Online Inquiry
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Click the 'Generate Form' link to pre-populate the form when you are ready.
<ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_A" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label required">First Name:</label><input name="CST_1" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Name_Last_A"> <i class="fa fa-font"></i><label class="er_fld_label required">Last Name:</label><input name="CST_10" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_EMail"> <i class="fa fa-font"></i><label class="er_fld_label required">Email Address:</label><input name="CST_2" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Phone_Mobile"> <i class="fa fa-font"></i><label class="er_fld_label">Phone Number:</label><input name="CST_3" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_City" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label required">City:</label><input name="CST_4" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Address_Zip"> <i class="fa fa-font"></i><label class="er_fld_label required">Zip Code</label><input name="CST_11" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;"><i class="fa fa-caret-down"></i><label class="er_fld_label">Preferred response:</label><select name="CST_5"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Email">Email</option><option value="Phone">Phone</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_ReferralSource"> <i class="fa fa-font"></i><label class="er_fld_label required">How did you hear about Youthnet?</label><input name="CST_6" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Do you have any age groups in mind that you're interested in fostering?</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_7" value="Infants">Infants</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_7" value="Toddlers">Toddlers</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_7" value="Elementary">Elementary</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_7" value="Teens">Teens</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_7" value="Youth ages 18-21 in Extended Foster Care">Youth ages 18-21 in Extended Foster Care</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_7" value="Other:">Other:<input class="cst_Other" name="CST_7_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_selected" draggable="false" style="width: 100%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">How can we help?</label><select name="CST_12" class="er_fld_required"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="I'm ready to apply and would like Youthnet to contact me regarding next steps.">I'm ready to apply and would like Youthnet to contact me regarding next steps.</option><option value="I'm ready to foster but have some questions before I apply.">I'm ready to foster but have some questions before I apply.</option><option value="I'm not quite ready to foster but would like to learn more.">I'm not quite ready to foster but would like to learn more.</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" map_to="FH_Inquiry_Comments" style="width: 50%;"> <i class="fa fa-paragraph"></i><label class="er_fld_label">Our team member Holland will reach out to you soon, within 24 hours Monday-Friday. If you have any initial questions about foster care or foster parenting, please feel welcome to include these here:</label><textarea name="CST_9" style="width:100%;"></textarea></li></ul>
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