{"id":236641,"date":"2021-09-07T14:12:44","date_gmt":"2021-09-07T19:12:44","guid":{"rendered":"https:\/\/urbanleaguela.org\/?page_id=236641"},"modified":"2021-09-15T17:56:55","modified_gmt":"2021-09-15T22:56:55","slug":"ida-recovery-assessment","status":"publish","type":"page","link":"https:\/\/urbanleaguela.org\/ida-recovery-assessment\/","title":{"rendered":"Hurricane Ida Disaster Recovery Assessment"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#0C71C3&#8243; custom_padding=&#8221;0px||4px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.10.7&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243; text_font_size=&#8221;21px&#8221; text_line_height=&#8221;1.4em&#8221; background_layout=&#8221;dark&#8221;]<\/p>\n<p>OFFICE OF WORKFORCE DEVELOPMENT HURRICANE IDA DISASTER RECOVERY ASSESSMENT<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;2px||4px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_blurb use_icon=&#8221;on&#8221; font_icon=&#8221;%%202%%&#8221; icon_color=&#8221;#0C71C3&#8243; icon_placement=&#8221;left&#8221; use_icon_font_size=&#8221;on&#8221; icon_font_size=&#8221;53px&#8221; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; header_font=&#8221;|700|||||||&#8221; header_text_align=&#8221;left&#8221; header_font_size=&#8221;21px&#8221; header_line_height=&#8221;1.2em&#8221; body_font=&#8221;|700|||||||&#8221; body_font_size=&#8221;20px&#8221; body_line_height=&#8221;2.1em&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>COMPLETE &amp; SUBMIT FORM<\/p>\n<p>[\/et_pb_blurb][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_blurb use_icon=&#8221;on&#8221; font_icon=&#8221;%%104%%&#8221; icon_color=&#8221;#0C71C3&#8243; icon_placement=&#8221;left&#8221; use_icon_font_size=&#8221;on&#8221; icon_font_size=&#8221;53px&#8221; module_class=&#8221;<i class=%22fas fa-phone-volume%22><\/i>&#8221; _builder_version=&#8221;4.9.7&#8243; _module_preset=&#8221;default&#8221; header_font=&#8221;|700|||||||&#8221; header_text_align=&#8221;left&#8221; header_font_size=&#8221;21px&#8221; header_line_height=&#8221;1.2em&#8221; body_font=&#8221;|700|||||||&#8221; body_font_size=&#8221;20px&#8221; body_line_height=&#8221;1.4em&#8221; global_colors_info=&#8221;{}&#8221; custom_css_before__hover_enabled=&#8221;on|desktop&#8221;]<\/p>\n<p>AN URBAN LEAGUE TEAM MEMBER WILL CALL YOU WITHIN 48 BUSINESS HOURS.<\/p>\n<p>[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.22&#8243; background_color=&#8221;#d6d6d6&#8243; custom_padding=&#8221;0px|0px|54px|0px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.10.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.9.9&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.10.7&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<style><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t.hide {<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t\tdisplay:none;<!-- [et_pb_line_break_holder] -->\t}<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t.show{<!-- [et_pb_line_break_holder] -->\t\t<!-- [et_pb_line_break_holder] -->\t\tdisplay:inline;<!-- [et_pb_line_break_holder] -->\t}<!-- [et_pb_line_break_holder] -->body {<!-- [et_pb_line_break_holder] -->       padding: 20px;<!-- [et_pb_line_break_holder] -->      }<!-- [et_pb_line_break_holder] -->      label {<!-- [et_pb_line_break_holder] -->        font-size: 16px;<!-- [et_pb_line_break_holder] -->        font-weight: 700;<!-- [et_pb_line_break_holder] -->        color: #1c87c9;<!-- [et_pb_line_break_holder] -->      }<!-- [et_pb_line_break_holder] -->      input {<!-- [et_pb_line_break_holder] -->        width: 50%;<!-- [et_pb_line_break_holder] -->        height: 28px;<!-- [et_pb_line_break_holder] -->        padding: 4px 10px;<!-- [et_pb_line_break_holder] -->        border: 1px solid #666;<!-- [et_pb_line_break_holder] -->        background: #cce6ff;<!-- [et_pb_line_break_holder] -->        color: #1c87c9;<!-- [et_pb_line_break_holder] -->        font-size: 16px;<!-- [et_pb_line_break_holder] -->      }<!-- [et_pb_line_break_holder] --><\/style>\n<p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><script><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\tfunction areYouEmployed(){<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t\tvar areYouEmp = document.getElementById('00NE0000005CGDh').value;<!-- [et_pb_line_break_holder] -->\t\t <!-- [et_pb_line_break_holder] -->\t\tif(areYouEmp == 'Yes'){<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t\t\tdocument.getElementById('Current_Employer_School_Organization').setAttribute('class', 'show');<!-- [et_pb_line_break_holder] -->\t\t}<!-- [et_pb_line_break_holder] -->\t\telse{<!-- [et_pb_line_break_holder] -->\t\t\tdocument.getElementById('Current_Employer_School_Organization').setAttribute('class', 'hide');<!-- [et_pb_line_break_holder] -->\t\t}<!-- [et_pb_line_break_holder] -->\t}<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\tfunction areYouStudent(){<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t\tvar areYouStudent = document.getElementById('00N44000006fIcM').value;<!-- [et_pb_line_break_holder] -->\t\t <!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t\tif(areYouStudent == 'Yes'){<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t\t\tdocument.getElementById('Current_Title_Student_Classification').setAttribute('class', 'show');<!-- [et_pb_line_break_holder] -->\t\t}<!-- [et_pb_line_break_holder] -->\t\telse{<!-- [et_pb_line_break_holder] -->\t\t\tdocument.getElementById('Current_Title_Student_Classification').setAttribute('class', 'hide');<!-- [et_pb_line_break_holder] -->\t\t}<!-- [et_pb_line_break_holder] -->\t}<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><\/script><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!--  NOTE: Please add the following <META> element to your page <HEAD>.      --><!-- [et_pb_line_break_holder] --><!--  If necessary, please modify the charset parameter to specify the        --><!-- [et_pb_line_break_holder] --><!--  character set of your HTML page.                                        --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><META HTTP-EQUIV=\"Content-type\" CONTENT=\"text\/html; charset=UTF-8\"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!--  NOTE: Please add the following <FORM> element to your page.             --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><\/p>\n<form action=\"https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8\" method=\"POST\"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><input type=hidden name=\"oid\" value=\"00DE0000000HkDW\"><!-- [et_pb_line_break_holder] --><input type=hidden name=\"recordType\" id=\"recordType\" value=\"0120h000000iAbi\"><!-- [et_pb_line_break_holder] --><input type=hidden name=\"retURL\" value=\"https:\/\/urbanleaguela.org\/38-2\/workforce\/\"><!-- [et_pb_line_break_holder] --><input type=hidden name=\"lead_source\" value=\"Web\"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!--  NOTE: These fields are optional debugging elements. Please uncomment    --><!-- [et_pb_line_break_holder] --><!--  these lines if you wish to test in debug mode.                          --><!-- [et_pb_line_break_holder] --><!--  <input type=\"hidden\" name=\"debug\" value=1>                              --><!-- [et_pb_line_break_holder] --><!--  <input type=\"hidden\" name=\"debugEmail\"                                  --><!-- [et_pb_line_break_holder] --><!--  value=\"cduckworth@urbanleaguela.org\">                                   --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><\/p>\n<style><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t.hide {<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t\tdisplay:none;<!-- [et_pb_line_break_holder] -->\t}<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->\t.show{<!-- [et_pb_line_break_holder] -->\t\t<!-- [et_pb_line_break_holder] -->\t\tdisplay:inline;<!-- [et_pb_line_break_holder] -->\t}<!-- [et_pb_line_break_holder] -->body {<!-- [et_pb_line_break_holder] -->       padding: 20px;<!-- [et_pb_line_break_holder] -->      }<!-- [et_pb_line_break_holder] -->      label {<!-- [et_pb_line_break_holder] -->        font-size: 20px;<!-- [et_pb_line_break_holder] -->        font-weight: 700;<!-- [et_pb_line_break_holder] -->        color: #1c87c9;<!-- [et_pb_line_break_holder] -->      }<!-- [et_pb_line_break_holder] -->      input {<!-- [et_pb_line_break_holder] -->        width: 50%;<!-- [et_pb_line_break_holder] -->        height: 28px;<!-- [et_pb_line_break_holder] -->        padding: 4px 10px;<!-- [et_pb_line_break_holder] -->        border: 1px solid #666;<!-- [et_pb_line_break_holder] -->        background: #cce6ff;<!-- [et_pb_line_break_holder] -->        color: #1c87c9;<!-- [et_pb_line_break_holder] -->        font-size: 16px;<!-- [et_pb_line_break_holder] -->      }<!-- [et_pb_line_break_holder] --><\/style>\n<p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!--  NOTE: Please add the following <META> element to your page <HEAD>.      --><!-- [et_pb_line_break_holder] --><!--  If necessary, please modify the charset parameter to specify the        --><!-- [et_pb_line_break_holder] --><!--  character set of your HTML page.                                        --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><META HTTP-EQUIV=\"Content-type\" CONTENT=\"text\/html; charset=UTF-8\"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!--  NOTE: Please add the following <FORM> element to your page.             --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><\/p>\n<form action=\"https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8\" method=\"POST\"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><input type=hidden name=\"oid\" value=\"00DE0000000HkDW\"><!-- [et_pb_line_break_holder] --><input type=hidden name=\"recordType\" id=\"recordType\" value=\"0120h000000iAbi\"><!-- [et_pb_line_break_holder] --><input type=hidden name=\"retURL\" value=\"https:\/\/urbanleaguela.org\/38-2\/workforce\/\"><!-- [et_pb_line_break_holder] --><input type=hidden name=\"lead_source\" value=\"Web\"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!--  NOTE: These fields are optional debugging elements. Please uncomment    --><!-- [et_pb_line_break_holder] --><!--  these lines if you wish to test in debug mode.                          --><!-- [et_pb_line_break_holder] --><!--  <input type=\"hidden\" name=\"debug\" value=1>                              --><!-- [et_pb_line_break_holder] --><!--  <input type=\"hidden\" name=\"debugEmail\"                                  --><!-- [et_pb_line_break_holder] --><!--  value=\"cduckworth@urbanleaguela.org\">                                   --><!-- [et_pb_line_break_holder] --><!--  ----------------------------------------------------------------------  --><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->  <label for=\"date\">Today&#39;s Date:  <span class=\"dateInput dateOnlyInput\"><input  id=\"00NE0000000QWVy\" name=\"00NE0000000QWVy\" size=\"12\" type=\"text\" \/><\/span><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><label for=\"salutation\">Salutation<\/label>\u00a0\u00a0  <select required id=\"salutation\" name=\"salutation\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Commissioner\">Commissioner<\/option><!-- [et_pb_line_break_holder] --><option value=\"Congressman\">Congressman<\/option><!-- [et_pb_line_break_holder] --><option value=\"Councilwoman\">Councilwoman<\/option><!-- [et_pb_line_break_holder] --><option value=\"Councilman\">Councilman<\/option><!-- [et_pb_line_break_holder] --><option value=\"Deacon\">Deacon<\/option><!-- [et_pb_line_break_holder] --><option value=\"Dr.\">Dr.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Father\">Father<\/option><!-- [et_pb_line_break_holder] --><option value=\"Judge\">Judge<\/option><!-- [et_pb_line_break_holder] --><option value=\"Mr.\">Mr.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Mrs.\">Mrs.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Ms.\">Ms.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Mx.\">Mx.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Pastor\">Pastor<\/option><!-- [et_pb_line_break_holder] --><option value=\"President\">President<\/option><!-- [et_pb_line_break_holder] --><option value=\"Prof.\">Prof.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Rev.\">Rev.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Reverend\">Reverend<\/option><!-- [et_pb_line_break_holder] --><option value=\"Secretary\">Secretary<\/option><!-- [et_pb_line_break_holder] --><option value=\"Sheriff\">Sheriff<\/option><!-- [et_pb_line_break_holder] --><option value=\"The Honorable\">The Honorable<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><label for=\"first_name\">First Name<\/label>\u00a0\u00a0  <input  id=\"first_name\" maxlength=\"40\" name=\"first_name\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><label for=\"last_name\">Last Name<\/label>\u00a0\u00a0  <input  id=\"last_name\" maxlength=\"80\" name=\"last_name\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"suffix\">Suffix:<\/label>\u00a0\u00a0  <select  id=\"00NE0000005DCZF\" name=\"00NE0000005DCZF\" title=\"Suffix\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Jr.\">Jr.<\/option><!-- [et_pb_line_break_holder] --><option value=\"Sr.\">Sr.<\/option><!-- [et_pb_line_break_holder] --><option value=\"III\">III<\/option><!-- [et_pb_line_break_holder] --><option value=\"IV\">IV<\/option><!-- [et_pb_line_break_holder] --><option value=\"V\">V<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"address\">Address:<\/label>\u00a0\u00a0  <input  id=\"00NE0000005rxME\" maxlength=\"80\" name=\"00NE0000005rxME\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"apt\/ste\">Apt.\/Ste:<\/label>\u00a0\u00a0  <input  id=\"00NE0000005rxMJ\" maxlength=\"70\" name=\"00NE0000005rxMJ\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"city\">City:<\/label>\u00a0\u00a0  <input  id=\"00NE0000000QXd1\" maxlength=\"25\" name=\"00NE0000000QXd1\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"state\">State:<\/label>\u00a0\u00a0  <input  id=\"00NE0000000QXd6\" maxlength=\"2\" name=\"00NE0000000QXd6\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"zip_code\">Zip Code:<\/label>\u00a0\u00a0  <input  id=\"00NE0000000QXdB\" maxlength=\"10\" name=\"00NE0000000QXdB\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><label for=\"phone\">Phone<\/label>\u00a0\u00a0  <input  id=\"phone\" maxlength=\"40\" name=\"phone\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"race\">Race:<\/label>\u00a0\u00a0  <select required id=\"00N0h000006UL7T\" name=\"00N0h000006UL7T\" title=\"Race\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Black or African American\">Black or African American<\/option><!-- [et_pb_line_break_holder] --><option value=\"American Indian or Alaskan Native\">American Indian or Alaskan Native<\/option><!-- [et_pb_line_break_holder] --><option value=\"Asian\">Asian<\/option><!-- [et_pb_line_break_holder] --><option value=\"Hispanic\">Hispanic<\/option><!-- [et_pb_line_break_holder] --><option value=\"White\">White<\/option><!-- [et_pb_line_break_holder] --><option value=\"Native Hawaiian or Pacific Islander\">Native Hawaiian or Pacific Islander<\/option><!-- [et_pb_line_break_holder] --><option value=\"Other\">Other<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"ethnicity\">Ethnicity:<\/label>\u00a0\u00a0  <select required id=\"00NE0000000QCjb\" multiple=\"multiple\" name=\"00NE0000000QCjb\" title=\"Ethnicity\"><option value=\"African American\">African American<\/option><!-- [et_pb_line_break_holder] --><option value=\"Asian\">Asian<\/option><!-- [et_pb_line_break_holder] --><option value=\"Caucasian\">Caucasian<\/option><!-- [et_pb_line_break_holder] --><option value=\"Hispanic\">Hispanic<\/option><!-- [et_pb_line_break_holder] --><option value=\"Latino\">Latino<\/option><!-- [et_pb_line_break_holder] --><option value=\"Other\">Other<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"gender\">Gender:<\/label>\u00a0  <select required id=\"00NE0000000QCj8\" name=\"00NE0000000QCj8\" title=\"Gender\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Female\">Female<\/option><!-- [et_pb_line_break_holder] --><option value=\"Male\">Male<\/option><!-- [et_pb_line_break_holder] --><option value=\"Non-binary\/third gender\">Non-binary\/third gender<\/option><!-- [et_pb_line_break_holder] --><option value=\"Prefer to self-describe\">Prefer to self-describe<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"gender_self\">Gender Self Description<\/label>\u00a0\u00a0  :<input  id=\"00N0h0000074gzn\" maxlength=\"25\" name=\"00N0h0000074gzn\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"current_age\">Current Age:<\/label>\u00a0\u00a0  <input  id=\"00NE0000005Y3yv\" name=\"00NE0000005Y3yv\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><label for=\"email\">Email<\/label>\u00a0\u00a0  <input  id=\"email\" maxlength=\"80\" name=\"email\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"emergency\">Name of your emergency contact:<\/label>\u00a0\u00a0  <input  id=\"00NE0000000QPtI\" maxlength=\"50\" name=\"00NE0000000QPtI\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"contact_number\">Emergency Contact No.:<\/label>\u00a0\u00a0  <input  id=\"00NE0000000QPtN\" maxlength=\"40\" name=\"00NE0000000QPtN\" onkeydown=\"formatPhoneOnEnter(this, event);\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"emplopyed\">Are you employed:\u00a0<\/label>\u00a0  <select required  id=\"00NE0000005CGDh\" name=\"00NE0000005CGDh\" title=\"Are you employed\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><option value=\"Self-Employed\">Self-Employed<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"employer\">Name of Current Employer\/Company:<\/label>\u00a0\u00a0  <input  id=\"00NE0000000QQCA\" maxlength=\"30\" name=\"00NE0000000QQCA\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"job\">Job Title:<\/label>\u00a0\u00a0  <input  id=\"00NE0000005CGDm\" maxlength=\"40\" name=\"00NE0000005CGDm\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"benefits\">Do you receive unemployment benefits?:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXy\" name=\"00N0h000007FSXy\" title=\"Do you receive unemployment benefits?\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Exhausted\">Exhausted<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"student\">Are you a student:<\/label>\u00a0\u00a0  <select required id=\"00N44000006fIcM\" name=\"00N44000006fIcM\" title=\"Are you a student\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"class\">Current Student Classification:<\/label>\u00a0\u00a0  <select  id=\"00N44000006fIcb\" name=\"00N44000006fIcb\" title=\"Current Student Classification\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"High School - Freshman\">High School &#8211; Freshman<\/option><!-- [et_pb_line_break_holder] --><option value=\"High School - Sophomore\">High School &#8211; Sophomore<\/option><!-- [et_pb_line_break_holder] --><option value=\"High School - Junior\">High School &#8211; Junior<\/option><!-- [et_pb_line_break_holder] --><option value=\"High School - Senior\">High School &#8211; Senior<\/option><!-- [et_pb_line_break_holder] --><option value=\"College -  Freshman\">College &#8211;  Freshman<\/option><!-- [et_pb_line_break_holder] --><option value=\"College - Sophomore\">College &#8211; Sophomore<\/option><!-- [et_pb_line_break_holder] --><option value=\"College - Junior\">College &#8211; Junior<\/option><!-- [et_pb_line_break_holder] --><option value=\"College - Senior\">College &#8211; Senior<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"school\">What School Do You Attend:<\/label>\u00a0\u00a0  <input  id=\"00N44000006fIcl\" maxlength=\"60\" name=\"00N44000006fIcl\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"impact\">Were you impacted by a Disaster?:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXK\" name=\"00N0h000007FSXK\" title=\"Were you impacted by a Disaster?\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"disaster\">Which Disaster Impacted your household:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXP\" name=\"00N0h000007FSXP\" title=\"Which Disaster Impacted your household\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Hurricane Ida\">Hurricane Ida<\/option><!-- [et_pb_line_break_holder] --><option value=\"Hurricane Laura\">Hurricane Laura<\/option><!-- [et_pb_line_break_holder] --><option value=\"Tropical Storm Marco\">Tropical Storm Marco<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"condition\">Condition of Home:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXo\" multiple=\"multiple\" name=\"00N0h000007FSXo\" title=\"Condition of Home\"><option value=\"No Exterior Damage\">No Exterior Damage<\/option><!-- [et_pb_line_break_holder] --><option value=\"No Interior Damage\">No Interior Damage<\/option><!-- [et_pb_line_break_holder] --><option value=\"5% of home exterior is damaged\">5% of home exterior is damaged<\/option><!-- [et_pb_line_break_holder] --><option value=\"25% of home exterior is damaged\">25% of home exterior is damaged<\/option><!-- [et_pb_line_break_holder] --><option value=\"75% of home exterior is damaged\">75% of home exterior is damaged<\/option><!-- [et_pb_line_break_holder] --><option value=\"100% of home exterior is damaged\">100% of home exterior is damaged<\/option><!-- [et_pb_line_break_holder] --><option value=\"5% of home interior is damaged\">5% of home interior is damaged<\/option><!-- [et_pb_line_break_holder] --><option value=\"25% of home  interior is damaged\">25% of home  interior is damaged<\/option><!-- [et_pb_line_break_holder] --><option value=\"75% of home  interior is damaged\">75% of home  interior is damaged<\/option><!-- [et_pb_line_break_holder] --><option value=\"100% of home  interior is damaged\">100% of home  interior is damaged<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"goods\">Do you have sufficient consumer goods?:<\/label>\u00a0\u00a0  <select required id=\"00N0h0000074hnd\" name=\"00N0h0000074hnd\" title=\"Do you have sufficient consumer goods?\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"goods_needed\">Please select the consumer goods needed:<\/label>\u00a0\u00a0  <select required id=\"00N0h0000074hni\" multiple=\"multiple\" name=\"00N0h0000074hni\" title=\"Please select the consumer goods needed\"><option value=\"N\/A\">N\/A<\/option><!-- [et_pb_line_break_holder] --><option value=\"Food\">Food<\/option><!-- [et_pb_line_break_holder] --><option value=\"Water\">Water<\/option><!-- [et_pb_line_break_holder] --><option value=\"Disinfectant\">Disinfectant<\/option><!-- [et_pb_line_break_holder] --><option value=\"Diapers\">Diapers<\/option><!-- [et_pb_line_break_holder] --><option value=\"Hand Sanitizer\">Hand Sanitizer<\/option><!-- [et_pb_line_break_holder] --><option value=\"Sanitary goods\">Sanitary goods<\/option><!-- [et_pb_line_break_holder] --><option value=\"Clean Running Water\">Clean Running Water<\/option><!-- [et_pb_line_break_holder] --><option value=\"Ice\">Ice<\/option><!-- [et_pb_line_break_holder] --><option value=\"Other, please specify other consumer goods needed\">Other, please specify other consumer goods needed<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"other_goods\">Other consumer goods needed:<\/label>\u00a0\u00a0  <input  id=\"00N0h0000074hnn\" maxlength=\"50\" name=\"00N0h0000074hnn\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"home_goods\">List of Home Goods Needed:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXt\" multiple=\"multiple\" name=\"00N0h000007FSXt\" title=\"List of Home Goods Needed\"><option value=\"N\/A\">N\/A<\/option><!-- [et_pb_line_break_holder] --><option value=\"Dinnerware\">Dinnerware<\/option><!-- [et_pb_line_break_holder] --><option value=\"Flatware\">Flatware<\/option><!-- [et_pb_line_break_holder] --><option value=\"Glassware\">Glassware<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"furniture\">Furniture Needed:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSYI\" multiple=\"multiple\" name=\"00N0h000007FSYI\" title=\"Furniture Needed\"><option value=\"N\/A\">N\/A<\/option><!-- [et_pb_line_break_holder] --><option value=\"Twin Size Bed\">Twin Size Bed<\/option><!-- [et_pb_line_break_holder] --><option value=\"Twin Size Bed Mattress Set\">Twin Size Bed Mattress Set<\/option><!-- [et_pb_line_break_holder] --><option value=\"Full Size Bed\">Full Size Bed<\/option><!-- [et_pb_line_break_holder] --><option value=\"Full Size Bed Mattress Set\">Full Size Bed Mattress Set<\/option><!-- [et_pb_line_break_holder] --><option value=\"Queen Size Bed\">Queen Size Bed<\/option><!-- [et_pb_line_break_holder] --><option value=\"Queen Size Bed Mattress Set\">Queen Size Bed Mattress Set<\/option><!-- [et_pb_line_break_holder] --><option value=\"King Size Bed\">King Size Bed<\/option><!-- [et_pb_line_break_holder] --><option value=\"King Size Bed Mattress Set\">King Size Bed Mattress Set<\/option><!-- [et_pb_line_break_holder] --><option value=\"Sofa\">Sofa<\/option><!-- [et_pb_line_break_holder] --><option value=\"Dinning Table\">Dinning Table<\/option><!-- [et_pb_line_break_holder] --><option value=\"Dinning Chairs\">Dinning Chairs<\/option><!-- [et_pb_line_break_holder] --><option value=\"Dresser\">Dresser<\/option><!-- [et_pb_line_break_holder] --><option value=\"Lamp\">Lamp<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"appliances\">Appliances Needed:<\/label>\u00a0  <select required id=\"00N0h000007FSYN\" multiple=\"multiple\" name=\"00N0h000007FSYN\" title=\"Appliances Needed\"><option value=\"N\/A\">N\/A<\/option><!-- [et_pb_line_break_holder] --><option value=\"Microwave\">Microwave<\/option><!-- [et_pb_line_break_holder] --><option value=\"Toaster\">Toaster<\/option><!-- [et_pb_line_break_holder] --><option value=\"Coffee Maker\">Coffee Maker<\/option><!-- [et_pb_line_break_holder] --><option value=\"Electric Stove\">Electric Stove<\/option><!-- [et_pb_line_break_holder] --><option value=\"Gas Stove\">Gas Stove<\/option><!-- [et_pb_line_break_holder] --><option value=\"Electric Oven\">Electric Oven<\/option><!-- [et_pb_line_break_holder] --><option value=\"Gas Oven\">Gas Oven<\/option><!-- [et_pb_line_break_holder] --><option value=\"Electric Cook Top\">Electric Cook Top<\/option><!-- [et_pb_line_break_holder] --><option value=\"Gas Cook Top\">Gas Cook Top<\/option><!-- [et_pb_line_break_holder] --><option value=\"Dishwasher\">Dishwasher<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\"># of School age youth in the household?:<\/label>\u00a0\u00a0  <select required id=\"00N0h0000074gv7\" name=\"00N0h0000074gv7\" title=\"# of School age youth in the household?\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"N\/A\">N\/A<\/option><!-- [et_pb_line_break_holder] --><option value=\"1\">1<\/option><!-- [et_pb_line_break_holder] --><option value=\"2\">2<\/option><!-- [et_pb_line_break_holder] --><option value=\"3\">3<\/option><!-- [et_pb_line_break_holder] --><option value=\"4\">4<\/option><!-- [et_pb_line_break_holder] --><option value=\"5\">5<\/option><!-- [et_pb_line_break_holder] --><option value=\"6\">6<\/option><!-- [et_pb_line_break_holder] --><option value=\"7\">7<\/option><!-- [et_pb_line_break_holder] --><option value=\"8\">8<\/option><!-- [et_pb_line_break_holder] --><option value=\"9\">9<\/option><!-- [et_pb_line_break_holder] --><option value=\"10\">10<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Do you have access to a computer:<\/label>\u00a0\u00a0  <select required id=\"00N0h0000074gui\" name=\"00N0h0000074gui\" title=\"Do you have access to a computer\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Do you have access to the Internet?:<\/label>\u00a0\u00a0  <select required id=\"00N0h0000074gun\" name=\"00N0h0000074gun\" title=\"Do you have access to the Internet?\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Lacks consistent reliable transportation:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXU\" name=\"00N0h000007FSXU\" title=\"Lacks consistent reliable transportation\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"No\">No<\/option><!-- [et_pb_line_break_holder] --><option value=\"Yes\">Yes<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Applicant Shoe Size:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSY3\" maxlength=\"2\" name=\"00N0h000007FSY3\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Applicant Pants Size:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSY8\" maxlength=\"3\" name=\"00N0h000007FSY8\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Applicant Shirt Size:<\/label>\u00a0\u00a0  <select  id=\"00N0h000007FSYD\" name=\"00N0h000007FSYD\" title=\"Applicant Shirt Size\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Small\">Small<\/option><!-- [et_pb_line_break_holder] --><option value=\"Medium\">Medium<\/option><!-- [et_pb_line_break_holder] --><option value=\"Large\">Large<\/option><!-- [et_pb_line_break_holder] --><option value=\"XLarge\">XLarge<\/option><!-- [et_pb_line_break_holder] --><option value=\"XXLarge\">XXLarge<\/option><!-- [et_pb_line_break_holder] --><option value=\"3XLarge\">3XLarge<\/option><!-- [et_pb_line_break_holder] --><option value=\"4XLarge\">4XLarge<\/option><!-- [et_pb_line_break_holder] --><option value=\"5XLarge\">5XLarge<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Insurance Coverage:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXF\" multiple=\"multiple\" name=\"00N0h000007FSXF\" title=\"Insurance Coverage\"><option value=\"No Insurance\">No Insurance<\/option><!-- [et_pb_line_break_holder] --><option value=\"Homeowners\">Homeowners<\/option><!-- [et_pb_line_break_holder] --><option value=\"Renters\">Renters<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\"># In Family indicated on FEMA App.:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSXj\" maxlength=\"2\" name=\"00N0h000007FSXj\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">FEMA\/SBA Application Status:<\/label>\u00a0\u00a0  <select required id=\"00N0h000007FSXA\" multiple=\"multiple\" name=\"00N0h000007FSXA\" title=\"FEMA\/SBA Application Status\"><option value=\"FEMA Award\">FEMA Award<\/option><!-- [et_pb_line_break_holder] --><option value=\"FEMA Denied\">FEMA Denied<\/option><!-- [et_pb_line_break_holder] --><option value=\"FEMA Pending\">FEMA Pending<\/option><!-- [et_pb_line_break_holder] --><option value=\"SBA Award\">SBA Award<\/option><!-- [et_pb_line_break_holder] --><option value=\"SBA Denied\">SBA Denied<\/option><!-- [et_pb_line_break_holder] --><option value=\"SBA Pending\">SBA Pending<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Please provide FEMA Registration Number:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSXZ\" maxlength=\"12\" name=\"00N0h000007FSXZ\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Please provide SBA Application Number:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSXe\" maxlength=\"12\" name=\"00N0h000007FSXe\" size=\"20\" type=\"text\" \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Where are you living?:<\/label>\u00a0\u00a0  <select required id=\"00N0h0000074guY\" name=\"00N0h0000074guY\" title=\"Where are you living?\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Home\">Home<\/option><!-- [et_pb_line_break_holder] --><option value=\"Homeless\">Homeless<\/option><!-- [et_pb_line_break_holder] --><option value=\"Hotel\">Hotel<\/option><!-- [et_pb_line_break_holder] --><option value=\"Living with a friend\">Living with a friend<\/option><!-- [et_pb_line_break_holder] --><option value=\"Living with a relative\">Living with a relative<\/option><!-- [et_pb_line_break_holder] --><option value=\"Living in a Shelter\">Living in a Shelter<\/option><!-- [et_pb_line_break_holder] --><option value=\"Motel\">Motel<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Evacuation Address:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSWl\" maxlength=\"30\" name=\"00N0h000007FSWl\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Evacuation City:<\/label>\u00a0  <input  id=\"00N0h000007FSWq\" maxlength=\"30\" name=\"00N0h000007FSWq\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Evacuation State:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSWv\" maxlength=\"30\" name=\"00N0h000007FSWv\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  <label for=\"first_name\">Evacuation Zip Code:<\/label>\u00a0\u00a0  <input  id=\"00N0h000007FSX0\" name=\"00N0h000007FSX0\" size=\"20\" type=\"text\" required \/><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->    Affiliation with the Urban League:<select required id=\"00N0h000007FSoG\" name=\"00N0h000007FSoG\" title=\"Affiliation with the Urban League\"><option value=\"\">&#8211;None&#8211;<\/option><option value=\"Not Affiliated with the Urban League of Louisiana\">Not Affiliated with the Urban League of Louisiana<\/option><!-- [et_pb_line_break_holder] --><option value=\"Community Partner\">Community Partner<\/option><!-- [et_pb_line_break_holder] --><option value=\"Employer Partner\">Employer Partner<\/option><!-- [et_pb_line_break_holder] --><option value=\"Former Employee\">Former Employee<\/option><!-- [et_pb_line_break_holder] --><option value=\"Guild Member\">Guild<\/option><!-- [et_pb_line_break_holder] --><option value=\"Member\">Member<\/option><!-- [et_pb_line_break_holder] --><option value=\"Participant\">Participant<\/option><!-- [et_pb_line_break_holder] --><option value=\"Staff\">Staff<\/option><!-- [et_pb_line_break_holder] --><option value=\"Training Partner\">Training Partner<\/option><!-- [et_pb_line_break_holder] --><option value=\"Volunteer\">Volunteer<\/option><!-- [et_pb_line_break_holder] --><option value=\"Young Professional\">Young Professional<\/option><!-- [et_pb_line_break_holder] --><\/select><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->    <!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><input type=\"SUBMIT\" name=\"submit\"><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><\/form>\n<p><!-- [et_pb_line_break_holder] -->[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>OFFICE OF WORKFORCE DEVELOPMENT HURRICANE IDA DISASTER RECOVERY ASSESSMENTCOMPLETE &amp; SUBMIT FORMAN URBAN LEAGUE TEAM MEMBER WILL CALL YOU WITHIN 48 BUSINESS HOURS.<\/p>\n","protected":false},"author":22,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"class_list":["post-236641","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/pages\/236641","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/users\/22"}],"replies":[{"embeddable":true,"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/comments?post=236641"}],"version-history":[{"count":11,"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/pages\/236641\/revisions"}],"predecessor-version":[{"id":236829,"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/pages\/236641\/revisions\/236829"}],"wp:attachment":[{"href":"https:\/\/urbanleaguela.org\/wp-json\/wp\/v2\/media?parent=236641"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}