{"id":6672,"date":"2024-07-28T07:38:33","date_gmt":"2024-07-28T07:38:33","guid":{"rendered":"https:\/\/brooklandlakeview.org\/formulario-de-admision-para-ayudar-a-las-familias\/"},"modified":"2024-12-17T10:13:54","modified_gmt":"2024-12-17T10:13:54","slug":"helping-families-intake-form","status":"publish","type":"page","link":"https:\/\/brooklandlakeview.org\/es\/helping-families-intake-form\/","title":{"rendered":"Helping families intake form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6672\" class=\"elementor elementor-6672\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-510085f9 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"510085f9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6a08ddb0\" data-id=\"6a08ddb0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-97a8012 elementor-widget elementor-widget-charite-banner-widget\" data-id=\"97a8012\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"charite-banner-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\r\n    <!-- banner area start -->\r\n    <div class=\"hero-area bgs-cover overlay pt-155 pb-170\" style=\"background-image: url();\">\r\n        <div class=\"container container-1370\">\r\n            <div class=\"hero-content text-center text-white\">\r\n                                    <h1>Siemer Institute: 2-Generation Approach <\/h1>\r\n                                                    <p>Helping Families with Case Management Services<\/p>\r\n                                <div class=\"hero-btns pt-30 rpt-10\">\r\n                                                        <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n    <!-- banner area end -->\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-4f5e606 e-flex e-con-boxed e-con e-parent\" data-id=\"4f5e606\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3c1ba8b elementor-widget elementor-widget-shortcode\" data-id=\"3c1ba8b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f6912-o1\" lang=\"es-ES\" dir=\"ltr\" data-wpcf7-id=\"6912\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/6672#wpcf7-f6912-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulario de contacto\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"6912\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"es_ES\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f6912-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"row\" style=\"border-bottom:solid 1px #640f24; padding-bottom:60px\">\n\t<div class=\"col-sm-12\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"reffered-by\">Remitido por<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" id=\"reffered-by\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Por favor, introduce el nombre, n\u00famero de tel\u00e9fono y direcci\u00f3n de correo electr\u00f3nico del trabajador social, orientador escolar, etc.*\" name=\"your-message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"first-name\">Nombre<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"firstname\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"last-name\">Apellidos<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-subject\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"lastname\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-subject\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"dob\">Fecha de nacimiento<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-950\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"dob\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-950\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"tdate\">Fecha de hoy<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-84\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control\" id=\"tdate\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-84\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-12\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"address\"> Direcci\u00f3n <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-951\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"address\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-951\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-4\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"city\"> Ciudad <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-952\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"city\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-952\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-4\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"state\">Estado <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-953\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"state\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-953\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-4\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"zip\">C\u00f3digo postal <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-954\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"zip\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-954\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"email\">Env\u00eda un correo electr\u00f3nico a<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" id=\"email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"phone\">Mejor n\u00famero de contacto<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-944\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel form-control\" id=\"phone\" autocomplete=\"tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"text-944\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"school-dstrict\">\u00bfTienes alg\u00fan hijo que asista actualmente a una escuela del Distrito Escolar Dos de Lexington?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-805\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required form-control\" id=\"school-dstricct\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-805\"><option value=\"S\u00ed\">S\u00ed<\/option><option value=\"No\">No<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"whichschool  \">En caso afirmativo, \u00bfen qu\u00e9 escuela? (Opcional) <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-955\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"whichschool\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-955\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"currently-employed\">\u00bfTienes trabajo actualmente<\/label>?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-806\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required form-control\" id=\"currently-employed\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-806\"><option value=\"S\u00ed\">S\u00ed<\/option><option value=\"No\">No<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-6\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"nameemployer\">\u00bfCu\u00e1l es el nombre de tu empleador? (Opcional) <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-956\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" id=\"nameemployer\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-956\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-4\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"county-do-reside\">\u00bfEn qu\u00e9 condado resides?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-957\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"county-do-reside\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-957\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-4\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"household-size\">\u00bfCu\u00e1l es el tama\u00f1o de tu hogar?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-958\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"household-size\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-958\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-4\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"household-income\">\u00bfCu\u00e1les son los ingresos mensuales de tu unidad familiar?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-959\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"household-income\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-959\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-12\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"source-income\">\u00bfCu\u00e1l es la fuente de ingresos de tu hogar?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-960\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" id=\"source-income\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-960\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-12\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"assistance-seeking\">\u00bfQu\u00e9 tipo de ayuda buscas? (Selecciona todas las que procedan)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-974\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Comida\" \/><span class=\"wpcf7-list-item-label\">Comida<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Ropa\" \/><span class=\"wpcf7-list-item-label\">Ropa<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Alojamiento temporal\" \/><span class=\"wpcf7-list-item-label\">Alojamiento temporal<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Encontrar trabajo\" \/><span class=\"wpcf7-list-item-label\">Encontrar trabajo<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Educaci\u00f3n para adultos\" \/><span class=\"wpcf7-list-item-label\">Educaci\u00f3n para adultos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Conseguir vivienda\" \/><span class=\"wpcf7-list-item-label\">Conseguir vivienda<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Crear un presupuesto mensual\" \/><span class=\"wpcf7-list-item-label\">Crear un presupuesto mensual<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Ayuda con los servicios p\u00fablicos\" \/><span class=\"wpcf7-list-item-label\">Ayuda con los servicios p\u00fablicos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Servicios jur\u00eddicos en caso de disputa con el casero\" \/><span class=\"wpcf7-list-item-label\">Servicios jur\u00eddicos en caso de disputa con el casero<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Ayuda para concertar una cita m\u00e9dica para un hijo\" \/><span class=\"wpcf7-list-item-label\">Ayuda para concertar una cita m\u00e9dica para un hijo<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-974[]\" value=\"Mentor\/tutor\/ayuda con los deberes para un hijo\" \/><span class=\"wpcf7-list-item-label\">Mentor\/tutor\/ayuda con los deberes para un hijo<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-sm-12\">\n\t\t<div class=\"form-group\">\n\t\t\t<p><label for=\"comments\">Comentarios del orientador\/trabajador social (Opcional)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-706\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" id=\"comments\" aria-invalid=\"false\" name=\"textarea-706\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"col-md-12\">\n\t\t<div class=\"form-group pt-10 mb-0\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enviar\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"130\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Siemer Institute: 2-Generation Approach Helping Families with Case Management Services<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-6672","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/pages\/6672","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/comments?post=6672"}],"version-history":[{"count":5,"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/pages\/6672\/revisions"}],"predecessor-version":[{"id":7291,"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/pages\/6672\/revisions\/7291"}],"wp:attachment":[{"href":"https:\/\/brooklandlakeview.org\/es\/wp-json\/wp\/v2\/media?parent=6672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}