{"id":4047,"date":"2020-11-23T13:21:13","date_gmt":"2020-11-23T18:21:13","guid":{"rendered":"https:\/\/nhsgb.org\/?page_id=4047"},"modified":"2020-11-23T13:24:34","modified_gmt":"2020-11-23T18:24:34","slug":"spanish-counseling-form","status":"publish","type":"page","link":"https:\/\/nhsgb.org\/buy-your-home\/counseling\/spanish-counseling-form\/","title":{"rendered":"Spanish Counseling Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]<div class=\"frm_forms  with_frm_style frm_center_submit frm_style_formidable-style\" id=\"frm_form_22_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_counseling_form_spanish\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Counseling 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=\"22\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_22\" id=\"frm_hide_fields_22\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"counseling_form_spanish\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_22\" name=\"frm_submit_entry_22\" value=\"89073f7a2c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/4047\" \/><div id=\"frm_field_1323_container\" class=\"frm_form_field form-field  frm_required_field frm_inline_container frm_full frm_preferred_language horizontal_radio\">\r\n    <div  id=\"field_preferred_language2542a7dfd3_label\" class=\"frm_primary_label\">Idioma preferido\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_preferred_language2542a7dfd3_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1323-0\"><label for=\"field_preferred_language2542a7dfd3-0\">\t\t<input type=\"radio\" name=\"item_meta[1323]\" id=\"field_preferred_language2542a7dfd3-0\" value=\"Ingles\"\n\t\t   data-reqmsg=\"Idioma preferido cannot be blank.\" data-invmsg=\"Idioma preferido is invalid\" aria-invalid=\"false\"  \/> Ingl\u00e9s<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1323-1\"><label for=\"field_preferred_language2542a7dfd3-1\">\t\t<input type=\"radio\" name=\"item_meta[1323]\" id=\"field_preferred_language2542a7dfd3-1\" value=\"Espanol\"\n\t\t   data-reqmsg=\"Idioma preferido cannot be blank.\" data-invmsg=\"Idioma preferido is invalid\" aria-invalid=\"false\"  \/> Espa\u00f1ol<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1324_container\" class=\"frm_form_field form-field  frm_required_field frm_inline_container frm_full frm_program horizontal_radio\">\r\n    <div  id=\"field_program3a791d39da_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_program3a791d39da_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1324-0\"><label for=\"field_program3a791d39da-0\">\t\t<input type=\"radio\" name=\"item_meta[1324]\" id=\"field_program3a791d39da-0\" value=\"HOP\"\n\t\t   data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> HOP<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1324-1\"><label for=\"field_program3a791d39da-1\">\t\t<input type=\"radio\" name=\"item_meta[1324]\" id=\"field_program3a791d39da-1\" value=\"FHA\/CCAL\"\n\t\t   data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> FHA\/CCAL<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1324-2\"><label for=\"field_program3a791d39da-2\">\t\t<input type=\"radio\" name=\"item_meta[1324]\" id=\"field_program3a791d39da-2\" value=\"HIP\"\n\t\t   data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> HIP<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1324-3\"><label for=\"field_program3a791d39da-3\">\t\t<input type=\"radio\" name=\"item_meta[1324]\" id=\"field_program3a791d39da-3\" value=\"MSRP\"\n\t\t   data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> MSRP<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1324-4\"><label for=\"field_program3a791d39da-4\">\t\t<input type=\"radio\" name=\"item_meta[1324]\" id=\"field_program3a791d39da-4\" value=\"LV GRANTS\"\n\t\t   data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> LV GRANTS<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1324-5\"><label for=\"field_program3a791d39da-5\">\t\t<input type=\"radio\" name=\"item_meta[1324]\" id=\"field_program3a791d39da-5\" value=\"FASTRAC\"\n\t\t   data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> FASTRAC<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1324-6\"><label for=\"field_program3a791d39da-6\">\t\t<input type=\"radio\" name=\"item_meta[1324]\" id=\"field_program3a791d39da-6\" value=\"COUNSELING\"\n\t\t   data-reqmsg=\"Programa cannot be blank.\" data-invmsg=\"Programa is invalid\" aria-invalid=\"false\"  \/> COUNSELING<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1325_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_1326_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_full_name5401ddcd39\" id=\"field_full_name5401ddcd39_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_name5401ddcd39\" name=\"item_meta[1326]\" value=\"\"  data-sectionid=\"1325\" 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_1327_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_email453db8092ae\" id=\"field_email453db8092ae_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_email453db8092ae\" name=\"item_meta[1327]\" value=\"\"  data-sectionid=\"1325\" 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_1328_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_two_thirds\">\r\n    <label for=\"field_street41ad8e69740\" id=\"field_street41ad8e69740_label\" class=\"frm_primary_label\">Calle\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_street41ad8e69740\" name=\"item_meta[1328]\" value=\"\"  data-sectionid=\"1325\" 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_1329_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_apt_nob8d6929f80\" id=\"field_apt_nob8d6929f80_label\" class=\"frm_primary_label\">Apt #\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_apt_nob8d6929f80\" name=\"item_meta[1329]\" value=\"\"  data-sectionid=\"1325\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1330_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n    <label for=\"field_city4c03eefd0dd\" id=\"field_city4c03eefd0dd_label\" class=\"frm_primary_label\">Ciudad\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_city4c03eefd0dd\" name=\"item_meta[1330]\" value=\"\"  data-sectionid=\"1325\" 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_1331_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_state4a957b8dddf\" id=\"field_state4a957b8dddf_label\" class=\"frm_primary_label\">Estado\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_state4a957b8dddf\" name=\"item_meta[1331]\" value=\"\"  data-sectionid=\"1325\" 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_1332_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_third\">\r\n    <label for=\"field_zip_code4181b59891a\" id=\"field_zip_code4181b59891a_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_code4181b59891a\" name=\"item_meta[1332]\" value=\"\"  data-sectionid=\"1325\" 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_1333_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_home_phone4d39ca76bd3\" id=\"field_home_phone4d39ca76bd3_label\" class=\"frm_primary_label\">Tel\u00e9fono residencial\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_home_phone4d39ca76bd3\" name=\"item_meta[1333]\" value=\"\"  data-sectionid=\"1325\" data-reqmsg=\"Tel\u00e9fono residencial 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}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1334_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_cell91b75cd273\" id=\"field_cell91b75cd273_label\" class=\"frm_primary_label\">Cell\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_cell91b75cd273\" name=\"item_meta[1334]\" value=\"\"  data-sectionid=\"1325\" data-reqmsg=\"Cell cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1335_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_social_security_no59d3929ade\" id=\"field_social_security_no59d3929ade_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_no59d3929ade\" name=\"item_meta[1335]\" value=\"\"  data-sectionid=\"1325\" 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_1336_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_birth_date4601af7a8b8\" id=\"field_birth_date4601af7a8b8_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_date4601af7a8b8\" name=\"item_meta[1336]\" value=\"\"  data-sectionid=\"1325\" 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_1337_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth horizontal_radio\">\r\n    <div  id=\"field_gender45de750ff85_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_gender45de750ff85_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1337-1325-0\"><label for=\"field_gender45de750ff85-0\">\t\t<input type=\"radio\" name=\"item_meta[1337]\" id=\"field_gender45de750ff85-0\" value=\"Masculino\"\n\t\t   data-sectionid=\"1325\" 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_1337-1325-1\"><label for=\"field_gender45de750ff85-1\">\t\t<input type=\"radio\" name=\"item_meta[1337]\" id=\"field_gender45de750ff85-1\" value=\"Femenino\"\n\t\t   data-sectionid=\"1325\" 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_1337-1325-2\"><label for=\"field_gender45de750ff85-2\">\t\t<input type=\"radio\" name=\"item_meta[1337]\" id=\"field_gender45de750ff85-2\" value=\"Otros\/No conformes\"\n\t\t   data-sectionid=\"1325\" 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_1338_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd horizontal_radio\">\r\n    <div  id=\"field_first_time_home_buyer3afd3d98882_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_buyer3afd3d98882_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1338-1325-0\"><label for=\"field_first_time_home_buyer3afd3d98882-0\">\t\t<input type=\"radio\" name=\"item_meta[1338]\" id=\"field_first_time_home_buyer3afd3d98882-0\" value=\"Si\"\n\t\t   data-sectionid=\"1325\" 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_1338-1325-1\"><label for=\"field_first_time_home_buyer3afd3d98882-1\">\t\t<input type=\"radio\" name=\"item_meta[1338]\" id=\"field_first_time_home_buyer3afd3d98882-1\" value=\"No\"\n\t\t   data-sectionid=\"1325\" 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_1339_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth horizontal_radio\">\r\n    <div  id=\"field_handicapped4d66d3f1c0c_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_handicapped4d66d3f1c0c_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1339-1325-0\"><label for=\"field_handicapped4d66d3f1c0c-0\">\t\t<input type=\"radio\" name=\"item_meta[1339]\" id=\"field_handicapped4d66d3f1c0c-0\" value=\"Si\"\n\t\t   data-sectionid=\"1325\" 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_1339-1325-1\"><label for=\"field_handicapped4d66d3f1c0c-1\">\t\t<input type=\"radio\" name=\"item_meta[1339]\" id=\"field_handicapped4d66d3f1c0c-1\" value=\"No\"\n\t\t   data-sectionid=\"1325\" 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_1340_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd horizontal_radio\">\r\n    <div  id=\"field_veteran4811e962e74_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_veteran4811e962e74_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1340-1325-0\"><label for=\"field_veteran4811e962e74-0\">\t\t<input type=\"radio\" name=\"item_meta[1340]\" id=\"field_veteran4811e962e74-0\" value=\"Si\"\n\t\t   data-sectionid=\"1325\" 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_1340-1325-1\"><label for=\"field_veteran4811e962e74-1\">\t\t<input type=\"radio\" name=\"item_meta[1340]\" id=\"field_veteran4811e962e74-1\" value=\"No\"\n\t\t   data-sectionid=\"1325\" 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_1341_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_current_housing_arrangement46b0d9cbcc9_label\" class=\"frm_primary_label\">Disposici\u00f3n actual de la vivienda\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_current_housing_arrangement46b0d9cbcc9_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1341-1325-0\"><label for=\"field_current_housing_arrangement46b0d9cbcc9-0\">\t\t<input type=\"radio\" name=\"item_meta[1341]\" id=\"field_current_housing_arrangement46b0d9cbcc9-0\" value=\"Renta\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Disposici\u00f3n actual de la vivienda cannot be blank.\" data-invmsg=\"Disposici\u00f3n actual de la vivienda is invalid\" aria-invalid=\"false\"  \/> Renta<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1341-1325-1\"><label for=\"field_current_housing_arrangement46b0d9cbcc9-1\">\t\t<input type=\"radio\" name=\"item_meta[1341]\" id=\"field_current_housing_arrangement46b0d9cbcc9-1\" value=\"Viviendo con familiares\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Disposici\u00f3n actual de la vivienda cannot be blank.\" data-invmsg=\"Disposici\u00f3n actual de la vivienda is invalid\" aria-invalid=\"false\"  \/> Viviendo con familiares<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1341-1325-2\"><label for=\"field_current_housing_arrangement46b0d9cbcc9-2\">\t\t<input type=\"radio\" name=\"item_meta[1341]\" id=\"field_current_housing_arrangement46b0d9cbcc9-2\" value=\"Sin vivienda\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Disposici\u00f3n actual de la vivienda cannot be blank.\" data-invmsg=\"Disposici\u00f3n actual de la vivienda is invalid\" aria-invalid=\"false\"  \/> Sin vivienda<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1342_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_rent04dcb073c8\" id=\"field_rent04dcb073c8_label\" class=\"frm_primary_label\">Renta\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rent04dcb073c8\" name=\"item_meta[1342]\" value=\"\"  data-sectionid=\"1325\" data-reqmsg=\"Renta 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_1343_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_household_type4099918e660_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_type4099918e660_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1343-1325-0\"><label for=\"field_household_type4099918e660-0\">\t\t<input type=\"radio\" name=\"item_meta[1343]\" id=\"field_household_type4099918e660-0\" value=\"Soltero (a)\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Soltero (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1343-1325-1\"><label for=\"field_household_type4099918e660-1\">\t\t<input type=\"radio\" name=\"item_meta[1343]\" id=\"field_household_type4099918e660-1\" value=\"Soltero (a) cabeza de hogar\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Soltero (a) cabeza de hogar<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1343-1325-2\"><label for=\"field_household_type4099918e660-2\">\t\t<input type=\"radio\" name=\"item_meta[1343]\" id=\"field_household_type4099918e660-2\" value=\"Casado con dependientes\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Casado con dependientes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1343-1325-3\"><label for=\"field_household_type4099918e660-3\">\t\t<input type=\"radio\" name=\"item_meta[1343]\" id=\"field_household_type4099918e660-3\" value=\"Casado sin dependientes\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Casado sin dependientes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1343-1325-4\"><label for=\"field_household_type4099918e660-4\">\t\t<input type=\"radio\" name=\"item_meta[1343]\" id=\"field_household_type4099918e660-4\" value=\"Dos adultos sin relacion\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Estado Matrimonial cannot be blank.\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Dos adultos sin relaci\u00f3n<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1344_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_family_size3471fde4f0\" id=\"field_family_size3471fde4f0_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_size3471fde4f0\" name=\"item_meta[1344]\" value=\"\"  data-sectionid=\"1325\" 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_1345_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_dependents32bd4d47a0\" id=\"field_dependents32bd4d47a0_label\" class=\"frm_primary_label\">Dependientes\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dependents32bd4d47a0\" name=\"item_meta[1345]\" value=\"\"  data-sectionid=\"1325\" 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_1346_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_monthly_incomed98a66f62b\" id=\"field_monthly_incomed98a66f62b_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_incomed98a66f62b\" name=\"item_meta[1346]\" value=\"\"  data-sectionid=\"1325\" 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_1347_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_household_income5d35bc1df8\" id=\"field_household_income5d35bc1df8_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_income5d35bc1df8\" name=\"item_meta[1347]\" value=\"\"  data-sectionid=\"1325\" 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_1348_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_employer_name3ce4f98814b\" id=\"field_employer_name3ce4f98814b_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_name3ce4f98814b\" name=\"item_meta[1348]\" value=\"\"  data-sectionid=\"1325\" 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_name3ce4f98814b\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_employer_name3ce4f98814b\">Si no est\u00e1 trabajando ingrese n\/a<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1349_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_employer_phone_number94469e6284\" id=\"field_employer_phone_number94469e6284_label\" class=\"frm_primary_label\">N\u00famero de tel\u00e9fono del empleador\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_employer_phone_number94469e6284\" name=\"item_meta[1349]\" value=\"\"  data-sectionid=\"1325\" data-reqmsg=\"N\u00famero de tel\u00e9fono del empleador 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}$\"   aria-describedby=\"frm_desc_field_employer_phone_number94469e6284\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_employer_phone_number94469e6284\">Si no est\u00e1 trabajando ingrese su n\u00famero de tel\u00e9fono<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_1350_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth\">\r\n    <label for=\"field_hourly_rate3994adf9aec\" id=\"field_hourly_rate3994adf9aec_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_rate3994adf9aec\" name=\"item_meta[1350]\" value=\"\"  data-sectionid=\"1325\" 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_1351_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_yrs_on_this_job913070055e\" id=\"field_yrs_on_this_job913070055e_label\" class=\"frm_primary_label\">A\u00f1os en este trabajo\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yrs_on_this_job913070055e\" name=\"item_meta[1351]\" value=\"\"  data-sectionid=\"1325\" data-reqmsg=\"A\u00f1os en este trabajo 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_1352_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_education_level4695830b96d_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_level4695830b96d_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1352-1325-0\"><label for=\"field_education_level4695830b96d-0\">\t\t<input type=\"radio\" name=\"item_meta[1352]\" id=\"field_education_level4695830b96d-0\" value=\"Menos de diploma de preparatoria\"\n\t\t   data-sectionid=\"1325\" 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\"  \/> Menos de diploma de preparatoria<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1352-1325-1\"><label for=\"field_education_level4695830b96d-1\">\t\t<input type=\"radio\" name=\"item_meta[1352]\" id=\"field_education_level4695830b96d-1\" value=\"Diploma de preparatoria o equivalente\"\n\t\t   data-sectionid=\"1325\" 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 de preparatoria o equivalente<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1352-1325-2\"><label for=\"field_education_level4695830b96d-2\">\t\t<input type=\"radio\" name=\"item_meta[1352]\" id=\"field_education_level4695830b96d-2\" value=\"Universidad de dos anos\"\n\t\t   data-sectionid=\"1325\" 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\"  \/> Universidad de dos a\u00f1os<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1352-1325-3\"><label for=\"field_education_level4695830b96d-3\">\t\t<input type=\"radio\" name=\"item_meta[1352]\" id=\"field_education_level4695830b96d-3\" value=\"Licenciatura\"\n\t\t   data-sectionid=\"1325\" 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\"  \/> Licenciatura<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1352-1325-4\"><label for=\"field_education_level4695830b96d-4\">\t\t<input type=\"radio\" name=\"item_meta[1352]\" id=\"field_education_level4695830b96d-4\" value=\"Maestria\"\n\t\t   data-sectionid=\"1325\" 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\"  \/> Maestr\u00eda<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1353_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container horizontal_radio\">\r\n    <div  id=\"field_ethnicity_hispanice3ce95a864_label\" class=\"frm_primary_label\">Etnico Hispano\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ethnicity_hispanice3ce95a864_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1353-1325-0\"><label for=\"field_ethnicity_hispanice3ce95a864-0\">\t\t<input type=\"radio\" name=\"item_meta[1353]\" id=\"field_ethnicity_hispanice3ce95a864-0\" value=\"Si\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Etnico Hispano cannot be blank.\" data-invmsg=\"Etnico Hispano is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1353-1325-1\"><label for=\"field_ethnicity_hispanice3ce95a864-1\">\t\t<input type=\"radio\" name=\"item_meta[1353]\" id=\"field_ethnicity_hispanice3ce95a864-1\" value=\"No\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Etnico Hispano cannot be blank.\" data-invmsg=\"Etnico Hispano is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1354_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_three_col\">\r\n    <div  id=\"field_race41c84cf6167_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_race41c84cf6167_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1354-1325-0\"><label for=\"field_race41c84cf6167-0\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-0\" value=\"Dominicano (a)\"\n\t\t   data-sectionid=\"1325\" 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_1354-1325-1\"><label for=\"field_race41c84cf6167-1\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-1\" value=\"Blanco\"\n\t\t   data-sectionid=\"1325\" 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_1354-1325-2\"><label for=\"field_race41c84cf6167-2\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-2\" value=\"Negro\"\n\t\t   data-sectionid=\"1325\" 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_1354-1325-3\"><label for=\"field_race41c84cf6167-3\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-3\" value=\"Mexicano (a)\"\n\t\t   data-sectionid=\"1325\" 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_1354-1325-4\"><label for=\"field_race41c84cf6167-4\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-4\" value=\"Puertorriqueno (a)\"\n\t\t   data-sectionid=\"1325\" 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_1354-1325-5\"><label for=\"field_race41c84cf6167-5\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-5\" value=\"Otro\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Otro<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1354-1325-6\"><label for=\"field_race41c84cf6167-6\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-6\" value=\"No disponible\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> No disponible<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1354-1325-7\"><label for=\"field_race41c84cf6167-7\">\t\t<input type=\"radio\" name=\"item_meta[1354]\" id=\"field_race41c84cf6167-7\" value=\"Eligio no responder\"\n\t\t   data-sectionid=\"1325\" data-reqmsg=\"Raza cannot be blank.\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Eligi\u00f3 no responder<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1356_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_1357_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third\">\r\n    <label for=\"field_co_full_name3965802d271\" id=\"field_co_full_name3965802d271_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_name3965802d271\" name=\"item_meta[1357]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1358_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_relationship_to_applicant50fe00b8ce\" id=\"field_relationship_to_applicant50fe00b8ce_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_applicant50fe00b8ce\" name=\"item_meta[1358]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1359_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_email5970a5936b9\" id=\"field_co_email5970a5936b9_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_co_email5970a5936b9\" name=\"item_meta[1359]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1360_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_two_thirds\">\r\n    <label for=\"field_co_street3ceaadf35e9\" id=\"field_co_street3ceaadf35e9_label\" class=\"frm_primary_label\">Calle\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_street3ceaadf35e9\" name=\"item_meta[1360]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1361_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_apt_no30488bc3489\" id=\"field_co_apt_no30488bc3489_label\" class=\"frm_primary_label\">Apt #\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_apt_no30488bc3489\" name=\"item_meta[1361]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1362_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third\">\r\n    <label for=\"field_co_city56ddfb51bb9\" id=\"field_co_city56ddfb51bb9_label\" class=\"frm_primary_label\">Ciudad\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_city56ddfb51bb9\" name=\"item_meta[1362]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1363_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_state57c102de154\" id=\"field_co_state57c102de154_label\" class=\"frm_primary_label\">Estado\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_state57c102de154\" name=\"item_meta[1363]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1364_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_zip_code5c68fd5dca6\" id=\"field_co_zip_code5c68fd5dca6_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_code5c68fd5dca6\" name=\"item_meta[1364]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1365_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_co_home_phone5efc0cb88a2\" id=\"field_co_home_phone5efc0cb88a2_label\" class=\"frm_primary_label\">Tel\u00e9fono residencial\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_co_home_phone5efc0cb88a2\" name=\"item_meta[1365]\" value=\"\"  data-sectionid=\"1356\" 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_1366_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_cell67c672cc3c\" id=\"field_co_cell67c672cc3c_label\" class=\"frm_primary_label\">Cell\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_co_cell67c672cc3c\" name=\"item_meta[1366]\" value=\"\"  data-sectionid=\"1356\" 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_1367_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_co_social_security_no3c99a14ba7f\" id=\"field_co_social_security_no3c99a14ba7f_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_no3c99a14ba7f\" name=\"item_meta[1367]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1368_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_birth_date4d9bc271f1a\" id=\"field_co_birth_date4d9bc271f1a_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_date4d9bc271f1a\" name=\"item_meta[1368]\" value=\"\"  data-sectionid=\"1356\" 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_1369_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth horizontal_radio\">\r\n    <div  id=\"field_co_gender4ec8088f7c3_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_gender4ec8088f7c3_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1369-1356-0\"><label for=\"field_co_gender4ec8088f7c3-0\">\t\t<input type=\"radio\" name=\"item_meta[1369]\" id=\"field_co_gender4ec8088f7c3-0\" value=\"Masculino\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Masculino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1369-1356-1\"><label for=\"field_co_gender4ec8088f7c3-1\">\t\t<input type=\"radio\" name=\"item_meta[1369]\" id=\"field_co_gender4ec8088f7c3-1\" value=\"Femenino\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"G\u00e9nero is invalid\" aria-invalid=\"false\"  \/> Femenino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1369-1356-2\"><label for=\"field_co_gender4ec8088f7c3-2\">\t\t<input type=\"radio\" name=\"item_meta[1369]\" id=\"field_co_gender4ec8088f7c3-2\" value=\"Otro\/No conformes\"\n\t\t   data-sectionid=\"1356\" 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_1370_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd horizontal_radio\">\r\n    <div  id=\"field_co_first_time_home_buyer4f620c8fbf2_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_buyer4f620c8fbf2_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1370-1356-0\"><label for=\"field_co_first_time_home_buyer4f620c8fbf2-0\">\t\t<input type=\"radio\" name=\"item_meta[1370]\" id=\"field_co_first_time_home_buyer4f620c8fbf2-0\" value=\"Si\"\n\t\t   data-sectionid=\"1356\" 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_1370-1356-1\"><label for=\"field_co_first_time_home_buyer4f620c8fbf2-1\">\t\t<input type=\"radio\" name=\"item_meta[1370]\" id=\"field_co_first_time_home_buyer4f620c8fbf2-1\" value=\"No\"\n\t\t   data-sectionid=\"1356\" 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_1371_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth horizontal_radio\">\r\n    <div  id=\"field_co_handicapped49d392b7622_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_handicapped49d392b7622_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1371-1356-0\"><label for=\"field_co_handicapped49d392b7622-0\">\t\t<input type=\"radio\" name=\"item_meta[1371]\" id=\"field_co_handicapped49d392b7622-0\" value=\"Si\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Discapacitados is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1371-1356-1\"><label for=\"field_co_handicapped49d392b7622-1\">\t\t<input type=\"radio\" name=\"item_meta[1371]\" id=\"field_co_handicapped49d392b7622-1\" value=\"No\"\n\t\t   data-sectionid=\"1356\" 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_1372_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd horizontal_radio\">\r\n    <div  id=\"field_co_veteran3de560e9d3a_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_veteran3de560e9d3a_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1372-1356-0\"><label for=\"field_co_veteran3de560e9d3a-0\">\t\t<input type=\"radio\" name=\"item_meta[1372]\" id=\"field_co_veteran3de560e9d3a-0\" value=\"Si\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Veterano is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1372-1356-1\"><label for=\"field_co_veteran3de560e9d3a-1\">\t\t<input type=\"radio\" name=\"item_meta[1372]\" id=\"field_co_veteran3de560e9d3a-1\" value=\"No\"\n\t\t   data-sectionid=\"1356\" 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_1373_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_co_current_housing_arrangement3d43e981b56_label\" class=\"frm_primary_label\">Disposici\u00f3n actual de la vivienda\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_current_housing_arrangement3d43e981b56_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1373-1356-0\"><label for=\"field_co_current_housing_arrangement3d43e981b56-0\">\t\t<input type=\"radio\" name=\"item_meta[1373]\" id=\"field_co_current_housing_arrangement3d43e981b56-0\" value=\"Renta\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Disposici\u00f3n actual de la vivienda is invalid\" aria-invalid=\"false\"  \/> Renta<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1373-1356-1\"><label for=\"field_co_current_housing_arrangement3d43e981b56-1\">\t\t<input type=\"radio\" name=\"item_meta[1373]\" id=\"field_co_current_housing_arrangement3d43e981b56-1\" value=\"Viviendo con familiares\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Disposici\u00f3n actual de la vivienda is invalid\" aria-invalid=\"false\"  \/> Viviendo con familiares<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1373-1356-2\"><label for=\"field_co_current_housing_arrangement3d43e981b56-2\">\t\t<input type=\"radio\" name=\"item_meta[1373]\" id=\"field_co_current_housing_arrangement3d43e981b56-2\" value=\"Sin vivienda\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Disposici\u00f3n actual de la vivienda is invalid\" aria-invalid=\"false\"  \/> Sin vivienda<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1374_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_co_rent3960a4cf66f\" id=\"field_co_rent3960a4cf66f_label\" class=\"frm_primary_label\">Renta\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_rent3960a4cf66f\" name=\"item_meta[1374]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1375_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_co_household_type3f593264e1a_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_type3f593264e1a_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1375-1356-0\"><label for=\"field_co_household_type3f593264e1a-0\">\t\t<input type=\"radio\" name=\"item_meta[1375]\" id=\"field_co_household_type3f593264e1a-0\" value=\"Soltero (a)\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Soltero (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1375-1356-1\"><label for=\"field_co_household_type3f593264e1a-1\">\t\t<input type=\"radio\" name=\"item_meta[1375]\" id=\"field_co_household_type3f593264e1a-1\" value=\"Soltero (a) cabeza de hogar\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Soltero (a) cabeza de hogar<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1375-1356-2\"><label for=\"field_co_household_type3f593264e1a-2\">\t\t<input type=\"radio\" name=\"item_meta[1375]\" id=\"field_co_household_type3f593264e1a-2\" value=\"Casado con dependientes\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Casado con dependientes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1375-1356-3\"><label for=\"field_co_household_type3f593264e1a-3\">\t\t<input type=\"radio\" name=\"item_meta[1375]\" id=\"field_co_household_type3f593264e1a-3\" value=\"Casado sin dependientes\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Casado sin dependientes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1375-1356-4\"><label for=\"field_co_household_type3f593264e1a-4\">\t\t<input type=\"radio\" name=\"item_meta[1375]\" id=\"field_co_household_type3f593264e1a-4\" value=\"Dos adultos sin relacion\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Estado Matrimonial is invalid\" aria-invalid=\"false\"  \/> Dos adultos sin relaci\u00f3n<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1376_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_co_family_size350c52f7d6c\" id=\"field_co_family_size350c52f7d6c_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_size350c52f7d6c\" name=\"item_meta[1376]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1377_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_dependents37a226ccb51\" id=\"field_co_dependents37a226ccb51_label\" class=\"frm_primary_label\">Dependientes\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_dependents37a226ccb51\" name=\"item_meta[1377]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1378_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_co_monthly_income355d2fce185\" id=\"field_co_monthly_income355d2fce185_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_income355d2fce185\" name=\"item_meta[1378]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1379_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_household_incomec2d6f1b8a1\" id=\"field_co_household_incomec2d6f1b8a1_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_incomec2d6f1b8a1\" name=\"item_meta[1379]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1380_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_fourth\">\r\n    <label for=\"field_co_employer_name3135b3a6fb3\" id=\"field_co_employer_name3135b3a6fb3_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_name3135b3a6fb3\" name=\"item_meta[1380]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1381_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_employer_phone_number3f3c9ec79cb\" id=\"field_co_employer_phone_number3f3c9ec79cb_label\" class=\"frm_primary_label\">N\u00famero de tel\u00e9fono del empleador\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_co_employer_phone_number3f3c9ec79cb\" name=\"item_meta[1381]\" value=\"\"  data-sectionid=\"1356\" 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_1382_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth\">\r\n    <label for=\"field_co_hourly_rate3668a731cd7\" id=\"field_co_hourly_rate3668a731cd7_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_rate3668a731cd7\" name=\"item_meta[1382]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1383_container\" class=\"frm_form_field form-field  frm_top_container frm_fourth frm_odd\">\r\n    <label for=\"field_co_yrs_on_this_job3b19508094a\" id=\"field_co_yrs_on_this_job3b19508094a_label\" class=\"frm_primary_label\">A\u00f1os en este trabajo\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_co_yrs_on_this_job3b19508094a\" name=\"item_meta[1383]\" value=\"\"  data-sectionid=\"1356\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1384_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_co_education_level376ea9b1b58_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_level376ea9b1b58_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1384-1356-0\"><label for=\"field_co_education_level376ea9b1b58-0\">\t\t<input type=\"radio\" name=\"item_meta[1384]\" id=\"field_co_education_level376ea9b1b58-0\" value=\"Menos de diploma de preparatoria\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Menos de diploma de preparatoria<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1384-1356-1\"><label for=\"field_co_education_level376ea9b1b58-1\">\t\t<input type=\"radio\" name=\"item_meta[1384]\" id=\"field_co_education_level376ea9b1b58-1\" value=\"Diploma de preparatoria o equivalente\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Diploma de preparatoria o equivalente<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1384-1356-2\"><label for=\"field_co_education_level376ea9b1b58-2\">\t\t<input type=\"radio\" name=\"item_meta[1384]\" id=\"field_co_education_level376ea9b1b58-2\" value=\"Universidad de dos anos\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Universidad de dos a\u00f1os<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1384-1356-3\"><label for=\"field_co_education_level376ea9b1b58-3\">\t\t<input type=\"radio\" name=\"item_meta[1384]\" id=\"field_co_education_level376ea9b1b58-3\" value=\"Licenciatura\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Licenciatura<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1384-1356-4\"><label for=\"field_co_education_level376ea9b1b58-4\">\t\t<input type=\"radio\" name=\"item_meta[1384]\" id=\"field_co_education_level376ea9b1b58-4\" value=\"Maestria\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Nivel de Educaci\u00f3n (por favor marque uno) is invalid\" aria-invalid=\"false\"  \/> Maestr\u00eda<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1385_container\" class=\"frm_form_field form-field  frm_top_container horizontal_radio\">\r\n    <div  id=\"field_co_ethnicity_hispanic3faa458354b_label\" class=\"frm_primary_label\">Etnico Hispano\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_co_ethnicity_hispanic3faa458354b_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1385-1356-0\"><label for=\"field_co_ethnicity_hispanic3faa458354b-0\">\t\t<input type=\"radio\" name=\"item_meta[1385]\" id=\"field_co_ethnicity_hispanic3faa458354b-0\" value=\"Si\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Etnico Hispano is invalid\" aria-invalid=\"false\"  \/> Si<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1385-1356-1\"><label for=\"field_co_ethnicity_hispanic3faa458354b-1\">\t\t<input type=\"radio\" name=\"item_meta[1385]\" id=\"field_co_ethnicity_hispanic3faa458354b-1\" value=\"No\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Etnico Hispano is invalid\" aria-invalid=\"false\"  \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1386_container\" class=\"frm_form_field form-field  frm_top_container frm_three_col\">\r\n    <div  id=\"field_co_race46aacbb09e3_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_race46aacbb09e3_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-0\"><label for=\"field_co_race46aacbb09e3-0\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-0\" value=\"Dominicano (a)\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Dominicano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-1\"><label for=\"field_co_race46aacbb09e3-1\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-1\" value=\"Blanco\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Blanco<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-2\"><label for=\"field_co_race46aacbb09e3-2\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-2\" value=\"Negro\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Negro<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-3\"><label for=\"field_co_race46aacbb09e3-3\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-3\" value=\"Mexicano (a)\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Mexicano (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-4\"><label for=\"field_co_race46aacbb09e3-4\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-4\" value=\"Puertorriqueno (a)\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Puertorrique\u00f1o (a)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-5\"><label for=\"field_co_race46aacbb09e3-5\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-5\" value=\"Otro\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Otro<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-6\"><label for=\"field_co_race46aacbb09e3-6\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-6\" value=\"No disponible\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> No disponible<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1386-1356-7\"><label for=\"field_co_race46aacbb09e3-7\">\t\t<input type=\"radio\" name=\"item_meta[1386]\" id=\"field_co_race46aacbb09e3-7\" value=\"Eligio no responder\"\n\t\t   data-sectionid=\"1356\" data-invmsg=\"Raza is invalid\" aria-invalid=\"false\"  \/> Eligi\u00f3 no responder<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1388_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_1389_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_full frm_three_col\">\r\n    <div  id=\"field_refered_by_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_by_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1389-1388-0\"><label for=\"field_refered_by-0\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-0\" value=\"Yo mismo\"  data-sectionid=\"1388\" 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_1389-1388-1\"><label for=\"field_refered_by-1\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-1\" value=\"Pagina de web de NHS\"  data-sectionid=\"1388\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Pagina de web de NHS<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1389-1388-2\"><label for=\"field_refered_by-2\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-2\" value=\"Facebook\"  data-sectionid=\"1388\" 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_1389-1388-3\"><label for=\"field_refered_by-3\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-3\" value=\"Personal del Gobierno\/Miembro Directivo\"  data-sectionid=\"1388\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Personal del Gobierno\/Miembro Directivo<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1389-1388-4\"><label for=\"field_refered_by-4\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-4\" value=\"Amigo (a)\"  data-sectionid=\"1388\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Amigo (a)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1389-1388-5\"><label for=\"field_refered_by-5\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-5\" value=\"Miembro de la familia\"  data-sectionid=\"1388\" data-reqmsg=\"Referido por cannot be blank.\" data-invmsg=\"Referido por is invalid\" aria-invalid=\"false\"   \/> Miembro de la familia<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_1389-1388-6\"><label for=\"field_refered_by-6\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-6\" value=\"Prestamista\"  data-sectionid=\"1388\" 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_1389-1388-7\"><label for=\"field_refered_by-7\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-7\" value=\"Agente de Bienes Raices\"  data-sectionid=\"1388\" 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_1389-1388-8\"><label for=\"field_refered_by-8\"><input type=\"checkbox\" name=\"item_meta[1389][]\" id=\"field_refered_by-8\" value=\"Otro\"  data-sectionid=\"1388\" 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_1390_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_referred_by_lenderd7caad711b\" id=\"field_referred_by_lenderd7caad711b_label\" class=\"frm_primary_label\">Prestamista\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_referred_by_lenderd7caad711b\" name=\"item_meta[1390]\" value=\"\"  data-sectionid=\"1388\" data-reqmsg=\"Prestamista 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_1391_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_referred_by_realtor040ebade68\" id=\"field_referred_by_realtor040ebade68_label\" class=\"frm_primary_label\">Agente de Bienes Ra\u00edces\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_referred_by_realtor040ebade68\" name=\"item_meta[1391]\" value=\"\"  data-sectionid=\"1388\" data-reqmsg=\"Agente de Bienes Ra\u00edces 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_1392_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_referred_by_other3a6e446f4d\" id=\"field_referred_by_other3a6e446f4d_label\" class=\"frm_primary_label\">Referido por otro\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_referred_by_other3a6e446f4d\" name=\"item_meta[1392]\" value=\"\"  data-sectionid=\"1388\" data-reqmsg=\"Referido por otro 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_1394_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_1395_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h5>Request and Authorize NHS HomeOwnership Center to:<\/h5>\n<p>Pull my\/our credit report to review my\/our credit file for housing counseling in connection with my pursuit of a loan to purchase real property.<\/p>\n<\/div>\n<div id=\"frm_field_1396_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third frm_authorization_type horizontal_radio\">\r\n    <div  id=\"field_authorization06d63411c8_label\" class=\"frm_primary_label\">Autorizaci\u00f3n tipo\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_authorization06d63411c8_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_1396-1394-0\"><label for=\"field_authorization06d63411c8-0\">\t\t<input type=\"radio\" name=\"item_meta[1396]\" id=\"field_authorization06d63411c8-0\" value=\"Autorizacion cara a cara\"\n\t\t   data-sectionid=\"1394\" data-invmsg=\"Autorizaci\u00f3n tipo is invalid\" aria-invalid=\"false\"  \/> Autorizaci\u00f3n cara a cara<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_1396-1394-1\"><label for=\"field_authorization06d63411c8-1\">\t\t<input type=\"radio\" name=\"item_meta[1396]\" id=\"field_authorization06d63411c8-1\" value=\"Por telefono\"\n\t\t   data-sectionid=\"1394\" data-invmsg=\"Autorizaci\u00f3n tipo is invalid\" aria-invalid=\"false\"  \/> Por tel\u00e9fono<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1397_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_authorization_date\">\r\n    <label for=\"field_authorization_ftf_date04e4f5dbce\" id=\"field_authorization_ftf_date04e4f5dbce_label\" class=\"frm_primary_label\">Fecha\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_authorization_ftf_date04e4f5dbce\" name=\"item_meta[1397]\" value=\"\"  data-sectionid=\"1394\" 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_1398_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_authorization_time\">\r\n    <div  id=\"field_authorization_ftf_time506f3ec2c4_label\" class=\"frm_primary_label\">Hora\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <select aria-labelledby=\"field_authorization_ftf_time506f3ec2c4_label\" name=\"item_meta[1398]\" id=\"field_authorization_ftf_time506f3ec2c4\"  data-sectionid=\"1394\" data-invmsg=\"Time is invalid\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"12:00 AM\" >12:00 AM<\/option><option value=\"12:30 AM\" >12:30 AM<\/option><option value=\"1:00 AM\" >1:00 AM<\/option><option value=\"1:30 AM\" >1:30 AM<\/option><option value=\"2:00 AM\" >2:00 AM<\/option><option value=\"2:30 AM\" >2:30 AM<\/option><option value=\"3:00 AM\" >3:00 AM<\/option><option value=\"3:30 AM\" >3:30 AM<\/option><option value=\"4:00 AM\" >4:00 AM<\/option><option value=\"4:30 AM\" >4:30 AM<\/option><option value=\"5:00 AM\" >5:00 AM<\/option><option value=\"5:30 AM\" >5:30 AM<\/option><option value=\"6:00 AM\" >6:00 AM<\/option><option value=\"6:30 AM\" >6:30 AM<\/option><option value=\"7:00 AM\" >7:00 AM<\/option><option value=\"7:30 AM\" >7:30 AM<\/option><option value=\"8:00 AM\" >8:00 AM<\/option><option value=\"8:30 AM\" >8:30 AM<\/option><option value=\"9:00 AM\" >9:00 AM<\/option><option value=\"9:30 AM\" >9:30 AM<\/option><option value=\"10:00 AM\" >10:00 AM<\/option><option value=\"10:30 AM\" >10:30 AM<\/option><option value=\"11:00 AM\" >11:00 AM<\/option><option value=\"11:30 AM\" >11:30 AM<\/option><option value=\"12:00 PM\" >12:00 PM<\/option><option value=\"12:30 PM\" >12:30 PM<\/option><option value=\"1:00 PM\" >1:00 PM<\/option><option value=\"1:30 PM\" >1:30 PM<\/option><option value=\"2:00 PM\" >2:00 PM<\/option><option value=\"2:30 PM\" >2:30 PM<\/option><option value=\"3:00 PM\" >3:00 PM<\/option><option value=\"3:30 PM\" >3:30 PM<\/option><option value=\"4:00 PM\" >4:00 PM<\/option><option value=\"4:30 PM\" >4:30 PM<\/option><option value=\"5:00 PM\" >5:00 PM<\/option><option value=\"5:30 PM\" >5:30 PM<\/option><option value=\"6:00 PM\" >6:00 PM<\/option><option value=\"6:30 PM\" >6:30 PM<\/option><option value=\"7:00 PM\" >7:00 PM<\/option><option value=\"7:30 PM\" >7:30 PM<\/option><option value=\"8:00 PM\" >8:00 PM<\/option><option value=\"8:30 PM\" >8:30 PM<\/option><option value=\"9:00 PM\" >9:00 PM<\/option><option value=\"9:30 PM\" >9:30 PM<\/option><option value=\"10:00 PM\" >10:00 PM<\/option><option value=\"10:30 PM\" >10:30 PM<\/option><option value=\"11:00 PM\" >11:00 PM<\/option><option value=\"11:30 PM\" >11:30 PM<\/option><\/select>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1399_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_authorization_date\">\r\n    <label for=\"field_authorization_otf_datedd96a98831\" id=\"field_authorization_otf_datedd96a98831_label\" class=\"frm_primary_label\">Fecha\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_authorization_otf_datedd96a98831\" name=\"item_meta[1399]\" value=\"\"  data-sectionid=\"1394\" 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_1400_container\" class=\"frm_form_field form-field  frm_top_container frm_third frm_authorization_time\">\r\n    <div  id=\"field_authorization_otf_time954d3a6e30_label\" class=\"frm_primary_label\">Hora\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/div>\r\n    <select aria-labelledby=\"field_authorization_otf_time954d3a6e30_label\" name=\"item_meta[1400]\" id=\"field_authorization_otf_time954d3a6e30\"  data-sectionid=\"1394\" data-invmsg=\"Time is invalid\" aria-invalid=\"false\"  ><option value=\"\"  selected='selected'><\/option><option value=\"12:00 AM\" >12:00 AM<\/option><option value=\"12:30 AM\" >12:30 AM<\/option><option value=\"1:00 AM\" >1:00 AM<\/option><option value=\"1:30 AM\" >1:30 AM<\/option><option value=\"2:00 AM\" >2:00 AM<\/option><option value=\"2:30 AM\" >2:30 AM<\/option><option value=\"3:00 AM\" >3:00 AM<\/option><option value=\"3:30 AM\" >3:30 AM<\/option><option value=\"4:00 AM\" >4:00 AM<\/option><option value=\"4:30 AM\" >4:30 AM<\/option><option value=\"5:00 AM\" >5:00 AM<\/option><option value=\"5:30 AM\" >5:30 AM<\/option><option value=\"6:00 AM\" >6:00 AM<\/option><option value=\"6:30 AM\" >6:30 AM<\/option><option value=\"7:00 AM\" >7:00 AM<\/option><option value=\"7:30 AM\" >7:30 AM<\/option><option value=\"8:00 AM\" >8:00 AM<\/option><option value=\"8:30 AM\" >8:30 AM<\/option><option value=\"9:00 AM\" >9:00 AM<\/option><option value=\"9:30 AM\" >9:30 AM<\/option><option value=\"10:00 AM\" >10:00 AM<\/option><option value=\"10:30 AM\" >10:30 AM<\/option><option value=\"11:00 AM\" >11:00 AM<\/option><option value=\"11:30 AM\" >11:30 AM<\/option><option value=\"12:00 PM\" >12:00 PM<\/option><option value=\"12:30 PM\" >12:30 PM<\/option><option value=\"1:00 PM\" >1:00 PM<\/option><option value=\"1:30 PM\" >1:30 PM<\/option><option value=\"2:00 PM\" >2:00 PM<\/option><option value=\"2:30 PM\" >2:30 PM<\/option><option value=\"3:00 PM\" >3:00 PM<\/option><option value=\"3:30 PM\" >3:30 PM<\/option><option value=\"4:00 PM\" >4:00 PM<\/option><option value=\"4:30 PM\" >4:30 PM<\/option><option value=\"5:00 PM\" >5:00 PM<\/option><option value=\"5:30 PM\" >5:30 PM<\/option><option value=\"6:00 PM\" >6:00 PM<\/option><option value=\"6:30 PM\" >6:30 PM<\/option><option value=\"7:00 PM\" >7:00 PM<\/option><option value=\"7:30 PM\" >7:30 PM<\/option><option value=\"8:00 PM\" >8:00 PM<\/option><option value=\"8:30 PM\" >8:30 PM<\/option><option value=\"9:00 PM\" >9:00 PM<\/option><option value=\"9:30 PM\" >9:30 PM<\/option><option value=\"10:00 PM\" >10:00 PM<\/option><option value=\"10:30 PM\" >10:30 PM<\/option><option value=\"11:00 PM\" >11:00 PM<\/option><option value=\"11:30 PM\" >11:30 PM<\/option><\/select>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1401_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>Client\u2019s Certification:<\/h5>\n<p>I\/We certify that the information included in this form is true and complete to the best of my\/our knowledge and belief.<\/p>\n<\/div>\n<div id=\"frm_field_1402_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_two_thirds\">\r\n    <label for=\"field_applicant_signatureedecd41da8\" id=\"field_applicant_signatureedecd41da8_label\" class=\"frm_primary_label\">Firma del solicitante\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1402\" 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[1402][typed]\" class=\"name\" id=\"field_applicant_signatureedecd41da8\" 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[1402][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1403_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_applicant_signature_date17f6237310\" id=\"field_applicant_signature_date17f6237310_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_date17f6237310\" name=\"item_meta[1403]\" value=\"\"  data-sectionid=\"1394\" 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_1404_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_two_thirds\">\r\n    <label for=\"field_co_applicant_signature9cf48886cb\" id=\"field_co_applicant_signature9cf48886cb_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=\"sigPad1404\" 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[1404][typed]\" class=\"name\" id=\"field_co_applicant_signature9cf48886cb\" 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[1404][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1405_container\" class=\"frm_form_field form-field  frm_top_container frm_third\">\r\n    <label for=\"field_co_applicant_signature_date96016a3adc\" id=\"field_co_applicant_signature_date96016a3adc_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_date96016a3adc\" name=\"item_meta[1405]\" value=\"\"  data-sectionid=\"1394\" 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_1407_container\" class=\"frm_form_field frm_section_heading form-field  frm_full frm_adp\">\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_1408_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h4>AUTORIZACI\u00d3N DE SERVICIOS DE ASESORAMIENTO DE NHSGB<\/h4>\n<h5>Mi informaci\u00f3n personal y los servicios de asesoramiento<\/h5>\n<p>Al firmar este formulario, acuerdo compartir mi informaci\u00f3n financiera y otra informaci\u00f3n privada. La firma de este documento les permite adem\u00e1s a los prestamistas y a la Agencia de Asesoramiento (NHSGB) discutir mis cuentas, cr\u00e9dito y finanzas, y compartir mi informaci\u00f3n personal privada, descrita en la Pol\u00edtica de Privacidad que se proporciona con esta autorizaci\u00f3n.<\/p>\n<p>Comprendo que los patrocinadores proporcionan becas para hacer posible el servicio de asesoramiento y que NHSGB comparte mi informaci\u00f3n con estos patrocinadores. Estos patrocinadores revisan los archivos de NHSGB, incluido mi archivo, y pueden contactarse conmigo para evaluar los servicios de asesoramiento que recibo.<\/p>\n<p>Autorizo a mi consejero y a NHSGB a negociar por m\u00ed. Los servicios de asesoramiento se ofrecen de manera gratuita, y ni el consejero ni NHSGB garantizan ning\u00fan resultado o consecuencia. Se me puede referir a otra agencia de vivienda para obtener sus servicios. No estoy obligado a aceptar los servicios o productos de NHSGB, de sus socios, ni de ninguna organizaci\u00f3n a la que se me refiera.<\/p>\n<p>Comprendo que mi consejero no puede ofrecerme asesor\u00eda ni representaci\u00f3n jur\u00eddica 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>El cliente debe colocar sus iniciales en todos los art\u00edculos que sean aplicables.<\/p>\n<\/div>\n<div id=\"frm_field_1409_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_1c9328c0b25e87138d861\" id=\"field_adp_initials_1c9328c0b25e87138d861_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\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_1c9328c0b25e87138d861\" name=\"item_meta[1409]\" value=\"\"  data-sectionid=\"1407\" 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_1410_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_23d01faa65bb1b4e4e675\" id=\"field_adp_initials_23d01faa65bb1b4e4e675_label\" class=\"frm_primary_label\">Comprendo que el consejero discutir\u00e1 mi presupuesto conmigo y recibir\u00e9 una copia de mi Presupuesto.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_23d01faa65bb1b4e4e675\" name=\"item_meta[1410]\" value=\"\"  data-sectionid=\"1407\" 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_1411_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_35025bc9197115e4afe65\" id=\"field_adp_initials_35025bc9197115e4afe65_label\" class=\"frm_primary_label\">Comprendo que el consejero 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\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_35025bc9197115e4afe65\" name=\"item_meta[1411]\" value=\"\"  data-sectionid=\"1407\" 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_1412_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_410f3a5d826cd73d5457a\" id=\"field_adp_initials_410f3a5d826cd73d5457a_label\" class=\"frm_primary_label\">Comprendo que el consejero me explicar\u00e1 los pr\u00f3ximos pasos necesarios para alcanzar mis metas financieras para mi satisfacci\u00f3n.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_410f3a5d826cd73d5457a\" name=\"item_meta[1412]\" value=\"\"  data-sectionid=\"1407\" 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_1413_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_55fd609c0e1d13efdcac2\" id=\"field_adp_initials_55fd609c0e1d13efdcac2_label\" class=\"frm_primary_label\">Consejer\u00eda para Compradores de Viviendas.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_55fd609c0e1d13efdcac2\" name=\"item_meta[1413]\" value=\"\"  data-sectionid=\"1407\" 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_1414_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_6ebaa65d35c3a99fef59c\" id=\"field_adp_initials_6ebaa65d35c3a99fef59c_label\" class=\"frm_primary_label\">Consejer\u00eda para Due\u00f1os de Viviendas (Programa de Reparaci\u00f3n).\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_6ebaa65d35c3a99fef59c\" name=\"item_meta[1414]\" value=\"\"  data-sectionid=\"1407\" 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_1415_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_791b19a5fcc\" id=\"field_adp_initials_791b19a5fcc_label\" class=\"frm_primary_label\">Educaci\u00f3n para Compradores de Viviendas.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_791b19a5fcc\" name=\"item_meta[1415]\" value=\"\"  data-sectionid=\"1407\" 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_1416_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_82875a38307228f8de1fb\" id=\"field_adp_initials_82875a38307228f8de1fb_label\" class=\"frm_primary_label\">Educaci\u00f3n por Morosidad e Incumplimiento.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_82875a38307228f8de1fb\" name=\"item_meta[1416]\" value=\"\"  data-sectionid=\"1407\" 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_1417_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_99c5e3ee3c048af99ff27\" id=\"field_adp_initials_99c5e3ee3c048af99ff27_label\" class=\"frm_primary_label\">Deseo comprar una casa en los pr\u00f3ximos seis (6) meses.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_99c5e3ee3c048af99ff27\" name=\"item_meta[1417]\" value=\"\"  data-sectionid=\"1407\" 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_1418_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_1031312c3898a6a89f1a1e\" id=\"field_adp_initials_1031312c3898a6a89f1a1e_label\" class=\"frm_primary_label\">Deseo comprar una casa, pero no en los pr\u00f3ximos seis (6) meses.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_1031312c3898a6a89f1a1e\" name=\"item_meta[1418]\" value=\"\"  data-sectionid=\"1407\" 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_1419_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_11195787ac2e6faa9e07fe\" id=\"field_adp_initials_11195787ac2e6faa9e07fe_label\" class=\"frm_primary_label\">Otros programas, servicios o productos:<br><span>Para los clientes de Consejer\u00eda Antes de Comprar, Antes de Cerrar y Educaci\u00f3n para Compradores de Viviendas.<\/span>\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_11195787ac2e6faa9e07fe\" name=\"item_meta[1419]\" value=\"\"  data-sectionid=\"1407\" 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_1420_container\" class=\"frm_form_field form-field  frm_left_container frm_full frm_initials\">\r\n    <label for=\"field_adp_initials_12aed126e1846c05abd7c9\" id=\"field_adp_initials_12aed126e1846c05abd7c9_label\" class=\"frm_primary_label\">He recibido los formularios del Departamento de Vivienda y Desarrollo Urbano (HUD, por sus siglas en ingl\u00e9s):<br><span>\"Diez Preguntas Importantes para Hacerle al Inspector de su Vivienda\u201d y \u201cPara su Protecci\u00f3n: Lleve a Cabo una Inspecci\u00f3n de la Vivienda\".<\/span>\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_input_group frm_with_box frm_with_post\"><input type=\"text\" id=\"field_adp_initials_12aed126e1846c05abd7c9\" name=\"item_meta[1420]\" value=\"\"  data-sectionid=\"1407\" 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_1421_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h5>Informaci\u00f3n de la Agencia de Asesoramiento<\/h5>\n<\/div>\n<div id=\"frm_field_1422_container\" class=\"frm_form_field form-field  frm_left_container frm_first frm_two_thirds\">\r\n    <label for=\"field_nhsgb_counselor_name8136c23bfe\" id=\"field_nhsgb_counselor_name8136c23bfe_label\" class=\"frm_primary_label\">Nombre del Asesor\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nhsgb_counselor_name8136c23bfe\" name=\"item_meta[1422]\" value=\"\"  data-sectionid=\"1407\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1423_container\" class=\"frm_form_field form-field  frm_left_container frm_third\">\r\n    <label for=\"field_nhsgb_phone3b71bb5ce9\" id=\"field_nhsgb_phone3b71bb5ce9_label\" class=\"frm_primary_label\">Tel\u00e9fono\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_nhsgb_phone3b71bb5ce9\" name=\"item_meta[1423]\" value=\"\"  data-sectionid=\"1407\" 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_1424_container\" class=\"frm_form_field form-field  frm_left_container frm_first frm_two_thirds\">\r\n    <label for=\"field_nhsgbbdf4b77708\" id=\"field_nhsgbbdf4b77708_label\" class=\"frm_primary_label\">Agencia de Asesoramiento\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nhsgbbdf4b77708\" name=\"item_meta[1424]\" value=\"Neighborhood Housing Services of Greater Berks, Inc.\"  readonly=\"readonly\"  data-sectionid=\"1407\" 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_1425_container\" class=\"frm_form_field form-field  frm_left_container frm_third\">\r\n    <label for=\"field_nhsgb_email8583be66be\" id=\"field_nhsgb_email8583be66be_label\" class=\"frm_primary_label\">Electr\u00f3nico\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_nhsgb_email8583be66be\" name=\"item_meta[1425]\" value=\"\"  data-sectionid=\"1407\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1426_container\" class=\"frm_form_field form-field  frm_left_container frm_first frm_two_thirds\">\r\n    <label for=\"field_nhsgb_counselormax_case_idb348f3144d\" id=\"field_nhsgb_counselormax_case_idb348f3144d_label\" class=\"frm_primary_label\">N\u00famero de Cliente en CMax\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nhsgb_counselormax_case_idb348f3144d\" name=\"item_meta[1426]\" value=\"\"  data-sectionid=\"1407\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1427_container\" class=\"frm_form_field form-field  frm_left_container frm_third\">\r\n    <label for=\"field_nhsgb_fax5072a38297\" id=\"field_nhsgb_fax5072a38297_label\" class=\"frm_primary_label\">Fax\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_nhsgb_fax5072a38297\" name=\"item_meta[1427]\" value=\"610-374-2866\"  readonly=\"readonly\"  data-sectionid=\"1407\" data-frmval=\"610-374-2866\" 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_1428_container\" class=\"frm_form_field form-field  frm_left_container frm_first frm_two_thirds\">\r\n    <label for=\"field_nhsgb_rx_client_numberae87859b7c\" id=\"field_nhsgb_rx_client_numberae87859b7c_label\" class=\"frm_primary_label\">N\u00famero de Cliente en RX\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_nhsgb_rx_client_numberae87859b7c\" name=\"item_meta[1428]\" value=\"\"  data-sectionid=\"1407\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1429_container\" class=\"frm_form_field form-field  frm_left_container frm_third\">\r\n    <label for=\"field_extra_line7db6d42e30\" id=\"field_extra_line7db6d42e30_label\" class=\"frm_primary_label\">\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_extra_line7db6d42e30\" name=\"item_meta[1429]\" value=\"\"  data-sectionid=\"1407\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_1431_container\" class=\"frm_form_field frm_section_heading form-field  frm_full frm_adp frm_adp_last\">\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_1432_container\" class=\"frm_form_field  frm_full frm_html_container form-field\">\n<h4>POL\u00cdTICA DE PRIVACIDAD<\/h4>\n<p>NHSGB 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 subsistencia y la informaci\u00f3n personal relativa a 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>Tipo de Informaci\u00f3n que Recopilamos sobre Usted:<\/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>Usted puede Optar por No Compartir la Informaci\u00f3n que Nos Brinda:<\/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 privada 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 NHSGB 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>De qu\u00e9 Manera Utilizamos su Informaci\u00f3n:<\/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 patrocinadores que hacen posible nuestros servicios.<\/li>\n<li>Podremos compartir su informaci\u00f3n con cualquiera seg\u00fan lo permita o lo requiera la ley (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. Tomamos 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>Autorizaci\u00f3n del Cliente<\/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 a NHSGB a recopilar informaci\u00f3n sobre mis cuentas y a compartir esta informaci\u00f3n con otros, incluidos los patrocinadores, seg\u00fan sea necesario para proporcionar los servicios de asesoramiento, para buscar ayuda de programas o para brindar productos y servicios relacionados. Autorizo a los patrocinadores a comunicarse conmigo para evaluar los programas en los que participo.<\/p>\n<\/div>\n<div id=\"frm_field_1433_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_1434_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_1435_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_1436_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_first frm_third\">\r\n    <label for=\"field_first_client_namefdeba71f8c\" id=\"field_first_client_namefdeba71f8c_label\" class=\"frm_primary_label\">NOMBRE DEL CLIENTE\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_first_client_namefdeba71f8c\" name=\"item_meta[1436]\" value=\"\"  data-sectionid=\"1431\" 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_1437_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_third\">\r\n    <label for=\"field_first_client_signature83832cbfe3\" id=\"field_first_client_signature83832cbfe3_label\" class=\"frm_primary_label\">FIRMA DEL CLIENTE\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1437\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px\">\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[1437][typed]\" class=\"name\" id=\"field_first_client_signature83832cbfe3\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1437][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1438_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third\">\r\n    <label for=\"field_first_client_date3aa21ac536\" id=\"field_first_client_date3aa21ac536_label\" class=\"frm_primary_label\">FECHA\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_first_client_date3aa21ac536\" name=\"item_meta[1438]\" value=\"\"  data-sectionid=\"1431\" 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_1439_container\" class=\"frm_form_field form-field  frm_hidden_container frm_first frm_third\">\r\n    <label for=\"field_second_client_name569cd4ea26\" id=\"field_second_client_name569cd4ea26_label\" class=\"frm_primary_label\">NOMBRE DEL CLIENTE\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_second_client_name569cd4ea26\" name=\"item_meta[1439]\" value=\"\"  data-sectionid=\"1431\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1440_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third\">\r\n    <label for=\"field_second_client_signature5e0ee887cf\" id=\"field_second_client_signature5e0ee887cf_label\" class=\"frm_primary_label\">FIRMA DEL CLIENTE\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad1440\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px\">\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[1440][typed]\" class=\"name\" id=\"field_second_client_signature5e0ee887cf\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[1440][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1441_container\" class=\"frm_form_field form-field  frm_hidden_container frm_third\">\r\n    <label for=\"field_second_client_date4559e8004b\" id=\"field_second_client_date4559e8004b_label\" class=\"frm_primary_label\">FECHA\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_second_client_date4559e8004b\" name=\"item_meta[1441]\" value=\"\"  data-sectionid=\"1431\" maxlength=\"10\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__653a32e32ae51\">\n\t\t\t\t<label for=\"frm_email_22\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_22\" type=\"text\" class=\"frm_verify\" name=\"frm__653a32e32ae51\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"fjQW\/qbu5hUaI+JNItMtr0U9wO2AfvKVREgO22KWG98=\" \/><div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Enviar<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n<script>\nvar 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href=\"https:\/\/nhsgb.org\/buy-your-home\/counseling\/spanish-counseling-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Spanish Counseling Form - Neighborhood Housing Services\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column][vc_column_text][\/vc_column_text][\/vc_column][\/vc_row]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/nhsgb.org\/buy-your-home\/counseling\/spanish-counseling-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Neighborhood Housing Services\" \/>\n<meta property=\"article:modified_time\" content=\"2020-11-23T18:24:34+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" 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