{"id":144,"date":"2020-05-05T14:00:56","date_gmt":"2020-05-05T18:00:56","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/?page_id=144"},"modified":"2020-05-05T14:06:11","modified_gmt":"2020-05-05T18:06:11","slug":"resource-mothers-program-interest-form","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/","title":{"rendered":"Resource Mothers Program Interest Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_3' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Thank you for your interest in the Resource Mothers Program.  Please complete this form and submit.\n<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/resource-mothers\/wp-json\/wp\/v2\/pages\/144' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_3_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_1'>\n                            \n                            <span id='input_3_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_3_2\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_3_2_1' value=''    aria-required='false'    \/>\n                                        <label for='input_3_2_1' id='input_3_2_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_2_2_container' >\n                                        <input type='text' name='input_2.2' id='input_3_2_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_2_2' id='input_3_2_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_3_2_3' value=''    aria-required='false'    \/>\n                                    <label for='input_3_2_3' id='input_3_2_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_2_4_container' >\n                                        <select name='input_2.4' id='input_3_2_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_3_2_4' id='input_3_2_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_3_2_5' value=''    aria-required='false'    \/>\n                                    <label for='input_3_2_5' id='input_3_2_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_2.6' id='input_3_2_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_3_3\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_3_3_container'>\n                                <span id='input_3_3_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3' id='input_3_3' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_3_3' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_3_3_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_3_2' id='input_3_3_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_3_3_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_3_4\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_4'>Home phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_3_4' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_5\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_5'>Cell phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_3_5' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_6\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_6'>Location of interest (city\/county)<\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_3_6' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_7\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you looking for services for yourself?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_7'>\n\t\t\t<li class='gchoice gchoice_3_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='Yes'  id='choice_3_7_0'    \/>\n\t\t\t\t<label for='choice_3_7_0' id='label_3_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='No'  id='choice_3_7_1'    \/>\n\t\t\t\t<label for='choice_3_7_1' id='label_3_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_8\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Are you looking for services as a caretaker for a friend, family member, client\/student?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_8'>\n\t\t\t<li class='gchoice gchoice_3_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Yes'  id='choice_3_8_0'    \/>\n\t\t\t\t<label for='choice_3_8_0' id='label_3_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='No'  id='choice_3_8_1'    \/>\n\t\t\t\t<label for='choice_3_8_1' id='label_3_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_9\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_9'>How did you hear about Resource Mothers?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_3_9' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_10\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >I am interested in (please check all that apply):<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_3_10'><li class='gchoice gchoice_3_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='Pregnancy\/ child birth preparation'  id='choice_3_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_1' id='label_3_10_1' class='gform-field-label gform-field-label--type-inline'>Pregnancy\/ child birth preparation<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Nutrition'  id='choice_3_10_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_2' id='label_3_10_2' class='gform-field-label gform-field-label--type-inline'>Nutrition<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Self-care\/wellness'  id='choice_3_10_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_3' id='label_3_10_3' class='gform-field-label gform-field-label--type-inline'>Self-care\/wellness<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Parenting skills'  id='choice_3_10_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_4' id='label_3_10_4' class='gform-field-label gform-field-label--type-inline'>Parenting skills<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='Teen empowerment'  id='choice_3_10_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_5' id='label_3_10_5' class='gform-field-label gform-field-label--type-inline'>Teen empowerment<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='Community resources'  id='choice_3_10_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_6' id='label_3_10_6' class='gform-field-label gform-field-label--type-inline'>Community resources<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.7' type='checkbox'  value='Education\/ job resources'  id='choice_3_10_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_7' id='label_3_10_7' class='gform-field-label gform-field-label--type-inline'>Education\/ job resources<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.8' type='checkbox'  value='Reproductive health education'  id='choice_3_10_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_8' id='label_3_10_8' class='gform-field-label gform-field-label--type-inline'>Reproductive health education<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_3_10_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.9' type='checkbox'  value='Other'  id='choice_3_10_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_10_9' id='label_3_10_9' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_11\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_11'>If other, please specify:<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_3_11' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_12\" class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_12'>CAPTCHA<\/label><div id='input_3_12' class='ginput_container ginput_recaptcha' data-sitekey='6LefrHAUAAAAAPYx2_JNNWRqAxjDmBOPugQEjb1I'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='iU8qjSnhHy6Cz1oC9w3St+X2\/QcnB6xTuBASuSK7Wgg2D+p477JZNxwiqe7zEXkPXvfD9pCC9+8NyARsJYqVq4xPniC42u9MJ1JO64O3LLykoKU=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJbXSIsImZkODQzZjIzM2EyNGQ0MzUzYjc2YzI3MzQ3OWI4OWM2Il0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/www.vdh.virginia.gov\/content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_3').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_3').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_3').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_3').val();gformInitSpinner( 3, 'https:\/\/www.vdh.virginia.gov\/content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [3, current_page]);window['gf_submitting_3'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_3').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [3]);window['gf_submitting_3'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_3').text());}else{jQuery('#gform_3').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"3\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_3\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_3\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_3\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 3, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":289,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-144","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Resource Mothers Program Interest Form - Resource Mothers<\/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:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Resource Mothers Program Interest Form - Resource Mothers\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Resource Mothers\" \/>\n<meta property=\"article:modified_time\" content=\"2020-05-05T18:06:11+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/resource-mothers-program-interest-form\\\/\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/resource-mothers-program-interest-form\\\/\",\"name\":\"Resource Mothers Program Interest Form - Resource Mothers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/#website\"},\"datePublished\":\"2020-05-05T18:00:56+00:00\",\"dateModified\":\"2020-05-05T18:06:11+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/resource-mothers-program-interest-form\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/resource-mothers-program-interest-form\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/resource-mothers-program-interest-form\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Resource Mothers Program Interest Form\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/#website\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/\",\"name\":\"Resource Mothers\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/resource-mothers\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Resource Mothers Program Interest Form - Resource Mothers","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/","og_locale":"en_US","og_type":"article","og_title":"Resource Mothers Program Interest Form - Resource Mothers","og_url":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/","og_site_name":"Resource Mothers","article_modified_time":"2020-05-05T18:06:11+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/","url":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/","name":"Resource Mothers Program Interest Form - Resource Mothers","isPartOf":{"@id":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/#website"},"datePublished":"2020-05-05T18:00:56+00:00","dateModified":"2020-05-05T18:06:11+00:00","breadcrumb":{"@id":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/resource-mothers-program-interest-form\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/"},{"@type":"ListItem","position":2,"name":"Resource Mothers Program Interest Form"}]},{"@type":"WebSite","@id":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/#website","url":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/","name":"Resource Mothers","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/pages\/144","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/users\/289"}],"replies":[{"embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/comments?post=144"}],"version-history":[{"count":1,"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/pages\/144\/revisions"}],"predecessor-version":[{"id":145,"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/pages\/144\/revisions\/145"}],"wp:attachment":[{"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/media?parent=144"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.vdh.virginia.gov\/resource-mothers\/wp-json\/wp\/v2\/tags?post=144"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}