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_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Inquiry Form</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_Last_A" style="width: 25%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Last Name (Applicant #1)</label><input name="CST_4" type="text" class="er_fld_width100 er_fld_required" value=""></li><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_A" style="width: 25%;"> <i class="fa fa-font"></i><label class="er_fld_label required">First Name (Applicant #1)</label><input name="CST_2" type="text" class="er_fld_width100 er_fld_required"></li><li class="er_fld_type_text" draggable="false" map_to="FH_DOB_A" style="width: 25%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Date of Birth (Applicant #1)</label><input name="CST_46" type="text" class="er_fld_width50 er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_Last_B" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label">Last Name (Applicant #2)</label><input name="CST_12" type="text" class="er_fld_width100"></li><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_B" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label">First Name (Applicant #2)</label><input name="CST_13" type="text" class="er_fld_width100"></li><li class="er_fld_type_text" draggable="false" map_to="FH_DOB_B" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label">Date of Birth (Applicant #2)</label><input name="CST_47" type="text" class="er_fld_width50"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Street_1" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Address Line 1</label><input name="CST_7" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Street_2" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Address Line 2</label><input name="CST_8" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_City" style="width: 20%;"> <i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_9" type="text" class="er_fld_width100 er_fld_required"></li><li class="er_fld_type_text" draggable="false" map_to="FH_Address_State" style="width: 20%;"> <i class="fa fa-font"></i><label class="er_fld_label required">State</label><input name="CST_10" type="text" class="er_fld_width25 er_fld_required"></li><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Zip" style="width: 20%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Zip Code</label><input name="CST_11" type="text" class="er_fld_width75 er_fld_required"></li><li class="er_fld_type_text" draggable="false" map_to="FH_Address_County" style="width: 20%;"> <i class="fa fa-font"></i><label class="er_fld_label required">County</label><input name="CST_14" type="text" class="er_fld_width100 er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Phone_Home" style="width: 25%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Home Phone</label><input name="CST_15" type="text" class="er_fld_width100 er_fld_required"></li><li class="er_fld_type_text" draggable="false" map_to="FH_Phone_Mobile" style="width: 25%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Mobile Phone (Applicant #1)</label><input name="CST_16" type="text" class="er_fld_width100 er_fld_required"></li><li class="er_fld_type_text" draggable="false" map_to="FH_Phone_Mobile_B" style="width: 25%;"> <i class="fa fa-font"></i><label class="er_fld_label">Mobile Phone (Applicant #2)</label><input name="CST_17" type="text" class="er_fld_width75"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_selected" draggable="false" map_to="FH_EMail" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label required">Primary Email</label><input name="CST_18" 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_2" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Secondary Email</label><input name="CST_19" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Household</label><hr></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">Type of Home</label><select name="CST_50"><option value="Home ">Home </option><option value="Apartment">Apartment</option></select></li><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;"><i class="fa fa-caret-down"></i><label class="er_fld_label">Number of Bedrooms</label><select name="CST_22" class="er_fld_width25"><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" map_to="none" style="width: 50%;"><i class="fa fa-caret-down"></i><label class="er_fld_label">Number of Adults</label><select name="CST_24"><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Adult #1</label><input name="CST_27" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Adult #2</label><input name="CST_28" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Adult #3</label><input name="CST_29" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Adult #4</label><input name="CST_30" type="text"></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">Number of Children in the Home</label><select name="CST_32"><option value="0">0</option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Child #1</label><input name="CST_33" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Child #2</label><input name="CST_34" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Child #3</label><input name="CST_35" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Name of Child #4</label><input name="CST_36" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Single Line Text</label><input name="CST_37" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_number" draggable="false" style="width: 33.3333%;"> <i class="fa fa-hashtag"></i><label class="er_fld_label">Age Preference</label><input name="CST_38" type="text" class="er_fld_width75"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label">Gender Preference</label><input name="CST_39" type="text" class="er_fld_width75"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 100%;"><i class="fa fa-header"></i><label>Source of Income</label><hr></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">Have you ever been Live Scan fingerprinted? </label><select name="CST_41"><option value="- Not Specified -">- Not Specified -</option><option value="Yes">Yes</option><option value="No">No</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Occupation_A" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label">Occupation (Applicant #1)</label><input name="CST_42" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Occupation_B"> <i class="fa fa-font"></i><label class="er_fld_label">Occupation (Applicant #2)</label><input name="CST_43" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Employer_A" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label">Employer</label><input name="CST_44" type="text"></li><li class="er_fld_type_text" draggable="false" map_to="FH_Employer_A" style="width: 33.3333%;"> <i class="fa fa-font"></i><label class="er_fld_label">Employer</label><input name="CST_45" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false"><i class="fa fa-header"></i><label></label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" map_to="FH_Inquiry_How_Referred"><i class="fa fa-caret-down"></i><label class="er_fld_label">How did you hear about our agency?</label><select name="CST_52"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Flyer">Flyer</option><option value="Event/Booth">Event/Booth</option><option value="Advertisement">Advertisement</option><option value="Yard Sign">Yard Sign</option><option value="Resource Parent Referral">Resource Parent Referral</option><option value="GSFS Employee">GSFS Employee</option><option value="Website">Website</option><option value="Other">Other</option></select></li></ul><ul id="er_row_last" class="er_fld_row"><li class="er_fld_type_text" draggable="false"> <i class="fa fa-font"></i><label class="er_fld_label">If referred by Employee or Current Resource Parent Please write name below:</label><input name="CST_53" type="text"></li></ul>
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