-field_11_{CLONE}-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][11_{CLONE}][state]\" aria-errormessage=\"wpforms-1669-field_11_{CLONE}-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-1669-field_11_{CLONE}-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1669-field_11_{CLONE}-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][11_{CLONE}][postal]\" aria-errormessage=\"wpforms-1669-field_11_{CLONE}-postal-error\" ><label for=\"wpforms-1669-field_11_{CLONE}-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Remove\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div>\n\t\t\t<\/div><\/script><div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-rows wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1669-field_11-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Additional Address(es)<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1669-field_11\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][11][address1]\" aria-errormessage=\"wpforms-1669-field_11-error\" ><label for=\"wpforms-1669-field_11\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1669-field_11-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][11][address2]\" aria-errormessage=\"wpforms-1669-field_11-address2-error\" ><label for=\"wpforms-1669-field_11-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1669-field_11-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][11][city]\" aria-errormessage=\"wpforms-1669-field_11-city-error\" ><label for=\"wpforms-1669-field_11-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1669-field_11-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][11][state]\" aria-errormessage=\"wpforms-1669-field_11-state-error\" ><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-1669-field_11-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1669-field_11-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][11][postal]\" aria-errormessage=\"wpforms-1669-field_11-postal-error\" ><label for=\"wpforms-1669-field_11-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Remove\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div><\/div><div id=\"wpforms-1669-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_12\">Program Description <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1669-field_12\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-1669-field_12-error\" aria-describedby=\"wpforms-1669-field_12-description\" required><\/textarea><div id=\"wpforms-1669-field_12-description\" class=\"wpforms-field-description\">1-3 paragraph description of your program. \n\n\n<b>Please include:<\/b> focus population, primary services offered, and what a youth should do if they want to find out more.\n\n\n<b>Tip:<\/b> Write conversationally, as if speaking to a youth!<\/div><\/div><div id=\"wpforms-1669-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_13\">Hours<\/label><textarea id=\"wpforms-1669-field_13\" class=\"wpforms-field-small\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-1669-field_13-error\" ><\/textarea><\/div><div id=\"wpforms-1669-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_14\">Emergency Message<\/label><textarea id=\"wpforms-1669-field_14\" class=\"wpforms-field-small\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-1669-field_14-error\" ><\/textarea><\/div><div id=\"wpforms-1669-field_15-container\" class=\"wpforms-field wpforms-field-url\" data-field-type=\"url\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_15\">Website \/ URL<\/label><input type=\"url\" id=\"wpforms-1669-field_15\" class=\"wpforms-field-large\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-1669-field_15-error\" ><\/div><div id=\"wpforms-1669-field_16-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_16\">Program Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1669-field_16\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][16]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1669-field_16-error\" required><\/div><div id=\"wpforms-1669-field_17-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"17\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tPhone 1\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1669-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_18\">Phone 1 Label<\/label><input type=\"text\" id=\"wpforms-1669-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1669-field_18-error\" aria-describedby=\"wpforms-1669-field_18-description\" ><div id=\"wpforms-1669-field_18-description\" class=\"wpforms-field-description\">You may include a label, like: &#8220;Intake line,&#8221; &#8220;Office,&#8221; etc.\n<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1669-field_19-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_19\">Phone 1<\/label><input type=\"tel\" id=\"wpforms-1669-field_19\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][19]\" aria-label=\"Phone 1\" aria-errormessage=\"wpforms-1669-field_19-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1669-field_20-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"20\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tPhone 2\n\t\t\t<\/h3><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-1669-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_21\">Phone 2 Label<\/label><input type=\"text\" id=\"wpforms-1669-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-1669-field_21-error\" aria-describedby=\"wpforms-1669-field_21-description\" ><div id=\"wpforms-1669-field_21-description\" class=\"wpforms-field-description\">You may include a label, like: &#8220;Intake line,&#8221; &#8220;Office,&#8221; etc.\n<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-67\"><div id=\"wpforms-1669-field_22-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_22\">Phone 2<\/label><input type=\"tel\" id=\"wpforms-1669-field_22\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][22]\" aria-label=\"Phone 2\" aria-errormessage=\"wpforms-1669-field_22-error\" ><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1669-field_23-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_23\">Crisis Line<\/label><input type=\"tel\" id=\"wpforms-1669-field_23\" class=\"wpforms-field-large wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][23]\" aria-label=\"Crisis Line\" aria-errormessage=\"wpforms-1669-field_23-error\" ><\/div><div id=\"wpforms-1669-field_25-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"25\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1669-field_24-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-type=\"number-slider\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_24\">Minimum Age<\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-1669-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" value=\"0\" aria-errormessage=\"wpforms-1669-field_24-error\"\t\tmin=\"0\"\n\tmax=\"25\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Min Age: {value}\">\n\tMin Age: <b>0<\/b><\/div>\n<\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1669-field_26-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-type=\"number-slider\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_26\">Maximum Age<\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-1669-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" value=\"0\" aria-errormessage=\"wpforms-1669-field_26-error\"\t\tmin=\"0\"\n\tmax=\"25\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Max Age: {value}\">\n\tMax Age: <b>0<\/b><\/div>\n<\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1669-field_35-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_35\">Additional Eligibility Requirements <\/label><textarea id=\"wpforms-1669-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-1669-field_35-error\" aria-describedby=\"wpforms-1669-field_35-description\" ><\/textarea><div id=\"wpforms-1669-field_35-description\" class=\"wpforms-field-description\">What \ud835\ude67\ud835\ude5a\ud835\ude66\ud835\ude6a\ud835\ude5e\ud835\ude67\ud835\ude5a\ud835\ude62\ud835\ude5a\ud835\ude63\ud835\ude69\ud835\ude68 must someone meet to be eligible to for your program? <\/div><\/div><div id=\"wpforms-1669-field_45-container\" class=\"wpforms-field wpforms-field-repeater wpforms-field-repeater-display-rows\" data-rows-min=\"1\" data-rows-max=\"10\" data-clone-num=\"2\" data-field-type=\"repeater\" data-field-id=\"45\"><input type=\"hidden\" class=\"wpforms-field-repeater-clone-list\" name=\"wpforms[fields][45][clone_list]\" value=\"[]\"><script type=\"text\/html\" class=\"tmpl-wpforms-field-repeater-template-45-1669\"><div id=\"wpforms-1669-repeater-field_45-clone_{CLONE}\" class=\"wpforms-field-repeater-clone-wrap\" data-clone=\"{CLONE}\">\n\t\t\t\t<div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-rows wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1669-field_36_{CLONE}-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"36_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_36_{CLONE}\">Languages Offered<\/label><select id=\"wpforms-1669-field_36_{CLONE}\" class=\"wpforms-field-large\" name=\"wpforms[fields][36_{CLONE}]\"><option value=\"English\"  class=\"choice-4 depth-1\"  >English<\/option><option value=\"Spanish\"  class=\"choice-5 depth-1\"  >Spanish<\/option><option value=\"ASL (American Sign Language)\"  class=\"choice-6 depth-1\"  >ASL (American Sign Language)<\/option><option value=\"Vietnamese\"  class=\"choice-7 depth-1\"  >Vietnamese<\/option><option value=\"Filipino\"  class=\"choice-8 depth-1\"  >Filipino<\/option><option value=\"Mandarin\"  class=\"choice-9 depth-1\"  >Mandarin<\/option><option value=\"Interpretation available upon request\"  class=\"choice-10 depth-1\"  >Interpretation available upon request<\/option><option value=\"Other languages are available upon request\"  class=\"choice-11 depth-1\"  >Other languages are available upon request<\/option><option value=\"Hebrew\"  class=\"choice-12 depth-1\"  >Hebrew<\/option><option value=\"Russian\"  class=\"choice-13 depth-1\"  >Russian<\/option><option value=\"Somali\"  class=\"choice-14 depth-1\"  >Somali<\/option><option value=\"Swahili\"  class=\"choice-15 depth-1\"  >Swahili<\/option><option value=\"Arabic\"  class=\"choice-16 depth-1\"  >Arabic<\/option><option value=\"Cantonese\"  class=\"choice-17 depth-1\"  >Cantonese<\/option><option value=\"Thai\"  class=\"choice-18 depth-1\"  >Thai<\/option><option value=\"Lao\"  class=\"choice-19 depth-1\"  >Lao<\/option><option value=\"Farsi\"  class=\"choice-20 depth-1\"  >Farsi<\/option><option value=\"Korean\"  class=\"choice-21 depth-1\"  >Korean<\/option><option value=\"Burmese\"  class=\"choice-22 depth-1\"  >Burmese<\/option><option value=\"French\"  class=\"choice-23 depth-1\"  >French<\/option><option value=\"German\"  class=\"choice-24 depth-1\"  >German<\/option><option value=\"Italian\"  class=\"choice-25 depth-1\"  >Italian<\/option><option value=\"Nepali\"  class=\"choice-26 depth-1\"  >Nepali<\/option><\/select><div id=\"wpforms-1669-field_36_{CLONE}-description\" class=\"wpforms-field-description\">What language(s) do you offer services in?<\/div><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Remove\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div>\n\t\t\t<\/div><\/script><div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-rows wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1669-field_36-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_36\">Languages Offered<\/label><select id=\"wpforms-1669-field_36\" class=\"wpforms-field-large\" name=\"wpforms[fields][36]\"><option value=\"English\"  class=\"choice-4 depth-1\"  >English<\/option><option value=\"Spanish\"  class=\"choice-5 depth-1\"  >Spanish<\/option><option value=\"ASL (American Sign Language)\"  class=\"choice-6 depth-1\"  >ASL (American Sign Language)<\/option><option value=\"Vietnamese\"  class=\"choice-7 depth-1\"  >Vietnamese<\/option><option value=\"Filipino\"  class=\"choice-8 depth-1\"  >Filipino<\/option><option value=\"Mandarin\"  class=\"choice-9 depth-1\"  >Mandarin<\/option><option value=\"Interpretation available upon request\"  class=\"choice-10 depth-1\"  >Interpretation available upon request<\/option><option value=\"Other languages are available upon request\"  class=\"choice-11 depth-1\"  >Other languages are available upon request<\/option><option value=\"Hebrew\"  class=\"choice-12 depth-1\"  >Hebrew<\/option><option value=\"Russian\"  class=\"choice-13 depth-1\"  >Russian<\/option><option value=\"Somali\"  class=\"choice-14 depth-1\"  >Somali<\/option><option value=\"Swahili\"  class=\"choice-15 depth-1\"  >Swahili<\/option><option value=\"Arabic\"  class=\"choice-16 depth-1\"  >Arabic<\/option><option value=\"Cantonese\"  class=\"choice-17 depth-1\"  >Cantonese<\/option><option value=\"Thai\"  class=\"choice-18 depth-1\"  >Thai<\/option><option value=\"Lao\"  class=\"choice-19 depth-1\"  >Lao<\/option><option value=\"Farsi\"  class=\"choice-20 depth-1\"  >Farsi<\/option><option value=\"Korean\"  class=\"choice-21 depth-1\"  >Korean<\/option><option value=\"Burmese\"  class=\"choice-22 depth-1\"  >Burmese<\/option><option value=\"French\"  class=\"choice-23 depth-1\"  >French<\/option><option value=\"German\"  class=\"choice-24 depth-1\"  >German<\/option><option value=\"Italian\"  class=\"choice-25 depth-1\"  >Italian<\/option><option value=\"Nepali\"  class=\"choice-26 depth-1\"  >Nepali<\/option><\/select><div id=\"wpforms-1669-field_36-description\" class=\"wpforms-field-description\">What language(s) do you offer services in?<\/div><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Remove\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div><\/div><div id=\"wpforms-1669-field_37-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"37\"><fieldset><legend class=\"wpforms-field-label\">Is this program free?<\/legend><ul id=\"wpforms-1669-field_37\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1669-field_37_1\" name=\"wpforms[fields][37]\" value=\"Yes\" aria-errormessage=\"wpforms-1669-field_37_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1669-field_37_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1669-field_37_2\" name=\"wpforms[fields][37]\" value=\"No\" aria-errormessage=\"wpforms-1669-field_37_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1669-field_37_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1669-field_38-container\" class=\"wpforms-field wpforms-field-repeater wpforms-field-repeater-display-rows\" data-rows-min=\"1\" data-rows-max=\"10\" data-clone-num=\"2\" data-field-type=\"repeater\" data-field-id=\"38\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tSocial Media Profiles\n\t\t\t<\/h3><input type=\"hidden\" class=\"wpforms-field-repeater-clone-list\" name=\"wpforms[fields][38][clone_list]\" value=\"[]\"><script type=\"text\/html\" class=\"tmpl-wpforms-field-repeater-template-38-1669\"><div id=\"wpforms-1669-repeater-field_38-clone_{CLONE}\" class=\"wpforms-field-repeater-clone-wrap\" data-clone=\"{CLONE}\">\n\t\t\t\t<div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-rows wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1669-field_39_{CLONE}-container\" class=\"wpforms-field wpforms-field-url\" data-field-type=\"url\" data-field-id=\"39_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_39_{CLONE}\">Website \/ URL<\/label><input type=\"url\" id=\"wpforms-1669-field_39_{CLONE}\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39_{CLONE}]\" aria-errormessage=\"wpforms-1669-field_39_{CLONE}-error\" ><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Remove\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div>\n\t\t\t<\/div><\/script><div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-rows wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-1669-field_39-container\" class=\"wpforms-field wpforms-field-url\" data-field-type=\"url\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_39\">Website \/ URL<\/label><input type=\"url\" id=\"wpforms-1669-field_39\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-1669-field_39-error\" ><\/div><\/div><div class=\"wpforms-field-repeater-display-rows-buttons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\" title=\"Add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\" title=\"Remove\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div><\/div><div id=\"wpforms-1669-field_40-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"40\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1669-field_41-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_41\">Latitude<\/label><input type=\"text\" id=\"wpforms-1669-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-1669-field_41-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-1669-field_42-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-1669-field_42\">Longitude<\/label><input type=\"text\" id=\"wpforms-1669-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" aria-errormessage=\"wpforms-1669-field_42-error\" ><\/div><\/div><\/div><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1669-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1669-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1669-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3\" ><input type=\"hidden\" name=\"wpforms[recaptcha]\" value=\"\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1669\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/oregonyouthresourcemap.org\/es\/wp-json\/wp\/v2\/pages\/1671\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1669\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img 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Thank you for helping us build this free resource map for Oregon Youth!<\/p>","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1671","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Submit a Resource - Oregon Youth Resource Map<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/oregonyouthresourcemap.org\/es\/submit-a-resource\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Submit a Resource - Oregon Youth Resource Map\" \/>\n<meta property=\"og:description\" content=\"Instructions Message mapinfo@directionservice.org if you have questions, need assistance, or would like to submit information in an alternate format. 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