{"id":4258,"date":"2024-06-10T04:08:35","date_gmt":"2024-06-10T08:08:35","guid":{"rendered":"http:\/\/www.outreacheast.org\/?page_id=4258"},"modified":"2026-04-18T14:18:05","modified_gmt":"2026-04-18T18:18:05","slug":"apply-online-for-assistance","status":"publish","type":"page","link":"https:\/\/www.outreacheast.org\/?page_id=4258","title":{"rendered":"Apply Online for Assistance"},"content":{"rendered":"\n<figure class=\"wp-block-image aligncenter size-large is-resized\"><img decoding=\"async\" src=\"https:\/\/www.outreacheast.org\/wp-content\/uploads\/2020\/03\/ore-logo-banner-final2.png\" alt=\"\" class=\"wp-image-4387\"\/><\/figure>\n\n\n\n<p><strong><em>We are a non-denominational, walk-in, year-round emergency resource center servicing the Aprox. 225 square miles of east Genesee County with our office located in Davison, Mi.<\/em> <\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\"><em>1-Our Service Area includes the eastern side of Genesee County from Center Rd and east to the Lapeer County Line.<\/em><\/mark><\/strong><a title=\"\" href=\"https:\/\/www.outreacheast.org\/wp-content\/uploads\/2021\/02\/Service-area.pdf\" target=\"_blank\" rel=\"noopener\">( see map)<\/a><\/h3>\n\n\n\n<p><strong>2-<\/strong>Are you in need of food, clothing, utility assistance. You may fill out the application online (or in person), even upload your, pay stubs,  shut off, etc.   HOWEVER, You MUST Bring in the physical copy of your social security cards of all children and driver&#8217;s license for services the first time to finish the application process, and you <em>MUST COME IN to receive services. <\/em>We do require re-certifying all info every 6 months.<\/p>\n\n\n\n<p><strong>3-<\/strong>For financial assistance-Have you applied to DHS yet? We will need the DHS determinations to assist with utilities. You can fill out the application anytime but must come in on Mon or Tues for financial processing.<\/p>\n\n\n\n<p>4-<strong>Financial assistance is processed on MON 10:30-2:30 and TUES. 12:30-4:30<\/strong> ONLY.<\/p>\n\n\n\n<p><strong>5-<\/strong> <strong><em>At this time, we are currently out of funds for RENT assistance.<\/em><\/strong><\/p>\n\n\n<script>\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<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_14' >\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Application for Client Services<\/h2>\n                            <p class='gform_description'>Application for Client Services<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_14'  action='\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F4258' data-formid='14' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_14' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_14_1\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon 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_14_1'>TODAY&#039;S Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_1' id='input_14_1' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_14_1_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_14_1_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_14_1' class='gform_hidden' value='https:\/\/www.outreacheast.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_14_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths 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_14_56'>How did you hear about  Outreach East ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_14_56' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div data-fieldId=\"56\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"a2fb2992\"><\/div><div id=\"field_14_60\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_60'>Veteran<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_60' id='input_14_60' class='large gfield_select'  aria-describedby=\"gfield_description_14_60\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='YES' >YES<\/option><option value='NO' >NO<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_14_60'>Is anyone in your household a Veteran?\n<\/div><\/div><div id=\"field_14_62\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_62'>Name of Veteran and Service Branch<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_14_62' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_14_63\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I am In need of :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox gfield_choice--select_all_enabled' id='input_14_63'><div class='gchoice gchoice_14_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='Food Assistance'  id='choice_14_63_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_63_1' id='label_14_63_1' class='gform-field-label gform-field-label--type-inline'>Food Assistance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_14_63_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.2' type='checkbox'  value='Clothing'  id='choice_14_63_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_63_2' id='label_14_63_2' class='gform-field-label gform-field-label--type-inline'>Clothing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_14_63_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.3' type='checkbox'  value='Utility Assistance'  id='choice_14_63_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_63_3' id='label_14_63_3' class='gform-field-label gform-field-label--type-inline'>Utility Assistance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_14_63_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.4' type='checkbox'  value='Other'  id='choice_14_63_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_63_4' id='label_14_63_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_14_63_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.5' type='checkbox'  value='Rent\/Eviction Assistance'  id='choice_14_63_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_63_5' id='label_14_63_5' class='gform-field-label gform-field-label--type-inline'>Rent\/Eviction Assistance<\/label>\n\t\t\t\t\t\t\t<\/div><div class=\"gfield-choice-toggle-all\"><button type=\"button\" id=\"button_63_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/div><\/fieldset><div id=\"field_14_65\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full 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_14_65'>Total Number in Household<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_65' id='input_14_65' type='number' step='any'   value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_14_44\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Applying For :<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Utilities Total Amt. Owed<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">UTILITIES $ Amount  Needed<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Consumers Acct Number<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">OTHER<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Rent Eviction Total Amount<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Rent Eviction Amt. Needed<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_44_cell1 gform-grid-col' data-label='Utilities Total Amt. Owed'><input aria-invalid='false'   aria-label='Utilities Total Amt. Owed, Row 1' data-aria-label-template='Utilities Total Amt. Owed, Row {0}' type='text' name='input_44[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_44_cell2 gform-grid-col' data-label='UTILITIES $ Amount  Needed'><input aria-invalid='false'   aria-label='UTILITIES $ Amount  Needed, Row 1' data-aria-label-template='UTILITIES $ Amount  Needed, Row {0}' type='text' name='input_44[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_44_cell3 gform-grid-col' data-label='Consumers Acct Number'><input aria-invalid='false'   aria-label='Consumers Acct Number, Row 1' data-aria-label-template='Consumers Acct Number, Row {0}' type='text' name='input_44[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_44_cell4 gform-grid-col' data-label='OTHER'><input aria-invalid='false'   aria-label='OTHER, Row 1' data-aria-label-template='OTHER, Row {0}' type='text' name='input_44[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_44_cell5 gform-grid-col' data-label='Rent Eviction Total Amount'><input aria-invalid='false'   aria-label='Rent Eviction Total Amount, Row 1' data-aria-label-template='Rent Eviction Total Amount, Row {0}' type='text' name='input_44[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_44_cell6 gform-grid-col' data-label='Rent Eviction Amt. Needed'><input aria-invalid='false'   aria-label='Rent Eviction Amt. Needed, Row 1' data-aria-label-template='Rent Eviction Amt. Needed, Row {0}' type='text' name='input_44[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_14_2\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_14_2'>\n                            \n                            <span id='input_14_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_14_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_14_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_14_2_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.4' id='input_14_2_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_14_2_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_14_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_14_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_14_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_14_3\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_14_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_14_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_14_3_1' value=''    aria-required='true'    \/>\n                                        <label for='input_14_3_1' id='input_14_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_14_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_14_3_3' value=''    aria-required='true'    \/>\n                                    <label for='input_14_3_3' id='input_14_3_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_14_3_4_container' >\n                                        <input type='text' name='input_3.4' id='input_14_3_4' value=''      aria-required='true'    \/>\n                                        <label for='input_14_3_4' id='input_14_3_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_14_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_14_3_5' value=''    aria-required='true'    \/>\n                                    <label for='input_14_3_5' id='input_14_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_14_3_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_14_6\" class=\"gfield gfield--type-phone gfield--input-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_14_6'>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_6' id='input_14_6' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_14_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_14_5_container'>\n                                <span id='input_14_5_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_5' id='input_14_5' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_14_5' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_14_5_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_5_2' id='input_14_5_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_14_5_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><\/fieldset><div id=\"field_14_46\" class=\"gfield gfield--type-text gfield--input-type-text 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_14_46'>Last 4 Numbers of Social ( Must Still bring in Card)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_14_46' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_14_50\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date Of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_14_50' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_14_50_1_container'>\n                                            <input type='number' maxlength='2' name='input_50[]' id='input_14_50_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_14_50_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_14_50_2_container'>\n                                            <input type='number' maxlength='2' name='input_50[]' id='input_14_50_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_14_50_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_14_50_3_container'>\n                                            <input type='number' maxlength='4' name='input_50[]' id='input_14_50_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_14_50_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_14_41\" class=\"gfield gfield--type-text gfield--input-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_14_41'>DL \/ Or ID  Number<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_14_41' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_14_13\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Spouse or Sig. Other Name Living In the Home<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_14_13'>\n                            \n                            <span id='input_14_13_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_13.3' id='input_14_13_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_14_13_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_14_13_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_13.4' id='input_14_13_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_14_13_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_14_13_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_13.6' id='input_14_13_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_14_13_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_14_47\" class=\"gfield gfield--type-text gfield--input-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_14_47'>Last 4 Numbers of Soc Sec ( Must Still bring in Card )<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_14_47' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_14_54\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date Of Birth<\/legend><div id='input_14_54' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_14_54_1_container'>\n                                            <input type='number' maxlength='2' name='input_54[]' id='input_14_54_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_14_54_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_14_54_2_container'>\n                                            <input type='number' maxlength='2' name='input_54[]' id='input_14_54_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_14_54_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_14_54_3_container'>\n                                            <input type='number' maxlength='4' name='input_54[]' id='input_14_54_3' value=''   aria-required='false'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_14_54_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_14_39\" class=\"gfield gfield--type-text gfield--input-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_14_39'>DL \/ID   Number   &#8211;Must still bring in or upload<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_14_39' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_18\" class=\"gfield gfield--type-phone gfield--input-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_14_18'>Phone-2<\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_14_18' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_14_20\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_14_20'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_20' id='input_14_20' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_14_26\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >List ALL Children Under 19 LIVING WITH YOU- CLICK ON PLUS (+)+     TO ADD MORE Lines Click Plus+<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Child Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Date of Birth<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Last 4 numbers of Social Sec (Must still bring in Physical Card)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">&#8212;   Girl or Boy<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">School Name  Attending<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_26_cell1 gform-grid-col' data-label='Child Name'><input aria-invalid='false'   aria-label='Child Name, Row 1' data-aria-label-template='Child Name, Row {0}' type='text' name='input_26[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_26_cell2 gform-grid-col' data-label='Date of Birth'><input aria-invalid='false'   aria-label='Date of Birth, Row 1' data-aria-label-template='Date of Birth, Row {0}' type='text' name='input_26[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_26_cell3 gform-grid-col' data-label='Last 4 numbers of Social Sec (Must still bring in Physical Card)'><input aria-invalid='false'   aria-label='Last 4 numbers of Social Sec (Must still bring in Physical Card), Row 1' data-aria-label-template='Last 4 numbers of Social Sec (Must still bring in Physical Card), Row {0}' type='text' name='input_26[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_26_cell4 gform-grid-col' data-label='--   Girl or Boy'><input aria-invalid='false'   aria-label='--   Girl or Boy, Row 1' data-aria-label-template='--   Girl or Boy, Row {0}' type='text' name='input_26[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_26_cell5 gform-grid-col' data-label='School Name  Attending'><input aria-invalid='false'   aria-label='School Name  Attending, Row 1' data-aria-label-template='School Name  Attending, Row {0}' type='text' name='input_26[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 8)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 8)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_14_34\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >LIST ALL Other people living in the home<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">DOB<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Realtionship<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\"><\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false'   aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell2 gform-grid-col' data-label='DOB'><input aria-invalid='false'   aria-label='DOB, Row 1' data-aria-label-template='DOB, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell3 gform-grid-col' data-label='Realtionship'><input aria-invalid='false'   aria-label='Realtionship, Row 1' data-aria-label-template='Realtionship, Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_34_cell4 gform-grid-col' data-label=''><input aria-invalid='false'   aria-label=', Row 1' data-aria-label-template=', Row {0}' type='text' name='input_34[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_14_66\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third 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_14_66'>Does your household  receive Food Stamps ? -(will not affect you getting food from us.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_66' id='input_14_66' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><option value='Applied' >Applied<\/option><\/select><\/div><\/div><div id=\"field_14_67\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter 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_14_67'>Amount  SNAP Benefits receiving monthly<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_67' id='input_14_67' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_14_68\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Would you like information or assistance to help apply?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_14_68'><div class='gchoice gchoice_14_68_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.1' type='checkbox'  value='Yes'  id='choice_14_68_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_68_1' id='label_14_68_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_14_68_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.2' type='checkbox'  value='No'  id='choice_14_68_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_14_68_2' id='label_14_68_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_14_10\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">INCOME<\/h3><div class='gsection_description' id='gfield_description_14_10'>Please List ALL INCOME FROM ENTIRE HOUSEHOLD -All Members &#8211; EVERYONE -including , Work &#8211; Soc Sec, Disability, Cash assistance, Unemployment , SSI, MISHDA , Child Support ,\nCLICK ON THE PLUS SIGN  ( +  ) TO ADD A NEW LINE. TYPE , or PERSON&#8217;S INCOME  ( + )\n\n<\/div><\/div><fieldset id=\"field_14_7\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >List<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Who&#039;s Income<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">From what company<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Gross Amount Received Per Payday<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">How Often &#8211; Weekly, Bi-weekly,Monthly<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_7_cell1 gform-grid-col' data-label='Who&#039;s Income'><input aria-invalid='false' aria-required=\"true\"  aria-label='Who&#039;s Income, Row 1' data-aria-label-template='Who&#039;s Income, Row {0}' type='text' name='input_7[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_7_cell2 gform-grid-col' data-label='From what company'><input aria-invalid='false' aria-required=\"true\"  aria-label='From what company, Row 1' data-aria-label-template='From what company, Row {0}' type='text' name='input_7[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_7_cell3 gform-grid-col' data-label='Gross Amount Received Per Payday'><input aria-invalid='false' aria-required=\"true\"  aria-label='Gross Amount Received Per Payday, Row 1' data-aria-label-template='Gross Amount Received Per Payday, Row {0}' type='text' name='input_7[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_7_cell4 gform-grid-col' data-label='How Often - Weekly, Bi-weekly,Monthly'><input aria-invalid='false' aria-required=\"true\"  aria-label='How Often - Weekly, Bi-weekly,Monthly, Row 1' data-aria-label-template='How Often - Weekly, Bi-weekly,Monthly, Row {0}' type='text' name='input_7[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 10)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 10)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_14_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">RENT \/ MORTGAGE<\/h3><\/div><fieldset id=\"field_14_38\" class=\"gfield gfield--type-list gfield--input-type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >List Rent Or Mortgage Info &#8211; Add a line ( +) for additional Expenses<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">LANDLORD\/ Mortgage paid to:<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">AMOUNT PER MONTH<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Note<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Court Date?<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell1 gform-grid-col' data-label='LANDLORD\/ Mortgage paid to:'><input aria-invalid='false' aria-required=\"true\"  aria-label='LANDLORD\/ Mortgage paid to:, Row 1' data-aria-label-template='LANDLORD\/ Mortgage paid to:, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell2 gform-grid-col' data-label='AMOUNT PER MONTH'><input aria-invalid='false' aria-required=\"true\"  aria-label='AMOUNT PER MONTH, Row 1' data-aria-label-template='AMOUNT PER MONTH, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell3 gform-grid-col' data-label='Note'><input aria-invalid='false' aria-required=\"true\"  aria-label='Note, Row 1' data-aria-label-template='Note, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell4 gform-grid-col' data-label='Court Date?'><input aria-invalid='false' aria-required=\"true\"  aria-label='Court Date?, Row 1' data-aria-label-template='Court Date?, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 10)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 10)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_14_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third 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_14_69'>Car\/vehicle payment Amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_14_69' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div data-fieldId=\"69\" class=\"spacer gfield\" style=\"grid-column: span 7;\" data-groupId=\"14552807\"><\/div><div id=\"field_14_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third 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_14_70'>Vehicle Insurance Amount<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_14_70' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div data-fieldId=\"70\" class=\"spacer gfield\" style=\"grid-column: span 9;\" data-groupId=\"ea5ed040\"><\/div><div id=\"field_14_28\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--no-description field_description_below 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id='gform_uploaded_files_14' value='' \/>\n        <\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"15\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 14, 'https:\/\/www.outreacheast.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_14').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_14');var is_confirmation = 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} );} );\n<\/script>\n\n\n\n<p>Please add <em>Outreacheast@hotmail<\/em>.com to your contacts to receive your response in email. and check you junk\/spam folder.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-red-color\"><em>We will usually respond within 24 hours or sooner by email with instructions &#8211; please check your junk \/ spam mail so you do not miss our response.<\/em><\/mark> <em>If you have not received a response with 48 hrs please call 810-653-7711 or email us at Outreacheast@hotmail.com <\/em><\/h4>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\"\/>\n\n\n\n<p>Privacy Policy \/ Waiver<\/p>\n\n\n\n<pre class=\"wp-block-verse\">In consideration for receiving assistance from Outreach East, I hereby release, waive<strong>,<\/strong> discharge and covenant not to sue Outreach East Inc., or its board, officers, agents, servants, employees, donors, individuals, or businesses (hereinafter referred to as \u201creleasees\u201d) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of, or related to, any loss, damage, or injury, including death, that may be sustained by me, or my children; whether caused by the actions or negligence of the releasees, or otherwise; or caused by any furniture, clothing, other items, foodstuffs, toys, and services provided.\nI understand that this release includes children\u2019s toys and the risks associated with the use thereof, including, but not limited to, choking and lead poisoning.\nI further agree to indemnify and hold harmless the releasees from any loss, liability, damage or costs including court costs and attorney fees that they may incur in connection with receiving assistance from releasees. It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the members of my family, spouse, and estate. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Michigan. If any portion of this contract is illegal, the illegal portion shall be severed, and the remainder of the contract shall remain in full force and effect.\nI hereby give permission for Outreach East and its satellite St. Francis Xavier Parish located in Otisville, MI to request from or give and receive information to the Genesee County Department of Social Services, Lapeer County Department of Social Services and\/or any agencies that might be assisting me as well as any company to verify information.  \nI understand that I can only receive help from one organization and my file will be closed at Outreach East if I use other organizations in addition to Outreach East.\nI further understand that any false or misleading statements given will prevent me from obtaining any further assistance.\nIn signing this agreement, I acknowledge and represent that I have read the foregoing, understand it, and sign it voluntarily. No oral representations, statements, or inducements, apart from the foregoing written agreement, have been made. I execute this agreement for full, adequate and complete consideration intending to be bound by the same.<\/pre>\n\n\n\n<p><\/p>\n\n\n<!-- wp:themify-builder\/canvas \/-->","protected":false},"excerpt":{"rendered":"<p>We are a non-denominational, walk-in, year-round emergency resource center servicing the Aprox. 225 square miles of east Genesee County with our office located in Davison, Mi. 1-Our Service Area includes [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_eb_attr":"","_uag_custom_page_level_css":"","ngg_post_thumbnail":0,"footnotes":""},"class_list":["post-4258","page","type-page","status-publish","hentry","has-post-title","has-post-date","has-post-category","has-post-tag","has-post-comment","has-post-author",""],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false,"gform-image-choice-sm":false,"gform-image-choice-md":false,"gform-image-choice-lg":false,"mailpoet_newsletter_max":false,"psacp-medium":false,"woocommerce_thumbnail":false,"woocommerce_single":false,"woocommerce_gallery_thumbnail":false},"uagb_author_info":{"display_name":"Scott","author_link":"https:\/\/www.outreacheast.org\/?author=7"},"uagb_comment_info":0,"uagb_excerpt":"We are a non-denominational, walk-in, year-round emergency resource center servicing the Aprox. 225 square miles of east Genesee County with our office located in Davison, Mi. 1-Our Service Area includes [&hellip;]","builder_content":"","_links":{"self":[{"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=\/wp\/v2\/pages\/4258","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4258"}],"version-history":[{"count":3,"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=\/wp\/v2\/pages\/4258\/revisions"}],"predecessor-version":[{"id":15022,"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=\/wp\/v2\/pages\/4258\/revisions\/15022"}],"wp:attachment":[{"href":"https:\/\/www.outreacheast.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}