Online Inquiry
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<ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 25%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">FOSTER PARENT INQUIRY FORM</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_First_A"> <i class="fa fa-font"></i><label class="er_fld_label required">First Name</label><input name="CST_2" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Middle_A"> <i class="fa fa-font"></i><label class="er_fld_label">Middle Name</label><input name="CST_3" type="text" class=""></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Last_A"> <i class="fa fa-font"></i><label class="er_fld_label required">Last Name</label><input name="CST_4" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Phone_Mobile"> <i class="fa fa-font"></i><label class="er_fld_label required">Best Number to Return Your Call</label><input name="CST_5" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="FH_EMail"> <i class="fa fa-font"></i><label class="er_fld_label required">Email</label><input name="CST_1" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_selected" draggable="false" style="width: 25%;" map_to="FH_Address_Street_1"> <i class="fa fa-font"></i><label class="er_fld_label required">Address Line 1 (To reach the right office.)</label><input name="CST_6" type="text" class="er_fld_required"></li><li class="er_fld_type_text sortable-chosen" draggable="true" style="width: 25%;" map_to="FH_Address_Street_2"> <i class="fa fa-font"></i><label class="er_fld_label">Address Line 2</label><input name="CST_7" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text sortable-chosen" draggable="true" style="width: 25%;" map_to="FH_Address_City"> <i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_8" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_State"> <i class="fa fa-font"></i><label class="er_fld_label required">State</label><input name="CST_9" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_Zip"> <i class="fa fa-font"></i><label class="er_fld_label required">Zip</label><input name="CST_10" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="FH_ReferralSource"><i class="fa fa-caret-down"></i><label class="er_fld_label required">How did you hear about us?</label><select name="CST_11" class="er_fld_required"><option value="- Not Specified - ">- Not Specified - </option><option value="Internet">Internet</option><option value="Church/Pastor">Church/Pastor</option><option value="Display Table at Event">Display Table at Event</option><option value="Employee">Employee</option><option value="Foster Parent">Foster Parent</option><option value="Other">Other</option><option value="Other Agency">Other Agency</option><option value="Other Agency Foster Parent">Other Agency Foster Parent</option><option value="Protective Services">Protective Services</option><option value="Radio/TV Ad">Radio/TV Ad</option><option value="Social Media">Social Media</option><option value="Website">Website</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 100%;" map_to="FH_Inquiry_Comments"> <i class="fa fa-paragraph"></i><label class="er_fld_label">Comments</label><textarea name="CST_12" style="width:100%;"></textarea></li></ul>
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