{"id":2406,"date":"2020-01-27T14:08:35","date_gmt":"2020-01-27T19:08:35","guid":{"rendered":"https:\/\/nhsgreaterberks.org\/?page_id=2406"},"modified":"2024-03-20T19:29:11","modified_gmt":"2024-03-20T23:29:11","slug":"intake-form-spanish","status":"publish","type":"page","link":"https:\/\/nhsgb.org\/intake-form-spanish\/","title":{"rendered":"Spanish Intake Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row css=&#8221;.vc_custom_1710977339129{margin-top: 30px !important;}&#8221;][vc_column][vc_column_text]<div class=\"frm_forms  with_frm_style frm_center_submit frm_style_formidable-style\" id=\"frm_form_25_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form intake-form frm_js_validate  frm_ajax_submit  frm_pro_form \" id=\"form_intake_form_spanish2\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Intake Form - Spanish<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"25\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_25\" id=\"frm_hide_fields_25\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"intake_form_spanish2\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_25\" name=\"frm_submit_entry_25\" value=\"8106279192\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/2406\" \/><div id=\"frm_field_1624_container\" class=\"frm_form_field frm_section_heading form-field  frm_hide_section\">\r\n<h3 class=\"frm_pos_none frm_section_spacing\"><\/h3>\r\n\r\n\r\n<div id=\"frm_field_1626_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_program frm_first horizontal_radio\">\r\n    <div  id=\"field_program4_label\" class=\"frm_primary_label\">Programa\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_program4_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1626-1624-1\"><label for=\"field_program4-1\">\t\t<input type=\"radio\" name=\"item_meta[1626]\" id=\"field_program4-1\" value=\"CLASE DE PRIMER COMPRADOR\"\n\t\t   data-sectionid=\"1624\" data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> CLASE DE PRIMER COMPRADOR<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1626-1624-0\"><label for=\"field_program4-0\">\t\t<input type=\"radio\" name=\"item_meta[1626]\" id=\"field_program4-0\" value=\"CONSEJERIA DE CREDITO\"\n\t\t   data-sectionid=\"1624\" data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> CONSEJERIA DE CREDITO<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1626-1624-2\"><label for=\"field_program4-2\">\t\t<input type=\"radio\" name=\"item_meta[1626]\" id=\"field_program4-2\" value=\"PRESTAMOS PARA GASTOS DE CIERRE\"\n\t\t   data-sectionid=\"1624\" data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> PRESTAMOS PARA GASTOS DE CIERRE<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1626-1624-3\"><label for=\"field_program4-3\">\t\t<input type=\"radio\" name=\"item_meta[1626]\" id=\"field_program4-3\" value=\"MY LIFE - REPARACION\"\n\t\t   data-sectionid=\"1624\" data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> MY LIFE - REPARACION<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1628_container\" class=\"frm_form_field frm_section_heading form-field  frm_full section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">SOLICITANTE<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1629_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_full_name4\" id=\"field_full_name4_label\" class=\"frm_primary_label\">Nombre Completo\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_full_name4\" name=\"item_meta[1629]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Nombre Completo cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1630_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_email44\" id=\"field_email44_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_email44\" name=\"item_meta[1630]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Email cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1631_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <label for=\"field_street44\" id=\"field_street44_label\" class=\"frm_primary_label\">Calle\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_street44\" name=\"item_meta[1631]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Calle cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1633_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n    <label for=\"field_city44\" id=\"field_city44_label\" class=\"frm_primary_label\">Ciudad\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_city44\" name=\"item_meta[1633]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Ciudad cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1634_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_state44\" id=\"field_state44_label\" class=\"frm_primary_label\">Estado\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_state44\" name=\"item_meta[1634]\" value=\"\"  data-sectionid=\"1628\" maxlength=\"2\" data-reqmsg=\"Estado cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1635_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_zip_code44\" id=\"field_zip_code44_label\" class=\"frm_primary_label\">C\u00f3digo Postal\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zip_code44\" name=\"item_meta[1635]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"C\u00f3digo Postal cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1639_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_odd frm_first\">\r\n    <label for=\"field_birth_date44\" id=\"field_birth_date44_label\" class=\"frm_primary_label\">Fecha de nacimiento\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_birth_date44\" name=\"item_meta[1639]\" value=\"\"  data-sectionid=\"1628\" maxlength=\"10\" data-reqmsg=\"Fecha de nacimiento cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1636_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n    <label for=\"field_home_phone44\" id=\"field_home_phone44_label\" class=\"frm_primary_label\">Tel\u00e9fono\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_home_phone44\" name=\"item_meta[1636]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Tel\u00e9fono cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1638_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n    <label for=\"field_social_security_no4\" id=\"field_social_security_no4_label\" class=\"frm_primary_label\">Seguro Social #\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_social_security_no4\" name=\"item_meta[1638]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Seguro Social # cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1643_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first horizontal_radio\">\r\n    <div  id=\"field_us_citizen232fdbd88d2_label\" class=\"frm_primary_label\">Estado de ciudadan\u00eda\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_us_citizen232fdbd88d2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1643-1628-0\"><label for=\"field_us_citizen232fdbd88d2-0\">\t\t<input type=\"radio\" name=\"item_meta[1643]\" id=\"field_us_citizen232fdbd88d2-0\" value=\"Ciudadano (a)\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Estado de ciudadan\u00eda cannot be blank.\" data-invmsg=\"Estado de ciudadan\u00eda is invalid\" aria-invalid=\"false\"  \/> Ciudadano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1643-1628-1\"><label for=\"field_us_citizen232fdbd88d2-1\">\t\t<input type=\"radio\" name=\"item_meta[1643]\" id=\"field_us_citizen232fdbd88d2-1\" value=\"Residente permanente\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Estado de ciudadan\u00eda cannot be blank.\" data-invmsg=\"Estado de ciudadan\u00eda is invalid\" aria-invalid=\"false\"  \/> Residente permanente<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1643-1628-2\"><label for=\"field_us_citizen232fdbd88d2-2\">\t\t<input type=\"radio\" name=\"item_meta[1643]\" id=\"field_us_citizen232fdbd88d2-2\" value=\"Residente no permanente\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Estado de ciudadan\u00eda cannot be blank.\" data-invmsg=\"Estado de ciudadan\u00eda is invalid\" aria-invalid=\"false\"  \/> Residente no permanente<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1640_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 horizontal_radio\">\r\n    <div  id=\"field_gender44_label\" class=\"frm_primary_label\">G\u00e9nero\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_gender44_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1640-1628-0\"><label for=\"field_gender44-0\">\t\t<input type=\"radio\" name=\"item_meta[1640]\" id=\"field_gender44-0\" value=\"Masculino\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"G\u00e9nero cannot be blank.\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Masculino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1640-1628-1\"><label for=\"field_gender44-1\">\t\t<input type=\"radio\" name=\"item_meta[1640]\" id=\"field_gender44-1\" value=\"Femenino\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"G\u00e9nero cannot be blank.\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Femenino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1640-1628-2\"><label for=\"field_gender44-2\">\t\t<input type=\"radio\" name=\"item_meta[1640]\" id=\"field_gender44-2\" value=\"Otros\/No conformes\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"G\u00e9nero cannot be blank.\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Otros\/No conformes<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1645_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_odd frm_first horizontal_radio\">\r\n    <div  id=\"field_first_time_home_buyer34_label\" class=\"frm_primary_label\">Comprador de casa por primera vez\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_first_time_home_buyer34_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1645-1628-0\"><label for=\"field_first_time_home_buyer34-0\">\t\t<input type=\"radio\" name=\"item_meta[1645]\" id=\"field_first_time_home_buyer34-0\" value=\"Si\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Comprador de casa por primera vez cannot be blank.\" data-invmsg=\"Comprador de casa por primera vez is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1645-1628-1\"><label for=\"field_first_time_home_buyer34-1\">\t\t<input type=\"radio\" name=\"item_meta[1645]\" id=\"field_first_time_home_buyer34-1\" value=\"No\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Comprador de casa por primera vez cannot be blank.\" data-invmsg=\"Comprador de casa por primera vez is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1641_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 horizontal_radio\">\r\n    <div  id=\"field_handicapped44_label\" class=\"frm_primary_label\">Discapacitados\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_handicapped44_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1641-1628-0\"><label for=\"field_handicapped44-0\">\t\t<input type=\"radio\" name=\"item_meta[1641]\" id=\"field_handicapped44-0\" value=\"Si\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Discapacitados cannot be blank.\" data-invmsg=\"Discapacitados is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1641-1628-1\"><label for=\"field_handicapped44-1\">\t\t<input type=\"radio\" name=\"item_meta[1641]\" id=\"field_handicapped44-1\" value=\"No\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Discapacitados cannot be blank.\" data-invmsg=\"Discapacitados is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1642_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_odd horizontal_radio\">\r\n    <div  id=\"field_veteran44_label\" class=\"frm_primary_label\">Veterano\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_veteran44_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1642-1628-0\"><label for=\"field_veteran44-0\">\t\t<input type=\"radio\" name=\"item_meta[1642]\" id=\"field_veteran44-0\" value=\"Si\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Veterano cannot be blank.\" data-invmsg=\"Veterano is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1642-1628-1\"><label for=\"field_veteran44-1\">\t\t<input type=\"radio\" name=\"item_meta[1642]\" id=\"field_veteran44-1\" value=\"No\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Veterano cannot be blank.\" data-invmsg=\"Veterano is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1648_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_household_type44_label\" class=\"frm_primary_label\">Estado Matrimonial\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_household_type44_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1648-1628-0\"><label for=\"field_household_type44-0\">\t\t<input type=\"radio\" name=\"item_meta[1648]\" id=\"field_household_type44-0\" value=\"No Casado\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> No Casado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1648-1628-1\"><label for=\"field_household_type44-1\">\t\t<input type=\"radio\" name=\"item_meta[1648]\" id=\"field_household_type44-1\" value=\"Casado\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Casado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1648-1628-2\"><label for=\"field_household_type44-2\">\t\t<input type=\"radio\" name=\"item_meta[1648]\" id=\"field_household_type44-2\" value=\"Separado\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Separado<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1649_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_family_size4\" id=\"field_family_size4_label\" class=\"frm_primary_label\">Tama\u00f1o de la familia\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_family_size4\" name=\"item_meta[1649]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Tama\u00f1o de la familia cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1650_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_dependents4\" id=\"field_dependents4_label\" class=\"frm_primary_label\">Dependientes\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dependents4\" name=\"item_meta[1650]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Dependientes cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1651_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_monthly_income4\" id=\"field_monthly_income4_label\" class=\"frm_primary_label\">Ingreso Mensual\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_monthly_income4\" name=\"item_meta[1651]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Ingreso Mensual cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1652_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_household_income4\" id=\"field_household_income4_label\" class=\"frm_primary_label\">Ingreso del hogar\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_household_income4\" name=\"item_meta[1652]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Ingreso del hogar cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1653_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_employer_name32\" id=\"field_employer_name32_label\" class=\"frm_primary_label\">Nombre del empleador\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_employer_name32\" name=\"item_meta[1653]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Nombre del empleador cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_employer_name32\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_employer_name32\">Si no est\u00e1 trabajando ingrese n\/a<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1656_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n    <label for=\"field_hourly_rate32\" id=\"field_hourly_rate32_label\" class=\"frm_primary_label\">Tarifa por hora\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hourly_rate32\" name=\"item_meta[1656]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Tarifa por hora cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1657_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_odd\">\r\n    <label for=\"field_start_date7e6ec5accf2\" id=\"field_start_date7e6ec5accf2_label\" class=\"frm_primary_label\">Fecha de inicio\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_start_date7e6ec5accf2\" name=\"item_meta[1657]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Fecha de inicio cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1658_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_education_level44_label\" class=\"frm_primary_label\">Nivel de Educaci\u00f3n (por favor marque uno)\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_education_level44_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1658-1628-0\"><label for=\"field_education_level44-0\">\t\t<input type=\"radio\" name=\"item_meta[1658]\" id=\"field_education_level44-0\" value=\"No termino preparatoria\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) cannot be blank.\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> No termino preparatoria<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1658-1628-1\"><label for=\"field_education_level44-1\">\t\t<input type=\"radio\" name=\"item_meta[1658]\" id=\"field_education_level44-1\" value=\"Diploma preparatoria\/equivalente\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) cannot be blank.\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Diploma preparatoria\/equivalente<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1658-1628-2\"><label for=\"field_education_level44-2\">\t\t<input type=\"radio\" name=\"item_meta[1658]\" id=\"field_education_level44-2\" value=\"Otros\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) cannot be blank.\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Otros<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1659_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_ethnicity_hispanic4_label\" class=\"frm_primary_label\">Hispano\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ethnicity_hispanic4_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1659-1628-0\"><label for=\"field_ethnicity_hispanic4-0\">\t\t<input type=\"radio\" name=\"item_meta[1659]\" id=\"field_ethnicity_hispanic4-0\" value=\"Si\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Hispano cannot be blank.\" data-invmsg=\"Hispano is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1659-1628-1\"><label for=\"field_ethnicity_hispanic4-1\">\t\t<input type=\"radio\" name=\"item_meta[1659]\" id=\"field_ethnicity_hispanic4-1\" value=\"No\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Hispano cannot be blank.\" data-invmsg=\"Hispano is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1660_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first frm_three_col\">\r\n    <div  id=\"field_race44_label\" class=\"frm_primary_label\">Raza\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_race44_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1660-1628-0\"><label for=\"field_race44-0\">\t\t<input type=\"radio\" name=\"item_meta[1660]\" id=\"field_race44-0\" value=\"Dominicano (a)\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Dominicano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1660-1628-1\"><label for=\"field_race44-1\">\t\t<input type=\"radio\" name=\"item_meta[1660]\" id=\"field_race44-1\" value=\"Blanco\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Blanco<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1660-1628-2\"><label for=\"field_race44-2\">\t\t<input type=\"radio\" name=\"item_meta[1660]\" id=\"field_race44-2\" value=\"Negro\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Negro<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1660-1628-3\"><label for=\"field_race44-3\">\t\t<input type=\"radio\" name=\"item_meta[1660]\" id=\"field_race44-3\" value=\"Mexicano (a)\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Mexicano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1660-1628-4\"><label for=\"field_race44-4\">\t\t<input type=\"radio\" name=\"item_meta[1660]\" id=\"field_race44-4\" value=\"Puertorriqueno (a)\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Puertorrique\u00f1o (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1660-1628-7\"><label for=\"field_race44-7\">\t\t<input type=\"radio\" name=\"item_meta[1660]\" id=\"field_race44-7\" value=\"Eligio no responder\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Eligi\u00f3 no responder<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1660-1628-8\"><label for=\"field_race44-8\">\t\t<input type=\"radio\" name=\"item_meta[1660]\" id=\"field_race44-8\" value=\"Otro\"\n\t\t   data-sectionid=\"1628\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Otro<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1661_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_race_other4aaf9f42542\" id=\"field_race_other4aaf9f42542_label\" class=\"frm_primary_label\">Ingrese su raza\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_race_other4aaf9f42542\" name=\"item_meta[1661]\" value=\"\"  data-sectionid=\"1628\" data-reqmsg=\"Ingrese su raza cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1663_container\" class=\"frm_form_field frm_section_heading form-field  frm_full  section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">CO-SOLICITANTE<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1664_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third\">\r\n    <label for=\"field_co_full_name32\" id=\"field_co_full_name32_label\" class=\"frm_primary_label\">Nombre Completo\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_full_name32\" name=\"item_meta[1664]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1665_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_relationship_to_applicant4\" id=\"field_relationship_to_applicant4_label\" class=\"frm_primary_label\">Relaci\u00f3n al solicitante\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_relationship_to_applicant4\" name=\"item_meta[1665]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1666_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_email54\" id=\"field_co_email54_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_co_email54\" name=\"item_meta[1666]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1667_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_co_street34\" id=\"field_co_street34_label\" class=\"frm_primary_label\">Calle\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_street34\" name=\"item_meta[1667]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1669_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third\">\r\n    <label for=\"field_co_city54\" id=\"field_co_city54_label\" class=\"frm_primary_label\">Ciudad\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_city54\" name=\"item_meta[1669]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1670_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_state54\" id=\"field_co_state54_label\" class=\"frm_primary_label\">Estado\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_state54\" name=\"item_meta[1670]\" value=\"\"  data-sectionid=\"1663\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1671_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_zip_code54\" id=\"field_co_zip_code54_label\" class=\"frm_primary_label\">C\u00f3digo Postal\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_zip_code54\" name=\"item_meta[1671]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1675_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_odd frm_first\">\r\n    <label for=\"field_co_birth_date44\" id=\"field_co_birth_date44_label\" class=\"frm_primary_label\">Fecha de nacimiento\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_birth_date44\" name=\"item_meta[1675]\" value=\"\"  data-sectionid=\"1663\" maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1672_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_co_home_phone54\" id=\"field_co_home_phone54_label\" class=\"frm_primary_label\">Tel\u00e9fono\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_co_home_phone54\" name=\"item_meta[1672]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1674_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_co_social_security_no32\" id=\"field_co_social_security_no32_label\" class=\"frm_primary_label\">Seguro Social #\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_social_security_no32\" name=\"item_meta[1674]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1679_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first horizontal_radio\">\r\n    <div  id=\"field_co_us_citizenaad6c11ad32_label\" class=\"frm_primary_label\">Estado de ciudadan\u00eda\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_us_citizenaad6c11ad32_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1679-1663-0\"><label for=\"field_co_us_citizenaad6c11ad32-0\">\t\t<input type=\"radio\" name=\"item_meta[1679]\" id=\"field_co_us_citizenaad6c11ad32-0\" value=\"Ciudadano (a)\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Estado de ciudadan\u00eda is invalid\" aria-invalid=\"false\"  \/> Ciudadano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1679-1663-1\"><label for=\"field_co_us_citizenaad6c11ad32-1\">\t\t<input type=\"radio\" name=\"item_meta[1679]\" id=\"field_co_us_citizenaad6c11ad32-1\" value=\"Residente permanente\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Estado de ciudadan\u00eda is invalid\" aria-invalid=\"false\"  \/> Residente permanente<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1679-1663-2\"><label for=\"field_co_us_citizenaad6c11ad32-2\">\t\t<input type=\"radio\" name=\"item_meta[1679]\" id=\"field_co_us_citizenaad6c11ad32-2\" value=\"Residente no permanente\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Estado de ciudadan\u00eda is invalid\" aria-invalid=\"false\"  \/> Residente no permanente<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1676_container\" class=\"frm_form_field form-field  frm_top_container frm6 horizontal_radio\">\r\n    <div  id=\"field_co_gender44_label\" class=\"frm_primary_label\">G\u00e9nero\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_gender44_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1676-1663-0\"><label for=\"field_co_gender44-0\">\t\t<input type=\"radio\" name=\"item_meta[1676]\" id=\"field_co_gender44-0\" value=\"Masculino\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Masculino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1676-1663-1\"><label for=\"field_co_gender44-1\">\t\t<input type=\"radio\" name=\"item_meta[1676]\" id=\"field_co_gender44-1\" value=\"Femenino\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Femenino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1676-1663-2\"><label for=\"field_co_gender44-2\">\t\t<input type=\"radio\" name=\"item_meta[1676]\" id=\"field_co_gender44-2\" value=\"Otro\/No conformes\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Otro\/No conformes<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1681_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_odd frm_first horizontal_radio\">\r\n    <div  id=\"field_co_first_time_home_buyer44_label\" class=\"frm_primary_label\">Comprador de casa por primera vez\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_first_time_home_buyer44_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1681-1663-0\"><label for=\"field_co_first_time_home_buyer44-0\">\t\t<input type=\"radio\" name=\"item_meta[1681]\" id=\"field_co_first_time_home_buyer44-0\" value=\"Si\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Comprador de casa por primera vez is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1681-1663-1\"><label for=\"field_co_first_time_home_buyer44-1\">\t\t<input type=\"radio\" name=\"item_meta[1681]\" id=\"field_co_first_time_home_buyer44-1\" value=\"No\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Comprador de casa por primera vez is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1677_container\" class=\"frm_form_field form-field  frm_top_container frm4 horizontal_radio\">\r\n    <div  id=\"field_co_handicapped44_label\" class=\"frm_primary_label\">Discapacitados\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_handicapped44_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1677-1663-0\"><label for=\"field_co_handicapped44-0\">\t\t<input type=\"radio\" name=\"item_meta[1677]\" id=\"field_co_handicapped44-0\" value=\"Si\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Discapacitados is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1677-1663-1\"><label for=\"field_co_handicapped44-1\">\t\t<input type=\"radio\" name=\"item_meta[1677]\" id=\"field_co_handicapped44-1\" value=\"No\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Discapacitados is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1678_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_odd horizontal_radio\">\r\n    <div  id=\"field_co_veteran34_label\" class=\"frm_primary_label\">Veterano\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_veteran34_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1678-1663-0\"><label for=\"field_co_veteran34-0\">\t\t<input type=\"radio\" name=\"item_meta[1678]\" id=\"field_co_veteran34-0\" value=\"Si\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Veterano is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1678-1663-1\"><label for=\"field_co_veteran34-1\">\t\t<input type=\"radio\" name=\"item_meta[1678]\" id=\"field_co_veteran34-1\" value=\"No\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Veterano is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1684_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_co_household_type32_label\" class=\"frm_primary_label\">Estado Matrimonial\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_household_type32_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1684-1663-0\"><label for=\"field_co_household_type32-0\">\t\t<input type=\"radio\" name=\"item_meta[1684]\" id=\"field_co_household_type32-0\" value=\"No Casado\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> No Casado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1684-1663-1\"><label for=\"field_co_household_type32-1\">\t\t<input type=\"radio\" name=\"item_meta[1684]\" id=\"field_co_household_type32-1\" value=\"Casado\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Casado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1684-1663-2\"><label for=\"field_co_household_type32-2\">\t\t<input type=\"radio\" name=\"item_meta[1684]\" id=\"field_co_household_type32-2\" value=\"Separado\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Separado<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1685_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_co_family_size32\" id=\"field_co_family_size32_label\" class=\"frm_primary_label\">Tama\u00f1o de la familia\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_family_size32\" name=\"item_meta[1685]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1686_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_dependents32\" id=\"field_co_dependents32_label\" class=\"frm_primary_label\">Dependientes\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_dependents32\" name=\"item_meta[1686]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1687_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_co_monthly_income32\" id=\"field_co_monthly_income32_label\" class=\"frm_primary_label\">Ingreso mensual\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_monthly_income32\" name=\"item_meta[1687]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1688_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_household_income4\" id=\"field_co_household_income4_label\" class=\"frm_primary_label\">Ingreso del hogar\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_household_income4\" name=\"item_meta[1688]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1689_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first\">\r\n    <label for=\"field_co_employer_name32\" id=\"field_co_employer_name32_label\" class=\"frm_primary_label\">Nombre del empleador\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_employer_name32\" name=\"item_meta[1689]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1692_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_co_hourly_rate32\" id=\"field_co_hourly_rate32_label\" class=\"frm_primary_label\">Tarifa por hora\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_hourly_rate32\" name=\"item_meta[1692]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1693_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_odd\">\r\n    <label for=\"field_co_start_datecbd2013b3\" id=\"field_co_start_datecbd2013b3_label\" class=\"frm_primary_label\">Fecha de inicio\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_start_datecbd2013b3\" name=\"item_meta[1693]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1694_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_co_education_level32_label\" class=\"frm_primary_label\">Nivel de Educaci\u00f3n (por favor marque uno)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_education_level32_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1694-1663-0\"><label for=\"field_co_education_level32-0\">\t\t<input type=\"radio\" name=\"item_meta[1694]\" id=\"field_co_education_level32-0\" value=\"No termino preparatoria\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> No termino preparatoria<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1694-1663-1\"><label for=\"field_co_education_level32-1\">\t\t<input type=\"radio\" name=\"item_meta[1694]\" id=\"field_co_education_level32-1\" value=\"Diploma preparatoria\/equivalente\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Diploma preparatoria\/equivalente<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1694-1663-2\"><label for=\"field_co_education_level32-2\">\t\t<input type=\"radio\" name=\"item_meta[1694]\" id=\"field_co_education_level32-2\" value=\"Otros\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Otros<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1695_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_co_ethnicity_hispanic32_label\" class=\"frm_primary_label\">Hispano\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_ethnicity_hispanic32_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1695-1663-0\"><label for=\"field_co_ethnicity_hispanic32-0\">\t\t<input type=\"radio\" name=\"item_meta[1695]\" id=\"field_co_ethnicity_hispanic32-0\" value=\"Si\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Hispano is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1695-1663-1\"><label for=\"field_co_ethnicity_hispanic32-1\">\t\t<input type=\"radio\" name=\"item_meta[1695]\" id=\"field_co_ethnicity_hispanic32-1\" value=\"No\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Hispano is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1696_container\" class=\"frm_form_field form-field  frm_top_container frm_three_col\">\r\n    <div  id=\"field_co_race44_label\" class=\"frm_primary_label\">Raza\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_race44_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1696-1663-0\"><label for=\"field_co_race44-0\">\t\t<input type=\"radio\" name=\"item_meta[1696]\" id=\"field_co_race44-0\" value=\"Dominicano (a)\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Dominicano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1696-1663-1\"><label for=\"field_co_race44-1\">\t\t<input type=\"radio\" name=\"item_meta[1696]\" id=\"field_co_race44-1\" value=\"Blanco\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Blanco<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1696-1663-2\"><label for=\"field_co_race44-2\">\t\t<input type=\"radio\" name=\"item_meta[1696]\" id=\"field_co_race44-2\" value=\"Negro\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Negro<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1696-1663-3\"><label for=\"field_co_race44-3\">\t\t<input type=\"radio\" name=\"item_meta[1696]\" id=\"field_co_race44-3\" value=\"Mexicano (a)\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Mexicano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1696-1663-4\"><label for=\"field_co_race44-4\">\t\t<input type=\"radio\" name=\"item_meta[1696]\" id=\"field_co_race44-4\" value=\"Puertorriqueno (a)\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Puertorrique\u00f1o (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1696-1663-7\"><label for=\"field_co_race44-7\">\t\t<input type=\"radio\" name=\"item_meta[1696]\" id=\"field_co_race44-7\" value=\"Eligio no responder\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Eligi\u00f3 no responder<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1696-1663-8\"><label for=\"field_co_race44-8\">\t\t<input type=\"radio\" name=\"item_meta[1696]\" id=\"field_co_race44-8\" value=\"Otro\"\n\t\t   data-sectionid=\"1663\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Otro<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1697_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_co_race_other49b7af3d7d2\" id=\"field_co_race_other49b7af3d7d2_label\" class=\"frm_primary_label\">Ingrese su raza\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_race_other49b7af3d7d2\" name=\"item_meta[1697]\" value=\"\"  data-sectionid=\"1663\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1704_container\" class=\"frm_form_field frm_section_heading form-field  frm_full section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">REFERIDO AL CENTRO DE PROPIEDAD DE VIVIENDA POR: (POR FAVOR MARQUE TODAS LAS QUE APLIQUE)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1705_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_full frm_three_col\">\r\n    <div  id=\"field_refered_by3_label\" class=\"frm_primary_label\">Referido por\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_refered_by3_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1705-1704-0\"><label for=\"field_refered_by3-0\"><input type=\"checkbox\" name=\"item_meta[1705][]\" id=\"field_refered_by3-0\" value=\"Yo mismo\"  data-sectionid=\"1704\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> Yo mismo<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1705-1704-1\"><label for=\"field_refered_by3-1\"><input type=\"checkbox\" name=\"item_meta[1705][]\" id=\"field_refered_by3-1\" value=\"Pagina web NHS\"  data-sectionid=\"1704\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Pagina web NHS<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1705-1704-2\"><label for=\"field_refered_by3-2\"><input type=\"checkbox\" name=\"item_meta[1705][]\" id=\"field_refered_by3-2\" value=\"Facebook\"  data-sectionid=\"1704\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Facebook<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1705-1704-3\"><label for=\"field_refered_by3-3\"><input type=\"checkbox\" name=\"item_meta[1705][]\" id=\"field_refered_by3-3\" value=\"Amigo o familiar\"  data-sectionid=\"1704\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Amigo o familiar<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1705-1704-6\"><label for=\"field_refered_by3-6\"><input type=\"checkbox\" name=\"item_meta[1705][]\" id=\"field_refered_by3-6\" value=\"Prestamista\"  data-sectionid=\"1704\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Prestamista<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1705-1704-7\"><label for=\"field_refered_by3-7\"><input type=\"checkbox\" name=\"item_meta[1705][]\" id=\"field_refered_by3-7\" value=\"Agente de Bienes Raices\"  data-sectionid=\"1704\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Agente de Bienes Ra\u00edces<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1705-1704-8\"><label for=\"field_refered_by3-8\"><input type=\"checkbox\" name=\"item_meta[1705][]\" id=\"field_refered_by3-8\" value=\"Otro\"  data-sectionid=\"1704\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Otro<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1700_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first horizontal_radio\">\r\n    <div  id=\"field_working_with_lender734464009e2_label\" class=\"frm_primary_label\">Estas Trabajando Actualmente con un Lender\/ Banco\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_working_with_lender734464009e2_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1700-1704-0\"><label for=\"field_working_with_lender734464009e2-0\">\t\t<input type=\"radio\" name=\"item_meta[1700]\" id=\"field_working_with_lender734464009e2-0\" value=\"Si\"\n\t\t   data-sectionid=\"1704\" data-invmsg=\"Estas Trabajando Actualmente con un Lender\/ Banco is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1700-1704-1\"><label for=\"field_working_with_lender734464009e2-1\">\t\t<input type=\"radio\" name=\"item_meta[1700]\" id=\"field_working_with_lender734464009e2-1\" value=\"No\"\n\t\t   data-sectionid=\"1704\" data-invmsg=\"Estas Trabajando Actualmente con un Lender\/ Banco is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1701_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_name_of_bank79b41ca2d\" id=\"field_name_of_bank79b41ca2d_label\" class=\"frm_primary_label\">Nombre del Banco\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_name_of_bank79b41ca2d\" name=\"item_meta[1701]\" value=\"\"  data-sectionid=\"1704\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1710_container\" class=\"frm_form_field frm_section_heading form-field  frm_full section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">AUTORIZACI\u00d3N Y CERTIFICACI\u00d3N<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1711_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h4>SOLICITO Y AUTORIZO A NHS GREATER BERKS A:<\/h4>\n<p>Pida mi\/nuestro informe de cr\u00e9dito para revisar mi\/nuestro archivo de cr\u00e9dito para la Consejer\u00eda de vivienda en relaci\u00f3n con mi b\u00fasqueda de unpr\u00e9stamo para comprar bienes inmobiliarios.<\/p>\n<h4>CERTIFICACI\u00d3N DEL CLIENTE:<\/h4>\n<p>Yo\/Nosotros certificamos que la informaci\u00f3n incluida en este formulario es verdadera y completa a lo mejor de mi\/nuestro conocimiento ycreencia.<\/p><\/div>\n<div id=\"frm_field_1716_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_two_thirds frm_sig\">\r\n    <label for=\"field_applicant_signature4\" id=\"field_applicant_signature4_label\" class=\"frm_primary_label\">Firma del solicitante\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1716\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:100px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:10px;--button-size:16px;--button-padding:8px;--button-side-margin:20px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[1716][typed]\" class=\"name\" id=\"field_applicant_signature4\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"100\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1716][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1717_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_applicant_signature_date4\" id=\"field_applicant_signature_date4_label\" class=\"frm_primary_label\">Fecha\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_applicant_signature_date4\" name=\"item_meta[1717]\" value=\"\"  data-sectionid=\"1710\" maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1718_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_two_thirds frm_sig\">\r\n    <label for=\"field_co_applicant_signature4\" id=\"field_co_applicant_signature4_label\" class=\"frm_primary_label\">Firma del Co-solicitante\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1718\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:100px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:10px;--button-size:16px;--button-padding:8px;--button-side-margin:20px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[1718][typed]\" class=\"name\" id=\"field_co_applicant_signature4\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"100\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1718][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1719_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_applicant_signature_date4\" id=\"field_co_applicant_signature_date4_label\" class=\"frm_primary_label\">Fecha\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_applicant_signature_date4\" name=\"item_meta[1719]\" value=\"\"  data-sectionid=\"1710\" maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1796_container\" class=\"frm_form_field frm_section_heading form-field  frm_full frm_adp section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">DECLARACI\u00d3N DE AUTORIZACI\u00d3N, DIVULGACI\u00d3N Y PRIVACIDAD (3 en 1)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1798_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h4>MI INFORMACI\u00d3N PERSONAL Y LOS SERVICIOS DE ASESORAMIENTO<\/h4>\n<p>Al firmar este formulario, acepto compartir mi informaci\u00f3n financiera y otra informaci\u00f3n privada. La firma de este documento les permite a los prestamistas y la Agencia de Consejeria discutir mis cuentas, cr\u00e9dito y finanzas, y compartir mi informaci\u00f3n personal no publica, privada, descrita en la Pol\u00edtica de Privacidad que se proporciona con esta autorizaci\u00f3n.<\/p>\n<p>Comprendo que los financiadores proporcionan subvenciones (becas) para hacer posible el servicio de asesoramiento y que la Agencia de Consejeria comparte mi informaci\u00f3n con estos financiadores. Estos financiadores revisan los archivos de la Agencia de Consejeria, incluido mi archivo, y pueden contactarse conmigo para evaluar los servicios de consejeria que recibo.<\/p>\n<p>Autorizo a mi consejero (a) y la Agencia de Consejeria a negociar por m\u00ed. Los servicios de consejeria se ofrecen de manera gratuita, y ni el consejero (a) ni la Agencia de Consejeria garantizan ning\u00fan resultado o consecuencia. Se me puede referir a otra agencia de vivienda para obtener sus servicios. No estoy obligado (a) a aceptar los servicios o productos de la Agencia de Consejeria, de sus socios, ni de ninguna organizaci\u00f3n a la que se me refiera.<\/p>\n<p>Comprendo que mi consejero (a) no puede ofrecerme asesor\u00eda, ni representaci\u00f3n jur\u00eddica (legal) ni ninguna otra asesor\u00eda o representaci\u00f3n profesional. Si necesito servicios legales u otros servicios profesionales puedo solicitarle a mi Asesor que me proporcione informaci\u00f3n sobre servicios de referencia.<\/p>\n<h5>Lista de Control de los Servicios de Asesoramiento<\/h5>\n<p>Por favor ponga sus iniciales en todos los elementos aplicables.<\/p><\/div>\n<div id=\"frm_field_1799_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_wi2ok\" id=\"field_wi2ok_label\" class=\"frm_primary_label\">Me han informado verbalmente la lista de tarifas, si la hubiera, con anticipaci\u00f3n a los servicios prestados.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_wi2ok\" name=\"item_meta[1799]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1877_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_i4ph1\" id=\"field_i4ph1_label\" class=\"frm_primary_label\">He discutido las opciones para el comprador de vivienda y los temas relacionados con la Pre-Compra y he recibido los formularios de HUD. \u201cDiez preguntas importantes para hacerle a su inspector de viviendas\u201d y \"Para su protecci\u00f3n: obtenga una inspecci\u00f3n de la vivienda\"\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_i4ph1\" name=\"item_meta[1877]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1878_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_21t1s\" id=\"field_21t1s_label\" class=\"frm_primary_label\">He recibido y revisado una copia del Folleto de Vivienda Justa\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_21t1s\" name=\"item_meta[1878]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1800_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_3ub8v\" id=\"field_3ub8v_label\" class=\"frm_primary_label\">Entiendo que el consejero (a) discutir\u00e1 mi presupuesto conmigo y recibir\u00e9 una copia de mi presupuesto\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_3ub8v\" name=\"item_meta[1800]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1801_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_x720\" id=\"field_x720_label\" class=\"frm_primary_label\">Entiendo que el consejero (a) discutir\u00e1 mi Plan de Acci\u00f3n conmigo y recibir\u00e9 una copia de mi Plan de Acci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_x720\" name=\"item_meta[1801]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1802_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_79kpq\" id=\"field_79kpq_label\" class=\"frm_primary_label\">Entiendo que el consejero (a) me explicar\u00e1 los pr\u00f3ximos pasos necesarios para alcanzar mis metas financieras para mi satisfacci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_79kpq\" name=\"item_meta[1802]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1803_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_z9fer\" id=\"field_z9fer_label\" class=\"frm_primary_label\">Consejer\u00eda para Compradores de Viviendas.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_z9fer\" name=\"item_meta[1803]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1804_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_1z8md\" id=\"field_1z8md_label\" class=\"frm_primary_label\">Educaci\u00f3n para Compradores de Viviendas\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_1z8md\" name=\"item_meta[1804]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1883_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_622uq\" id=\"field_622uq_label\" class=\"frm_primary_label\">Consejer\u00eda para Propietarios de Viviendas\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_622uq\" name=\"item_meta[1883]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1884_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_cs22o\" id=\"field_cs22o_label\" class=\"frm_primary_label\">Educaci\u00f3n para Propietarios de Vivienda\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_cs22o\" name=\"item_meta[1884]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1805_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_ynsuc\" id=\"field_ynsuc_label\" class=\"frm_primary_label\">Consejeria sobre Delincuencia\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_ynsuc\" name=\"item_meta[1805]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1806_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_i3t2f\" id=\"field_i3t2f_label\" class=\"frm_primary_label\">Educaci\u00f3n para delincuencia de incumplimiento de pago\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_i3t2f\" name=\"item_meta[1806]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1807_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_3gmlw\" id=\"field_3gmlw_label\" class=\"frm_primary_label\">Consejeria de Hipotecas Inversas\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_3gmlw\" name=\"item_meta[1807]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1808_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_pzn4h\" id=\"field_pzn4h_label\" class=\"frm_primary_label\">Educaci\u00f3n sobre Vivienda Justa\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_pzn4h\" name=\"item_meta[1808]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1809_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_asvp6\" id=\"field_asvp6_label\" class=\"frm_primary_label\">Consejeria para Inquilinos\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_asvp6\" name=\"item_meta[1809]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1810_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_58hiq\" id=\"field_58hiq_label\" class=\"frm_primary_label\">Consejeria para personas sin hogar y desplazados\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_58hiq\" name=\"item_meta[1810]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1880_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_xlici\" id=\"field_xlici_label\" class=\"frm_primary_label\">Quiero comprar una casa en los pr\u00f3ximo seis (6) meses\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_xlici\" name=\"item_meta[1880]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1882_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_d81a\" id=\"field_d81a_label\" class=\"frm_primary_label\">Quiero comprar una casa, pero no en los pr\u00f3ximos seis (6) meses\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_d81a\" name=\"item_meta[1882]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1881_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_5nuwa\" id=\"field_5nuwa_label\" class=\"frm_primary_label\">Otros programas, servicios, o productos\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_5nuwa\" name=\"item_meta[1881]\" value=\"\"  data-sectionid=\"1796\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1811_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h5><u>Informaci\u00f3n de la Agencia de Asesoramiento<\/u><\/h5>\n<\/div>\n<div id=\"frm_field_1812_container\" class=\"frm_form_field form-field  frm_left_container frm_first frm_two_thirds frm_hnsgb_info\">\r\n    <label for=\"field_z5j3k\" id=\"field_z5j3k_label\" class=\"frm_primary_label\">Nombre del Consejero (a)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_z5j3k\" name=\"item_meta[1812]\" value=\"\"  data-sectionid=\"1796\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1813_container\" class=\"frm_form_field form-field  frm_left_container frm_third frm_hnsgb_info\">\r\n    <label for=\"field_ynr1q\" id=\"field_ynr1q_label\" class=\"frm_primary_label\">Tel\u00e9fono\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ynr1q\" name=\"item_meta[1813]\" value=\"610-372-8433\"  readonly=\"readonly\"  data-sectionid=\"1796\" data-frmval=\"610-372-8433\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1819_container\" class=\"frm_form_field form-field  frm_left_container frm_first frm_two_thirds frm_hnsgb_info\">\r\n    <label for=\"field_4n1f3\" id=\"field_4n1f3_label\" class=\"frm_primary_label\">Agencia de Asesoramiento\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_4n1f3\" name=\"item_meta[1819]\" value=\"Neighborhood Housing Services of Greater Berks, Inc.\"  readonly=\"readonly\"  data-sectionid=\"1796\" data-frmval=\"Neighborhood Housing Services of Greater Berks, Inc.\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1818_container\" class=\"frm_form_field form-field  frm_left_container frm_third frm_hnsgb_info\">\r\n    <label for=\"field_5rdvq\" id=\"field_5rdvq_label\" class=\"frm_primary_label\">Correo Electr\u00f3nico\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_5rdvq\" name=\"item_meta[1818]\" value=\"\"  data-sectionid=\"1796\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1814_container\" class=\"frm_form_field form-field  frm_left_container frm_first frm_two_thirds frm_hnsgb_info\">\r\n    <label for=\"field_wlw0v\" id=\"field_wlw0v_label\" class=\"frm_primary_label\">N\u00famero de Cliente en RX\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_wlw0v\" name=\"item_meta[1814]\" value=\"\"  data-sectionid=\"1796\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1817_container\" class=\"frm_form_field form-field  frm_left_container frm_third frm_hnsgb_info\">\r\n    <label for=\"field_2a5d4\" id=\"field_2a5d4_label\" class=\"frm_primary_label\">Fax\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2a5d4\" name=\"item_meta[1817]\" value=\"610-374-2866\"  readonly=\"readonly\"  data-sectionid=\"1796\" data-frmval=\"610-374-2866\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1820_container\" class=\"frm_form_field frm_section_heading form-field  frm_full frm_adp frm_adp_last section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">DECLARACI\u00d3N DE AUTORIZACI\u00d3N, DIVULGACI\u00d3N Y PRIVACIDAD (3 en 1)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1822_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h4>POL\u00cdTICA DE PRIVACIDAD<\/h4>\n<p>La Agencia de Consejeria respeta la privacidad de las personas que vienen a nosotros en busca de ayuda. Comprendemos que los asuntos que discute con nosotros son muy personales. Toda la informaci\u00f3n oral y escrita que comparta con nosotros se gestionar\u00e1 teniendo en consideraci\u00f3n nuestras obligaciones legales y \u00e9ticas hacia usted. No venderemos su informaci\u00f3n personal y solamente la compartiremos para proporcionarle servicios de Asesoramiento.<\/p>\n<p>Su \"informaci\u00f3n personal privada\" (incluida la informaci\u00f3n total de la deuda, los ingresos, los gastos de manutenci\u00f3n y la informaci\u00f3n personal relacionada con sus circunstancias financieras) ser\u00e1 compartida con los acreedores, proveedores de fondos y otros solo despu\u00e9s de firmar la autorizaci\u00f3n de Servicios de Asesoramiento. Tambi\u00e9n podremos recopilar, utilizar y compartir informaci\u00f3n del expediente agregada de forma an\u00f3nima para evaluar nuestros servicios, para recopilar informaci\u00f3n valiosa de investigaci\u00f3n y para el dise\u00f1o de programas futuros.<\/p>\n<h5><u>Tipo de Informaci\u00f3n que Recopilamos sobre Usted:<\/u><\/h5>\n<ul class=\"adp-list-bullets\">\n<li>informaci\u00f3n oral o escrita en las solicitudes y otros documentos, tal como su nombre, direcci\u00f3n, n\u00famero de seguro social, activos e ingresos;<\/li>\n<li>informaci\u00f3n sobre sus transacciones con nosotros, sus acreedores u otros, como su saldo de cuenta, historial de pagos, las partes en las transacciones y el uso de tarjetas de cr\u00e9dito; e<\/li>\n<li>informaci\u00f3n que recibimos de una agencia de reportes de cr\u00e9dito, tal como su historial de cr\u00e9dito.<\/li>\n<\/ul>\n<h5><u>Usted puede Optar por No Compartir la Informaci\u00f3n que Nos Brinda:<\/u><\/h5>\n<ul class=\"adp-list-bullets\">\n<li>Usted puede \"optar por no\" compartir su informaci\u00f3n para prevenir la divulgaci\u00f3n de su informaci\u00f3n personal<br \/>\nprivada a terceros (tal como sus acreedores).<\/li>\n<li>Si usted opta por no compartirla, no podremos compartir su informaci\u00f3n personal privada ni podremos responder preguntas de sus acreedores. Necesitamos compartir su informaci\u00f3n para proporcionarle la mayor\u00eda de los servicios.<\/li>\n<li>Puede optar por no compartir informaci\u00f3n en cualquier momento llamando a la Agencia de Consejeria al n\u00famero de tel\u00e9fono que figura en la Autorizaci\u00f3n de Servicios de Asesoramiento que le proporcionamos junto con esta Pol\u00edtica de Privacidad.<\/li>\n<\/ul>\n<h5><u>De qu\u00e9 Manera Utilizamos su Informaci\u00f3n:<\/u><\/h5>\n<ul class=\"adp-list-bullets\">\n<li>Si usted no opta por negarse a compartir la informaci\u00f3n, podremos compartir la informaci\u00f3n que recopilamos con sus acreedores o con otros si pensamos que puede serle de ayuda, que puede ayudarnos a asesorarlo o cuando lo requieran los financiadores que hacen posible nuestros servicios.<\/li>\n<li>Podremos compartir su informaci\u00f3n con cualquiera seg\u00fan lo permita o lo requiera la ley (F H) (por ejemplo, si una Corte solicita que se la proporcionemos con los documentos).<\/li>\n<li>Dentro de nuestra organizaci\u00f3n, restringimos el acceso a su informaci\u00f3n a aquellos empleados que necesitan saber esa informaci\u00f3n para proporcionarle servicios. Mantenemos medidas de seguridad f\u00edsica, electr\u00f3nica y de procedimiento para proteger su informaci\u00f3n seg\u00fan lo requiere la ley federal y estatal.<\/li>\n<\/ul>\n<h5><u>Autorizaci\u00f3n del Cliente<\/u><\/h5>\n<p>Al firmar debajo, autorizo a mis empleadores, prestamistas, acreedores, recaudadores y otros a compartir informaci\u00f3n personal y financiera con mi Asesor y con la Agencia de Asesoramiento. Autorizo a mi Asesor y la Agencia de<br \/>\nConsejeria a recopilar informaci\u00f3n sobre mis cuentas y a compartir esta informaci\u00f3n con otros, incluidos los financiadores,<br \/>\nseg\u00fan sea necesario para proporcionar los servicios de asesoramiento, para buscar ayuda de programas o para brindar productos y servicios relacionados. Autorizo a los financiadores a comunicarse conmigo para evaluar los programas en los<br \/>\nque participo.<\/p><\/div>\n<div id=\"frm_field_1828_container\" class=\"frm_form_field  frm_first frm_third frm_adp_label frm_html_container form-field\">\n<h5>NOMBRE DEL CLIENTE <span class=\"frm_required\">*<\/span><\/h5>\n<\/div>\n<div id=\"frm_field_1824_container\" class=\"frm_form_field  frm_third frm_third frm_adp_label frm_html_container form-field\">\n<h5>FIRMA DEL CLIENTE <span class=\"frm_required\">*<\/span><\/h5>\n<\/div>\n<div id=\"frm_field_1825_container\" class=\"frm_form_field  frm_third frm_adp_label frm_html_container form-field\">\n<h5>FECHA <span class=\"frm_required\">*<\/span><\/h5>\n<\/div>\n<div id=\"frm_field_1829_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_first frm_third frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_esl8d\" id=\"field_esl8d_label\" class=\"frm_primary_label\">NOMBRE DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_esl8d\" name=\"item_meta[1829]\" value=\"\"  data-sectionid=\"1820\" data-reqmsg=\"NOMBRE DEL CLIENTE cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1830_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_third frm_res_label\">\r\n    <label for=\"field_oap2v\" id=\"field_oap2v_label\" class=\"frm_primary_label\">FIRMA DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1830\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:100px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:10px;--button-size:16px;--button-padding:8px;--button-side-margin:20px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[1830][typed]\" class=\"name\" id=\"field_oap2v\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"100\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1830][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1831_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_third frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_m0yqb\" id=\"field_m0yqb_label\" class=\"frm_primary_label\">FECHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_m0yqb\" name=\"item_meta[1831]\" value=\"\"  data-sectionid=\"1820\" data-reqmsg=\"FECHA cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1834_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third frm_first frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_mbe8t\" id=\"field_mbe8t_label\" class=\"frm_primary_label\">NOMBRE DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mbe8t\" name=\"item_meta[1834]\" value=\"\"  data-sectionid=\"1820\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1832_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third frm_res_label\">\r\n    <label for=\"field_di4qu\" id=\"field_di4qu_label\" class=\"frm_primary_label\">FIRMA DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1832\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:100px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:10px;--button-size:16px;--button-padding:8px;--button-side-margin:20px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[1832][typed]\" class=\"name\" id=\"field_di4qu\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"100\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1832][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1833_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_i73q\" id=\"field_i73q_label\" class=\"frm_primary_label\">FECHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_i73q\" name=\"item_meta[1833]\" value=\"\"  data-sectionid=\"1820\" data-invmsg=\"Text is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1885_container\" class=\"frm_form_field frm_section_heading form-field  frm_full frm_adp frm_adp_last section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">DECLARACI\u00d3N DE AUTORIZACI\u00d3N, DIVULGACI\u00d3N Y PRIVACIDAD (3 en 1)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1886_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h4>ACUERDO DE COMPROMISO CON EL CLIENTE<\/h4>\n<p>(Este acuerdo es opcional y no afecta al resto de la forma 3 en 1)<\/p>\n<p>El consumidor de hoy busca informaci\u00f3n en tiempo real sobre c\u00f3mo maniobrar a trav\u00e9s del laberinto de productos y servicios financieros, establecer o reconstruir cr\u00e9dito, reducir la deuda y ahorrar para el futuro. Ayudar a los clientes a alcanzar su potencial a trav\u00e9s de una variedad de servicios nunca ha sido m\u00e1s esencial.<\/p>\n<p>El asesoramiento financiero es un campo emergente que apoya a los clientes a medida que trabajan para alcanzar sus objetivos y se esfuerzan por maximizar su potencial financiero. A trav\u00e9s de un proceso continuo, sistem\u00e1tico y colaborativo, los coaches que se especializan en capacidades financieras pueden facilitar cambios en los h\u00e1bitos financieros de los clientes para que puedan alcanzar la seguridad financiera. Participar en un curso reglamentado de servicios de asesoramiento financiero puede aumentar la sensaci\u00f3n de bienestar y seguridad del cliente a trav\u00e9s del conocimiento, y promover comportamientos cambiantes que mejorar\u00e1n su situaci\u00f3n financiera.<\/p>\n<p>Si est\u00e1 interesado en mejorar sus capacidades financieras, acepte lo siguiente:<\/p>\n<p>Estoy dispuesto a comprometerme a realizar al menos cuatro sesiones (m\u00ednimo de una hora por sesi\u00f3n) en el transcurso de 12 meses y un m\u00ednimo de una encuesta de seguimiento dentro de los tres meses posteriores a la sesi\u00f3n final.<\/p>\n<p>La primera sesi\u00f3n debe ser una sesi\u00f3n cara a cara con un consejero. Una vez presentada la documentaci\u00f3n requerida, las sesiones posteriores pueden llevarse a cabo utilizando m\u00e9todos alternativos de comunicaci\u00f3n como: tel\u00e9fono, Internet, Skype, tel\u00e9fono inteligente, etc.<\/p>\n<p>Entiendo que mi consejero revisar\u00e1 y discutir\u00e1 un Plan de Acci\u00f3n actualizado para cada sesi\u00f3n, y recibir\u00e9 una copia.<\/p><\/div>\n<div id=\"frm_field_1887_container\" class=\"frm_form_field  frm_first frm_third frm_adp_label frm_html_container form-field\">\n<h5>NOMBRE DEL CLIENTE <span class=\"frm_required\">*<\/span><\/h5>\n<\/div>\n<div id=\"frm_field_1888_container\" class=\"frm_form_field  frm_third frm_third frm_adp_label frm_html_container form-field\">\n<h5>FIRMA DEL CLIENTE <span class=\"frm_required\">*<\/span><\/h5>\n<\/div>\n<div id=\"frm_field_1889_container\" class=\"frm_form_field  frm_third frm_adp_label frm_html_container form-field\">\n<h5>FECHA <span class=\"frm_required\">*<\/span><\/h5>\n<\/div>\n<div id=\"frm_field_1890_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_first frm_third frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_srhpr\" id=\"field_srhpr_label\" class=\"frm_primary_label\">NOMBRE DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_srhpr\" name=\"item_meta[1890]\" value=\"\"  data-sectionid=\"1885\" data-reqmsg=\"NOMBRE DEL CLIENTE cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1891_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_third frm_res_label\">\r\n    <label for=\"field_hs1kq\" id=\"field_hs1kq_label\" class=\"frm_primary_label\">FIRMA DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1891\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:100px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:10px;--button-size:16px;--button-padding:8px;--button-side-margin:20px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[1891][typed]\" class=\"name\" id=\"field_hs1kq\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"100\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1891][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1892_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_third frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_8qoer\" id=\"field_8qoer_label\" class=\"frm_primary_label\">FECHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_8qoer\" name=\"item_meta[1892]\" value=\"\"  data-sectionid=\"1885\" data-reqmsg=\"FECHA cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1893_container\" class=\"frm_form_field form-field  frm_hidden_container frm_first frm_third frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_bx2pd\" id=\"field_bx2pd_label\" class=\"frm_primary_label\">NOMBRE DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_bx2pd\" name=\"item_meta[1893]\" value=\"\"  data-sectionid=\"1885\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1894_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third frm_res_label\">\r\n    <label for=\"field_ver4c\" id=\"field_ver4c_label\" class=\"frm_primary_label\">FIRMA DEL CLIENTE\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1894\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:100px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:10px;--button-size:16px;--button-padding:8px;--button-side-margin:20px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[1894][typed]\" class=\"name\" id=\"field_ver4c\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"100\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1894][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1895_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third frm_res_label frm_signature_sibling\">\r\n    <label for=\"field_uy3uc\" id=\"field_uy3uc_label\" class=\"frm_primary_label\">FECHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_uy3uc\" name=\"item_meta[1895]\" value=\"\"  data-sectionid=\"1885\" data-invmsg=\"Text is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1897_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<div class=\"engagement-agreement-bottom\">\n  Preg\u00fantele a su consejero sobre estos otros tipos de asesoramiento que pueden estar disponibles para usted en esta<br \/>\nagencia.<\/p>\n<div class=\"row\">\n<div class=\"col-xs-12 col-sm-6\">\n      <span class=\"list-title\"><u>Consejer\u00eda Individual<\/u><\/span><\/p>\n<ul>\n<li>Pre-Compra<\/li>\n<li>Cr\u00e9dito y Presupuesto<\/li>\n<li>Despu\u00e9s de la compra - No Delincuente (Mantenimiento de la vivienda\/administraci\u00f3n financiera)<\/li>\n<li>Despu\u00e9s de la compra - Mitigaci\u00f3n de la ejecuci\u00f3n hipotecaria<\/li>\n<li>Hipoteca inversa\/HECM<\/li>\n<li>Temas de alquiler<\/li>\n<li>Asistencia para personas sin hogar<\/li>\n<li>Coaching de Educaci\u00f3n Financiera (despu\u00e9s del Taller de Educaci\u00f3n Financiera)<\/li>\n<\/ul><\/div>\n<div class=\"col-xs-12 col-sm-6\">\n      <span class=\"list-title\"><u>Talleres (Seminarios)<\/u><\/span><\/p>\n<ul>\n<li>Educaci\u00f3n Financiera<\/li>\n<li>Pre-Compra<\/li>\n<li>Pr\u00e9stamos Anti-Predatorios y Prevenci\u00f3n de Ejecuciones Hipotecaria<\/li>\n<li>Vivienda Justa\/ Prestamos Justos<\/li>\n<\/ul><\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"frm_field_1898_container\" class=\"frm_form_field frm_section_heading form-field  frm_full frm_adp frm_adp_last section-title\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">DECLARACI\u00d3N DE AUTORIZACI\u00d3N, DIVULGACI\u00d3N Y PRIVACIDAD (3 en 1)<\/h3>\r\n\r\n\r\n<div id=\"frm_field_1899_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h4><u>DIVULGACION DE AGENCIAS DE CONSEJER\u00cdA<\/u><\/h4>\n<p><u>Por favor, ponga sus iniciales<\/u><\/div>\n<div id=\"frm_field_1911_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_e6v4o\" id=\"field_e6v4o_label\" class=\"frm_primary_label\">Entiendo que no estoy obligado a recibir, comprar o usar servicios o productos de la Agencia de Consejer\u00eda, sus socios o cualquier organizaci\u00f3n a la que me refiera la Agencia de Consejer\u00eda.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_e6v4o\" name=\"item_meta[1911]\" value=\"\"  data-sectionid=\"1898\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1912_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_ax57v\" id=\"field_ax57v_label\" class=\"frm_primary_label\">La Agencia de Consejer\u00eda ha descrito en detalle los diferentes tipos de servicios prestados y cualquier relaci\u00f3n exclusiva, financiera o de otro tipo entre la Agencia de Consejer\u00eda y cualquier otro socio de la industria que pueda ser relevante para mis servicios, incluida la relaci\u00f3n entre la Agencia de Consejer\u00eda y los financiadores.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_ax57v\" name=\"item_meta[1912]\" value=\"\"  data-sectionid=\"1898\" maxlength=\"2\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/><span class=\"frm_inline_box\">Iniciales<\/span><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1913_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    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