{"id":146,"date":"2024-04-08T12:27:04","date_gmt":"2024-04-08T19:27:04","guid":{"rendered":"https:\/\/legalservices.lalgbtcenter.org\/?page_id=146"},"modified":"2025-09-26T16:56:37","modified_gmt":"2025-09-26T23:56:37","slug":"legal-services-request-form","status":"publish","type":"page","link":"https:\/\/legalservices.lalgbtcenter.org\/es\/legal-services-request-form\/","title":{"rendered":"Formulario de solicitud de servicios legales"},"content":{"rendered":"<p>&nbsp;<\/p>\r\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_4' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Formulario de solicitud de servicios legales<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/es\/wp-json\/wp\/v2\/pages\/146' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_13\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informaci\u00f3n de contacto<\/h3><\/div><div id=\"field_4_1\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div>\n    <span>\n        <i>Declaraci\u00f3n de confidencialidad: Su privacidad es importante para nosotros. Toda la informaci\u00f3n proporcionada en este formulario electr\u00f3nico de admisi\u00f3n legal es estrictamente confidencial y solo acceder\u00e1 a ella personal autorizado con el fin de evaluar y abordar sus necesidades legales. Cumplimos con estrictos est\u00e1ndares de confidencialidad y no divulgaremos ninguna informaci\u00f3n sin su consentimiento expl\u00edcito, excepto cuando lo exija la ley. Al enviar este formulario, reconoce y acepta los t\u00e9rminos de nuestra pol\u00edtica de confidencialidad.   <\/i>\n    <\/span>\n<\/div><\/div><div id=\"field_4_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_3'>Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_3'>Indique c\u00f3mo le gustar\u00eda que le llamaran<\/div><div class='ginput_container ginput_container_text'><input name='input_3' id='input_4_3' type='text' value='' class='large' maxlength='64' aria-describedby=\"gfield_description_4_3\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full sams-silly-class gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Apellido<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_4_4' type='text' value='' class='large' maxlength='64'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_5'>Nombre legal (si es diferente del anterior)<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_4_5' type='text' value='' class='large' maxlength='255'     aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_6\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Fecha de nacimiento<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div id='input_4_6' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_4_6_3_container'><label for='input_4_6_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>A\u00f1o<\/label><select name='input_6[]' id='input_4_6_3'   aria-required='true'  ><option value=''>A\u00f1o<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_4_6_1_container'><label for='input_4_6_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mes<\/label><select name='input_6[]' id='input_4_6_1'   aria-required='true'  ><option value=''>Mes<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_4_6_2_container'><label for='input_4_6_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>D\u00eda<\/label><select name='input_6[]' id='input_4_6_2'   aria-required='true'  ><option value=''>D\u00eda<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_4_7\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_7'>N\u00famero de tel\u00e9fono<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_4_7' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfEs seguro dejar un mensaje de voz que indique que llamamos desde el LA LGBT Center?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_40'>\n\t\t\t<div class='gchoice gchoice_4_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='1'  id='choice_4_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_40_0' id='label_4_40_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='0'  id='choice_4_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_40_1' id='label_4_40_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_40_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='2'  id='choice_4_40_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_40_2' id='label_4_40_2' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_108\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_108'>Explique su respuesta sobre si es seguro dejar un mensaje de voz que indique que llamamos desde el LA LGBT Center<\/label><div class='gfield_description' id='gfield_description_4_108'>Explique su respuesta sobre si es seguro dejar un mensaje de voz que indique que llamamos desde el LA LGBT Center:<\/div><div class='ginput_container ginput_container_text'><input name='input_108' id='input_4_108' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_108\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_125\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfEs seguro dejar un mensaje de voz o enviar un correo electr\u00f3nico sin que otros puedan acceder a \u00e9l?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_125'>\n\t\t\t<div class='gchoice gchoice_4_125_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='1'  id='choice_4_125_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_125_0' id='label_4_125_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_125_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_125' type='radio' value='0'  id='choice_4_125_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_125_1' id='label_4_125_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_126\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_126'>Mejor momento para contactarle<\/label><div class='gfield_description' id='gfield_description_4_126'>Ind\u00edquenos los mejores d\u00edas y horas para contactarle:<\/div><div class='ginput_container ginput_container_text'><input name='input_126' id='input_4_126' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_126\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_9\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_9'>Correo electr\u00f3nico<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_4_9' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_4_10\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Direcci\u00f3n<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_10' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_10_1_container' >\n                                        <label for='input_4_10_1' id='input_4_10_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                        <input type='text' name='input_10.1' id='input_4_10_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_10_3_container' >\n                                    <label for='input_4_10_3' id='input_4_10_3_label' class='gform-field-label gform-field-label--type-sub '>Ciudad<\/label>\n                                    <input type='text' name='input_10.3' id='input_4_10_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_4_10_4_container' >\n                                        <label for='input_4_10_4' id='input_4_10_4_label' class='gform-field-label gform-field-label--type-sub '>Estado<\/label>\n                                        <select name='input_10.4' id='input_4_10_4'     aria-required='false'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' selected='selected'>California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_10_5_container' >\n                                    <label for='input_4_10_5' id='input_4_10_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo postal<\/label>\n                                    <input type='text' name='input_10.5' id='input_4_10_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_10.6' id='input_4_10_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informaci\u00f3n de West Hollywood<\/h3><\/div><div id=\"field_4_22\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_22'>\u00bfVive en West Hollywood?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_4_22' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >S\u00ed<\/option><option value='0' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_4_101\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfD\u00f3nde vive en West Hollywood?<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_zip ginput_container_address gform-grid-row' id='input_4_101' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_101_1_container' >\n                                        <label for='input_4_101_1' id='input_4_101_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                        <input type='text' name='input_101.1' id='input_4_101_1' value=''    aria-required='false'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_101.4' id='input_4_101_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_101_5_container' >\n                                    <label for='input_4_101_5' id='input_4_101_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo Postal<\/label>\n                                    <input type='text' name='input_101.5' id='input_4_101_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_101.6' id='input_4_101_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_116\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_23'>\u00bfTrabaja en West Hollywood?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_4_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >S\u00ed<\/option><option value='0' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_4_102\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfD\u00f3nde trabaja en West Hollywood?<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_zip ginput_container_address gform-grid-row' id='input_4_102' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_102_1_container' >\n                                        <label for='input_4_102_1' id='input_4_102_1_label' class='gform-field-label gform-field-label--type-sub '>Empleador<\/label>\n                                        <input type='text' name='input_102.1' id='input_4_102_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_102_2_container' >\n                                        <label for='input_4_102_2' id='input_4_102_2_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                        <input type='text' name='input_102.2' id='input_4_102_2' value=''     aria-required='false'   \/>\n                                    <\/span><input type='hidden' class='gform_hidden' name='input_102.4' id='input_4_102_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_102_5_container' >\n                                    <label for='input_4_102_5' id='input_4_102_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo Postal<\/label>\n                                    <input type='text' name='input_102.5' id='input_4_102_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_102.6' id='input_4_102_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_117\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_24\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_24'>\u00bfEs propietario de alguna propiedad en West Hollywood?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_24' id='input_4_24' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >S\u00ed<\/option><option value='0' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_4_103\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfD\u00f3nde es propietario de alguna propiedad en West Hollywood?<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_zip ginput_container_address gform-grid-row' id='input_4_103' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_103_1_container' >\n                                        <label for='input_4_103_1' id='input_4_103_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                        <input type='text' name='input_103.1' id='input_4_103_1' value=''    aria-required='false'    \/>\n                                   <\/span><input type='hidden' class='gform_hidden' name='input_103.4' id='input_4_103_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_103_5_container' >\n                                    <label for='input_4_103_5' id='input_4_103_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo Postal<\/label>\n                                    <input type='text' name='input_103.5' id='input_4_103_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_103.6' id='input_4_103_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_118\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_25\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_25'>\u00bfAsiste a la escuela en West Hollywood?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_4_25' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >S\u00ed<\/option><option value='0' >No<\/option><\/select><\/div><\/div><div id=\"field_4_106\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_106'>Nombre de la escuela<\/label><div class='ginput_container ginput_container_text'><input name='input_106' id='input_4_106' type='text' value='' class='large' maxlength='255'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_119\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_4_26\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_26'>\u00bfPasa tiempo sin hogar en West Hollywood?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_4_26' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >S\u00ed<\/option><option value='0' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_4_105\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfD\u00f3nde pasa tiempo sin hogar en West Hollywood?<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_zip ginput_container_address gform-grid-row' id='input_4_105' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_105_1_container' >\n                                        <label for='input_4_105_1' id='input_4_105_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                        <input type='text' name='input_105.1' id='input_4_105_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_105_2_container' >\n                                        <label for='input_4_105_2' id='input_4_105_2_label' class='gform-field-label gform-field-label--type-sub '>Descripci\u00f3n de la ubicaci\u00f3n<\/label>\n                                        <input type='text' name='input_105.2' id='input_4_105_2' value=''     aria-required='false'   \/>\n                                    <\/span><input type='hidden' class='gform_hidden' name='input_105.4' id='input_4_105_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_4_105_5_container' >\n                                    <label for='input_4_105_5' id='input_4_105_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo Postal<\/label>\n                                    <input type='text' name='input_105.5' id='input_4_105_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_105.6' id='input_4_105_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_4_20\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Naturaleza de la consulta<\/h3><div class='gsection_description' id='gfield_description_4_20'>Ind\u00edquenos por qu\u00e9 se ha puesto en contacto con nosotros.<\/div><\/div><fieldset id=\"field_4_33\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Motivos para ponerse en contacto con los servicios legales<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_33'><div class='gchoice gchoice_4_33_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='1'  id='choice_4_33_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_33_1' id='label_4_33_1' class='gform-field-label gform-field-label--type-inline'>Servicios legales de inmigraci\u00f3n<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_33_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.2' type='checkbox'  value='2'  id='choice_4_33_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_33_2' id='label_4_33_2' class='gform-field-label gform-field-label--type-inline'>J\u00f3venes sin hogar y derechos de vivienda<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_33_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.3' type='checkbox'  value='3'  id='choice_4_33_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_33_3' id='label_4_33_3' class='gform-field-label gform-field-label--type-inline'>Violencia, acoso y discriminaci\u00f3n por odio anti-LGBTQI+<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_33_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.4' type='checkbox'  value='4'  id='choice_4_33_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_33_4' id='label_4_33_4' class='gform-field-label gform-field-label--type-inline'>Violencia dom\u00e9stica\/de pareja, agresi\u00f3n sexual, acecho y trata de personas<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_33_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.5' type='checkbox'  value='5'  id='choice_4_33_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_33_5' id='label_4_33_5' class='gform-field-label gform-field-label--type-inline'>Cl\u00ednica legal y servicio de derivaci\u00f3n a abogados<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_33_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.6' type='checkbox'  value='6'  id='choice_4_33_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_33_6' id='label_4_33_6' class='gform-field-label gform-field-label--type-inline'>Cambio de nombre y marcador de g\u00e9nero en los documentos de identificaci\u00f3n<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_33_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_33.7' type='checkbox'  value='7'  id='choice_4_33_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_33_7' id='label_4_33_7' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_28'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_28'>Ind\u00edquenos la naturaleza del problema legal:<\/div><div class='ginput_container ginput_container_text'><input name='input_28' id='input_4_28' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_28\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_130\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_130'>\u00bfSu problema legal involucra a un individuo o a una entidad como una empresa, organizaci\u00f3n o instituci\u00f3n?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_130' id='input_4_130' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Individuo<\/option><option value='2' >Empresa\/organizaci\u00f3n\/instituci\u00f3n<\/option><option value='3' >Ninguno<\/option><\/select><\/div><\/div><div id=\"field_4_131\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_131'>Indique el nombre del individuo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_131' id='input_4_131' type='text' value='' class='large' maxlength='255'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_132\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Si est\u00e1 disponible, indique la fecha de nacimiento del individuo<\/legend><div id='input_4_132' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_4_132_3_container'><label for='input_4_132_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>A\u00f1o<\/label><select name='input_132[]' id='input_4_132_3'   aria-required='false'  ><option value=''>A\u00f1o<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_4_132_1_container'><label for='input_4_132_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mes<\/label><select name='input_132[]' id='input_4_132_1'   aria-required='false'  ><option value=''>Mes<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_4_132_2_container'><label for='input_4_132_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>D\u00eda<\/label><select name='input_132[]' id='input_4_132_2'   aria-required='false'  ><option value=''>D\u00eda<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_4_134\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_134'>Indique el nombre de la empresa\/organizaci\u00f3n\/instituci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_134'>No nos pondremos en contacto con la parte contraria ni con ninguna otra parte. Toda la informaci\u00f3n proporcionada es completamente confidencial. <\/div><div class='ginput_container ginput_container_text'><input name='input_134' id='input_4_134' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_134\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_135\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Si est\u00e1 disponible, indique la direcci\u00f3n de la empresa\/organizaci\u00f3n\/instituci\u00f3n<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_4_135' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_4_135_1_container' >\n                                        <label for='input_4_135_1' id='input_4_135_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                        <input type='text' name='input_135.1' id='input_4_135_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_4_135_2_container' >\n                                        <label for='input_4_135_2' id='input_4_135_2_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n 2<\/label>\n                                        <input type='text' name='input_135.2' id='input_4_135_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_4_135_3_container' >\n                                    <label for='input_4_135_3' id='input_4_135_3_label' class='gform-field-label gform-field-label--type-sub '>Ciudad<\/label>\n                                    <input type='text' name='input_135.3' id='input_4_135_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_4_135_4_container' >\n                                        <label for='input_4_135_4' id='input_4_135_4_label' class='gform-field-label gform-field-label--type-sub '>Provincia<\/label>\n                                        <select name='input_135.4' id='input_4_135_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_4_135_5_container' >\n                                    <label for='input_4_135_5' id='input_4_135_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo Postal<\/label>\n                                    <input type='text' name='input_135.5' id='input_4_135_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_135.6' id='input_4_135_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_4_95\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfRecibe actualmente servicios del Centro?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_95'>\n\t\t\t<div class='gchoice gchoice_4_95_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_95' type='radio' value='1'  id='choice_4_95_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_95_0' id='label_4_95_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_95_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_95' type='radio' value='0'  id='choice_4_95_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_95_1' id='label_4_95_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_96\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_96'>Si responde &quot;S\u00ed&quot;, \u00bfcu\u00e1l de nuestras ubicaciones visita?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_96' id='input_4_96' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='3' >Mi centro (boyle heights)<\/option><option value='12' >Trans wellness Center (korea town)<\/option><option value='16' >Center south (south LA)<\/option><option value='17' >Youth Center (Hollywood)<\/option><option value='1' >The Village (Hollywood)<\/option><option value='4' >McDonald Wright (Hollywood)<\/option><option value='2' >Triangle square<\/option><option value='18' >Senior Center (Hollywood)<\/option><option value='otro' >Otro<\/option><\/select><\/div><\/div><div id=\"field_4_97\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_97'>Si es &quot;Otro&quot;, describa la ubicaci\u00f3n<\/label><div class='ginput_container ginput_container_text'><input name='input_97' id='input_4_97' type='text' value='' class='large' maxlength='255'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Solicitud de asistencia en materia de inmigraci\u00f3n<\/h3><div class='gsection_description' id='gfield_description_4_30'>El Proyecto de Ley de Inmigraci\u00f3n del Centro LGBT de Los \u00c1ngeles ofrece consultas legales, representaci\u00f3n ante los tribunales, incluso para la ley de asilo\/refugiados, y apoyo integral para proteger a los miembros de la comunidad LGBTQ+ que huyen de la persecuci\u00f3n y la tortura en sus pa\u00edses de origen. Proporcione la siguiente informaci\u00f3n: <\/div><\/div><fieldset id=\"field_4_31\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfQu\u00e9 tipo de asistencia busca?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_31'><div class='gchoice gchoice_4_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='1'  id='choice_4_31_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_1' id='label_4_31_1' class='gform-field-label gform-field-label--type-inline'>Consultas legales y evaluaciones de elegibilidad<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.2' type='checkbox'  value='2'  id='choice_4_31_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_2' id='label_4_31_2' class='gform-field-label gform-field-label--type-inline'>Preparaci\u00f3n de la solicitud de asilo, suspensi\u00f3n de la expulsi\u00f3n o protecci\u00f3n en virtud de la Convenci\u00f3n contra la Tortura<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.3' type='checkbox'  value='3'  id='choice_4_31_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_3' id='label_4_31_3' class='gform-field-label gform-field-label--type-inline'>Solicitud y renovaci\u00f3n de la autorizaci\u00f3n de empleo (permiso de trabajo)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.4' type='checkbox'  value='4'  id='choice_4_31_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_4' id='label_4_31_4' class='gform-field-label gform-field-label--type-inline'>Representaci\u00f3n ante el tribunal de inmigraci\u00f3n y el USCIS<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.5' type='checkbox'  value='5'  id='choice_4_31_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_5' id='label_4_31_5' class='gform-field-label gform-field-label--type-inline'>Defensa contra la expulsi\u00f3n<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_31_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.6' type='checkbox'  value='6'  id='choice_4_31_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_31_6' id='label_4_31_6' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_32'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_32'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_32' id='input_4_32' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_32\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_34\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_34'>\u00bfPuede confirmar su estado migratorio actual?<\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_4_34' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Ciudadano estadounidense<\/option><option value='14' >Indocumentado<\/option><option value='20' >En proceso de expulsi\u00f3n (actualmente)<\/option><option value='19' >Entrada con permiso de permanencia temporal<\/option><option value='25' >Admisi\u00f3n condicional; entrada con visado (turista, estudiante, empleo)<\/option><option value='12' >Otro estado<\/option><\/select><\/div><\/div><div id=\"field_4_127\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_127'>Explique su estado migratorio:<\/label><div class='gfield_description' id='gfield_description_4_127'>Explique su estado migratorio:<\/div><div class='ginput_container ginput_container_text'><input name='input_127' id='input_4_127' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_127\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_39\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfYa ha contratado a un abogado de inmigraci\u00f3n?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_39'>\n\t\t\t<div class='gchoice gchoice_4_39_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='1'  id='choice_4_39_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_39_0' id='label_4_39_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_39_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='0'  id='choice_4_39_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_39_1' id='label_4_39_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_39_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_39' type='radio' value='2'  id='choice_4_39_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_39_2' id='label_4_39_2' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_111\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_111'>Explique si ha contratado a un abogado de inmigraci\u00f3n:<\/label><div class='gfield_description' id='gfield_description_4_111'>Explique si ha contratado a un abogado de inmigraci\u00f3n:<\/div><div class='ginput_container ginput_container_text'><input name='input_111' id='input_4_111' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_111\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_38\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfTiene una fecha l\u00edmite o una audiencia judicial pr\u00f3xima ante un juez de inmigraci\u00f3n?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_38'>\n\t\t\t<div class='gchoice gchoice_4_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='1'  id='choice_4_38_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_38_0' id='label_4_38_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='0'  id='choice_4_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_38_1' id='label_4_38_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_77\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Si responde &quot;S\u00ed&quot; a lo anterior, indique la fecha de su fecha l\u00edmite o fecha judicial.<\/legend><div id='input_4_77' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_4_77_3_container'><label for='input_4_77_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>A\u00f1o<\/label><select name='input_77[]' id='input_4_77_3'   aria-required='false'  ><option value=''>A\u00f1o<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_4_77_1_container'><label for='input_4_77_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mes<\/label><select name='input_77[]' id='input_4_77_1'   aria-required='false'  ><option value=''>Mes<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_4_77_2_container'><label for='input_4_77_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>D\u00eda<\/label><select name='input_77[]' id='input_4_77_2'   aria-required='false'  ><option value=''>D\u00eda<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_4_78\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfCu\u00e1l fue la \u00faltima fecha en que entr\u00f3 en Estados Unidos?<\/legend><div id='input_4_78' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_4_78_3_container'><label for='input_4_78_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>A\u00f1o<\/label><select name='input_78[]' id='input_4_78_3'   aria-required='false'  ><option value=''>A\u00f1o<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_4_78_1_container'><label for='input_4_78_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mes<\/label><select name='input_78[]' id='input_4_78_1'   aria-required='false'  ><option value=''>Mes<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_4_78_2_container'><label for='input_4_78_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>D\u00eda<\/label><select name='input_78[]' id='input_4_78_2'   aria-required='false'  ><option value=''>D\u00eda<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_4_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfAlguna vez ha sido arrestado o condenado por un delito en alg\u00fan pa\u00eds?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_79'>\n\t\t\t<div class='gchoice gchoice_4_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='1'  id='choice_4_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_79_0' id='label_4_79_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='0'  id='choice_4_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_79_1' id='label_4_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_79_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='2'  id='choice_4_79_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_79_2' id='label_4_79_2' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_112\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_112'>Explique si ha sido arrestado o condenado por un delito en alg\u00fan pa\u00eds:<\/label><div class='gfield_description' id='gfield_description_4_112'>Explique si ha sido arrestado o condenado por un delito en alg\u00fan pa\u00eds:<\/div><div class='ginput_container ginput_container_text'><input name='input_112' id='input_4_112' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_112\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfAlguna vez ha sido v\u00edctima de un delito en Estados Unidos?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_80'>\n\t\t\t<div class='gchoice gchoice_4_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='1'  id='choice_4_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_80_0' id='label_4_80_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='0'  id='choice_4_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_80_1' id='label_4_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_80_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='2'  id='choice_4_80_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_80_2' id='label_4_80_2' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_114\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_114'>Explique si ha sido v\u00edctima de un delito en Estados Unidos:<\/label><div class='gfield_description' id='gfield_description_4_114'>Explique si ha sido v\u00edctima de un delito en Estados Unidos:<\/div><div class='ginput_container ginput_container_text'><input name='input_114' id='input_4_114' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_114\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_122\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_122'>Pa\u00eds de ciudadan\u00eda<\/label><div class='ginput_container ginput_container_select'><select name='input_122' id='input_4_122' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='EE. UU.' >Estados Unidos<\/option><option value='CA' >Canada<\/option><option value='MX' >Mexico<\/option><option value='AF' >Afganist\u00e1n<\/option><option value='AL' >Albania<\/option><option value='DZ' >Argelia<\/option><option value='AS' >Samoa Americana<\/option><option value='AD' >Andorra<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguila<\/option><option value='AQ' >Ant\u00e1rtida<\/option><option value='AG' >Antigua y Barbuda<\/option><option value='AR' >Argentina<\/option><option value='AM' >Armenia<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australia<\/option><option value='AT' >Austria<\/option><option value='AZ' >Azerbaiy\u00e1n<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bar\u00e9in<\/option><option value='BD' >Banglad\u00e9s<\/option><option value='BB' >Barbados<\/option><option value='BY' >Bielorrusia<\/option><option value='BE' >B\u00e9lgica<\/option><option value='BZ' >Belice<\/option><option value='BJ' >Benin<\/option><option value='BM' >Bermudas<\/option><option value='BT' >But\u00e1n<\/option><option value='BO' >Bolivia<\/option><option value='BQ' >Bonaire, San Eustaquio y Saba<\/option><option value='BA' >Bosnia y Herzegovina<\/option><option value='BW' >Botsuana<\/option><option value='BV' >Isla Bouvet<\/option><option value='BR' >Brasil<\/option><option value='IO' >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgaria<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='CV' >Cabo Verde<\/option><option value='KH' >Camboya<\/option><option value='CM' >Camer\u00fan<\/option><option value='KY' >Islas Caim\u00e1n<\/option><option value='CF' >Rep\u00fablica Centroafricana<\/option><option value='TD' >Chad<\/option><option value='CL' >Chile<\/option><option value='CN' >China<\/option><option value='CX' >Isla de Navidad<\/option><option value='CC' >Islas Cocos<\/option><option value='CO' >Colombia<\/option><option value='KM' >Comoras<\/option><option value='CG' >Congo<\/option><option value='CD' >Congo, Rep\u00fablica Democr\u00e1tica del<\/option><option value='CK' >Islas Cook<\/option><option value='CR' >Costa Rica<\/option><option value='HR' >Croacia<\/option><option value='CU' >Cuba<\/option><option value='CW' >Curazao<\/option><option value='CY' >Chipre<\/option><option value='CZ' >Chequia<\/option><option value='CI' >C\u00f4te d&#039;Ivoire<\/option><option value='DK' >Dinamarca<\/option><option value='DJ' >Yibuti<\/option><option value='DM' >Dominica<\/option><option value='DO' >Rep\u00fablica Dominicana<\/option><option value='EC' >Ecuador<\/option><option value='EG' >Egipto<\/option><option value='SV' >El Salvador<\/option><option value='GQ' >Guinea Ecuatorial<\/option><option value='ER' >Eritrea<\/option><option value='EE' >Estonia<\/option><option value='SZ' >Esuatini<\/option><option value='ET' >Etiop\u00eda<\/option><option value='FK' >Islas Malvinas<\/option><option value='FO' >Islas Feroe<\/option><option value='FJ' >Fiyi<\/option><option value='FI' >Finlandia<\/option><option value='FR' >Francia<\/option><option value='GF' >Guayana Francesa<\/option><option value='PF' >Polinesia Francesa<\/option><option value='TF' >Territorios Australes Franceses<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambia<\/option><option value='GE' >Georgia<\/option><option value='DE' >Alemania<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Grecia<\/option><option value='GL' >Groenlandia<\/option><option value='GD' >Granada<\/option><option value='GP' >Guadalupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guinea<\/option><option value='GW' >Guinea-Bis\u00e1u<\/option><option value='GY' >Guyana<\/option><option value='HT' >Haiti<\/option><option value='HM' >Isla Heard e Islas McDonald<\/option><option value='VA' >Santa Sede<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hungr\u00eda<\/option><option value='IS' >Islandia<\/option><option value='IN' >India<\/option><option value='ID' >Indonesia<\/option><option value='IR' >Iran<\/option><option value='IQ' >Irak<\/option><option value='IE' >Irlanda<\/option><option value='IM' >Isla de Man<\/option><option value='IL' >Israel<\/option><option value='IT' >Italia<\/option><option value='JM' >Jamaica<\/option><option value='JP' >Jap\u00f3n<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordania<\/option><option value='KZ' >Kazajist\u00e1n<\/option><option value='KE' >Kenia<\/option><option value='KI' >Kiribati<\/option><option value='KP' >Corea, Rep\u00fablica Popular Democr\u00e1tica de<\/option><option value='KR' >Corea, Rep\u00fablica de<\/option><option value='KW' >Kuwait<\/option><option value='KG' >Kirguist\u00e1n<\/option><option value='LA' >Rep\u00fablica Democr\u00e1tica Popular Lao<\/option><option value='LV' >Letonia<\/option><option value='LB' >L\u00edbano<\/option><option value='LS' >Lesoto<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libia<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituania<\/option><option value='LU' >Luxemburgo<\/option><option value='MO' >Macao<\/option><option value='MG' >Madagascar<\/option><option value='MW' >Malaui<\/option><option value='MY' >Malasia<\/option><option value='MV' >Maldivas<\/option><option value='ML' >Mali<\/option><option value='MT' >Malta<\/option><option value='MH' >Islas Marshall<\/option><option value='MQ' >Martinica<\/option><option value='MR' >Mauritania<\/option><option value='MU' >Mauricio<\/option><option value='YT' >Mayotte<\/option><option value='FM' >Micronesia<\/option><option value='MD' >Moldavia<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolia<\/option><option value='ME' >Montenegro<\/option><option value='MS' >Montserrat<\/option><option value='MA' >Marruecos<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibia<\/option><option value='NR' >Nauru<\/option><option value='NP' >Nepal<\/option><option value='NL' >Pa\u00edses Bajos<\/option><option value='NC' >Nueva Caledonia<\/option><option value='NZ' >Nueva Zelanda<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nigeria<\/option><option value='NU' >Niue<\/option><option value='NF' >Isla Norfolk<\/option><option value='MK' >Macedonia del Norte<\/option><option value='MP' >Islas Marianas del Norte<\/option><option value='NO' >Noruega<\/option><option value='OM' >Oman<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palaos<\/option><option value='PS' >Palestina, estado de<\/option><option value='PA' >Panama<\/option><option value='PG' >Pap\u00faa Nueva Guinea<\/option><option value='PY' >Paraguay<\/option><option value='PE' >Peru<\/option><option value='PH' >Filipinas<\/option><option value='PN' >Pitcairn<\/option><option value='PL' >Polonia<\/option><option value='PT' >Portugal<\/option><option value='PR' >Puerto Rico<\/option><option value='QA' >Catar<\/option><option value='RO' >Ruman\u00eda<\/option><option value='RU' >Federaci\u00f3n Rusa<\/option><option value='RW' >Ruanda<\/option><option value='RE' >R\u00e9union<\/option><option value='BL' >San Bartolom\u00e9<\/option><option value='SH' >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value='KN' >San Crist\u00f3bal y Nieves<\/option><option value='LC' >Santa Luc\u00eda<\/option><option value='MF' >San Mart\u00edn<\/option><option value='PM' >San Pedro y Miquel\u00f3n<\/option><option value='VC' >San Vicente y las Granadinas<\/option><option value='WS' >Samoa<\/option><option value='SM' >San Marino<\/option><option value='ST' >Santo Tom\u00e9 y Pr\u00edncipe<\/option><option value='SA' >Arabia Saudita<\/option><option value='SN' >Senegal<\/option><option value='RS' >Serbia<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leona<\/option><option value='SG' >Singapur<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Eslovaquia<\/option><option value='SI' >Eslovenia<\/option><option value='SB' >Islas Salom\u00f3n<\/option><option value='SO' >Somalia<\/option><option value='ZA' >Sud\u00e1frica<\/option><option value='GS' >Georgia del Sur y las Islas Sandwich del Sur<\/option><option value='SS' >Sud\u00e1n del Sur<\/option><option value='ES' >Espa\u00f1a<\/option><option value='LS' >Sri Lanka<\/option><option value='SD' >Sudan<\/option><option value='SR' >Surinam<\/option><option value='SJ' >Svalbard y Jan Mayen<\/option><option value='SE' >Suecia<\/option><option value='CH' >Suiza<\/option><option value='SY' >Rep\u00fablica \u00c1rabe Siria<\/option><option value='TW' >Taiwan<\/option><option value='TJ' >Tayikist\u00e1n<\/option><option value='TZ' >Tanzania, Rep\u00fablica Unida de<\/option><option value='TH' >Tailandia<\/option><option value='TL' >Timor-Leste<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinidad y Tobago<\/option><option value='TN' >T\u00fanez<\/option><option value='TM' >Turkmenistan<\/option><option value='TC' >Islas Turcas y Caicos<\/option><option value='TV' >Tuvalu<\/option><option value='TR' >T\u00fcrkiye<\/option><option value='UM' >Islas menores alejadas de EE. UU.<\/option><option value='UG' >Uganda<\/option><option value='UA' >Ucrania<\/option><option value='AE' >Emiratos \u00c1rabes Unidos<\/option><option value='GB' >Reino Unido<\/option><option value='UY' >Uruguay<\/option><option value='UZ' >Uzbekistan<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Viet Nam<\/option><option value='VG' >Islas V\u00edrgenes Brit\u00e1nicas<\/option><option value='VI' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='WF' >Wallis y Futuna<\/option><option value='EH' >Sahara Occidental<\/option><option value='YE' >Yemen<\/option><option value='ZM' >Zambia<\/option><option value='ZW' >Zimbabue<\/option><option value='AX' >Islas \u00c5land<\/option><\/select><\/div><\/div><div id=\"field_4_41\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">J\u00f3venes sin hogar y derechos de vivienda<\/h3><div class='gsection_description' id='gfield_description_4_41'>El Centro LGBT de Los \u00c1ngeles ofrece consultas legales, defensa, preparaci\u00f3n de documentos y representaci\u00f3n judicial para promover la estabilidad de la vivienda y prevenir la falta de vivienda. \n<br><br>Nuestro <b>Proyecto para J\u00f3venes sin Hogar<\/b> representa a j\u00f3venes de entre 18 y 24 a\u00f1os que est\u00e1n en riesgo de quedarse sin hogar o que est\u00e1n experimentando la falta de vivienda, mientras que nuestro <b>Proyecto de Derechos de Vivienda<\/b> proporciona servicios legales directos y defensa a personas y familias de bajos ingresos en riesgo de quedarse sin hogar, con un enfoque en personas de 55 a\u00f1os o m\u00e1s.<\/div><\/div><fieldset id=\"field_4_42\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfEs usted un joven de entre 18 y 24 a\u00f1os o una persona de 55 a\u00f1os o m\u00e1s?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_42'>\n\t\t\t<div class='gchoice gchoice_4_42_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='1'  id='choice_4_42_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_42_0' id='label_4_42_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed, joven (18-24)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_42_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='2'  id='choice_4_42_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_42_1' id='label_4_42_1' class='gform-field-label gform-field-label--type-inline'>S\u00ed, persona mayor (55 a\u00f1os o m\u00e1s)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_42_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_42' type='radio' value='0'  id='choice_4_42_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_42_2' id='label_4_42_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfLe ha remitido un proveedor de servicios para personas sin hogar?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_82'>\n\t\t\t<div class='gchoice gchoice_4_82_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='1'  id='choice_4_82_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_82_0' id='label_4_82_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_82_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='0'  id='choice_4_82_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_82_1' id='label_4_82_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_83\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_83'>Confirme qu\u00e9 proveedor de servicios para personas sin hogar le ha remitido.<\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_4_83' type='text' value='' class='large' maxlength='255'     aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfQu\u00e9 tipo de asistencia busca?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_84'>\n\t\t\t<div class='gchoice gchoice_4_84_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='1'  id='choice_4_84_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_84_0' id='label_4_84_0' class='gform-field-label gform-field-label--type-inline'>Desalojo y\/o desahucio<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_84_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='2'  id='choice_4_84_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_84_1' id='label_4_84_1' class='gform-field-label gform-field-label--type-inline'>Problemas de elegibilidad para viviendas subvencionadas<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_84_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='3'  id='choice_4_84_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_84_2' id='label_4_84_2' class='gform-field-label gform-field-label--type-inline'>Solicitudes de adaptaci\u00f3n razonable<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_84_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='4'  id='choice_4_84_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_84_3' id='label_4_84_3' class='gform-field-label gform-field-label--type-inline'>Prestaciones p\u00fablicas<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_84_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='5'  id='choice_4_84_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_84_4' id='label_4_84_4' class='gform-field-label gform-field-label--type-inline'>Eliminaci\u00f3n de antecedentes penales<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_84_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='6'  id='choice_4_84_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_84_5' id='label_4_84_5' class='gform-field-label gform-field-label--type-inline'>Peticiones de \u00f3rdenes de alejamiento<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_84_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_84' type='radio' value='7'  id='choice_4_84_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_84_6' id='label_4_84_6' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_110\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_110'>Explique qu\u00e9 otro tipo de asistencia busca:<\/label><div class='gfield_description' id='gfield_description_4_110'>Explique qu\u00e9 otro tipo de asistencia busca:<\/div><div class='ginput_container ginput_container_text'><input name='input_110' id='input_4_110' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_110\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_43\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Violencia, acoso y discriminaci\u00f3n por odio anti-LGBTQI+<\/h3><div class='gsection_description' id='gfield_description_4_43'>Si ha sido v\u00edctima de un delito o incidente de odio:\n<br><br>Tome las medidas adecuadas para protegerse. Primero; si est\u00e1 herido, busque asistencia m\u00e9dica. Segundo; tome notas detalladas, incluyendo informaci\u00f3n de testigos y cualquier palabra de odio utilizada. Tercero; documente la ubicaci\u00f3n, las lesiones y los da\u00f1os a la propiedad con fotograf\u00edas. Cuarto; ll\u00e1menos para obtener asistencia y apoyo.     \n<br><br>Nuestro Proyecto contra la Violencia proporciona servicios integrales y hol\u00edsticos para supervivientes de violencia, delitos de odio, acoso, discriminaci\u00f3n y mala conducta policial.<\/div><\/div><fieldset id=\"field_4_44\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfHa sido v\u00edctima\/superviviente de lo siguiente?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_44'><div class='gchoice gchoice_4_44_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.1' type='checkbox'  value='1'  id='choice_4_44_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_44_1' id='label_4_44_1' class='gform-field-label gform-field-label--type-inline'>Delito \/ incidente de odio<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_44_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.2' type='checkbox'  value='2'  id='choice_4_44_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_44_2' id='label_4_44_2' class='gform-field-label gform-field-label--type-inline'>Acoso<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_44_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.3' type='checkbox'  value='3'  id='choice_4_44_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_44_3' id='label_4_44_3' class='gform-field-label gform-field-label--type-inline'>Discriminaci\u00f3n<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_44_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.4' type='checkbox'  value='4'  id='choice_4_44_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_44_4' id='label_4_44_4' class='gform-field-label gform-field-label--type-inline'>Mala conducta policial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_44_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_44.5' type='checkbox'  value='5'  id='choice_4_44_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_44_5' id='label_4_44_5' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_45'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_45'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_45' id='input_4_45' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_45\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_47\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Violencia dom\u00e9stica \/ de pareja, agresi\u00f3n sexual, acecho y trata de personas<\/h3><div class='gsection_description' id='gfield_description_4_47'>Nuestro Proyecto de Defensa Legal para Supervivientes proporciona servicios legales directos y defensa con informaci\u00f3n sobre traumas y espec\u00edficos para LGBTQ+ para v\u00edctimas LGBTQ+ de violencia dom\u00e9stica\/de pareja\/en el noviazgo, agresi\u00f3n sexual, acecho, trata y\/u otra victimizaci\u00f3n delictiva.\n<br><br><i>Si se encuentra en peligro inmediato, llame al 911. Tambi\u00e9n puede comunicarse con la L\u00ednea Directa Nacional contra la Violencia Dom\u00e9stica: (800) 799-7233 o env\u00ede un mensaje de texto con la palabra START al 88788 <\/i><\/div><\/div><fieldset id=\"field_4_48\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfHa sido v\u00edctima\/superviviente de lo siguiente?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_48'><div class='gchoice gchoice_4_48_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.1' type='checkbox'  value='1'  id='choice_4_48_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_1' id='label_4_48_1' class='gform-field-label gform-field-label--type-inline'>Violencia dom\u00e9stica \/ de pareja \/ en el noviazgo<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_48_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.2' type='checkbox'  value='2'  id='choice_4_48_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_2' id='label_4_48_2' class='gform-field-label gform-field-label--type-inline'>Agresi\u00f3n sexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_48_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.3' type='checkbox'  value='3'  id='choice_4_48_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_3' id='label_4_48_3' class='gform-field-label gform-field-label--type-inline'>Acecho<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_48_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.4' type='checkbox'  value='4'  id='choice_4_48_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_4' id='label_4_48_4' class='gform-field-label gform-field-label--type-inline'>Trata de personas<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_48_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.5' type='checkbox'  value='5'  id='choice_4_48_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_48_5' id='label_4_48_5' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_49'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_49'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_49' id='input_4_49' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_49\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Cl\u00ednica legal y derivaci\u00f3n a abogados<\/h3><div class='gsection_description' id='gfield_description_4_51'>El Centro LGBT de Los \u00c1ngeles ofrece consultas legales gratuitas y confidenciales con abogados voluntarios experimentados. \n<br><br>Tambi\u00e9n ofrecemos un Servicio de Derivaci\u00f3n a Abogados. Si no puede permitirse pagar a un abogado, nuestro Servicio de Derivaci\u00f3n a Abogados certificado por el Colegio de Abogados del Estado puede proporcionarle una consulta y representaci\u00f3n directa. Hay una tarifa de 25 $ para acceder a este servicio.  <\/div><\/div><div id=\"field_4_52\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_52'>Ind\u00edquenos en qu\u00e9 \u00e1rea del derecho busca asistencia.<\/label><div class='ginput_container ginput_container_select'><select name='input_52' id='input_4_52' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Quiebra<\/option><option value='2' >Derecho mercantil<\/option><option value='3' >Derechos civiles<\/option><option value='4' >Derecho del consumidor<\/option><option value='5' >Educaci\u00f3n<\/option><option value='6' >Derecho laboral<\/option><option value='7' >Civil general<\/option><option value='8' >Prestaciones gubernamentales<\/option><option value='9' >Vivienda y propietario\/inquilino<\/option><option value='10' >Lesiones personales<\/option><option value='11' >Inmigraci\u00f3n<\/option><option value='12' >Derecho de familia<\/option><option value='13' >Otro<\/option><\/select><\/div><\/div><div id=\"field_4_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_53'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_53'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_53' id='input_4_53' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_53\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_54\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >\u00bfEst\u00e1 interesado en una consulta o en la derivaci\u00f3n a un abogado?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_54'><div class='gchoice gchoice_4_54_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.1' type='checkbox'  value='1'  id='choice_4_54_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_54_1' id='label_4_54_1' class='gform-field-label gform-field-label--type-inline'>Consulta<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_54_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.2' type='checkbox'  value='2'  id='choice_4_54_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_54_2' id='label_4_54_2' class='gform-field-label gform-field-label--type-inline'>Derivaci\u00f3n a un abogado<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_54_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.3' type='checkbox'  value='3'  id='choice_4_54_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_54_3' id='label_4_54_3' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_55'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_55'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_55' id='input_4_55' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_55\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_56\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Cambio de nombre y marcador de g\u00e9nero en los documentos de identificaci\u00f3n<\/h3><\/div><fieldset id=\"field_4_57\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Indique qu\u00e9 documentos desea cambiar. Marque todas las opciones que correspondan: <\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_57'><div class='gchoice gchoice_4_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='1'  id='choice_4_57_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_57_1' id='label_4_57_1' class='gform-field-label gform-field-label--type-inline'>Cambio de nombre y\/o g\u00e9nero ordenado por el tribunal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_57_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.2' type='checkbox'  value='2'  id='choice_4_57_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_57_2' id='label_4_57_2' class='gform-field-label gform-field-label--type-inline'>Certificado de nacimiento<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_57_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.3' type='checkbox'  value='3'  id='choice_4_57_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_57_3' id='label_4_57_3' class='gform-field-label gform-field-label--type-inline'>Permiso de conducir<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_57_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.4' type='checkbox'  value='4'  id='choice_4_57_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_57_4' id='label_4_57_4' class='gform-field-label gform-field-label--type-inline'>Seguro Social<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_57_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.5' type='checkbox'  value='5'  id='choice_4_57_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_57_5' id='label_4_57_5' class='gform-field-label gform-field-label--type-inline'>Pasaporte<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_57_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.6' type='checkbox'  value='6'  id='choice_4_57_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_57_6' id='label_4_57_6' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_58\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_58'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_58'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_58' id='input_4_58' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_58\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_93\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfYa ha cambiado alguno de sus documentos?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_93'>\n\t\t\t<div class='gchoice gchoice_4_93_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='1'  id='choice_4_93_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_93_0' id='label_4_93_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_93_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='0'  id='choice_4_93_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_93_1' id='label_4_93_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_94'>Si es &quot;S\u00ed&quot;, \u00bfqu\u00e9 documentos ya ha cambiado?<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_4_94' type='text' value='' class='large' maxlength='255'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informaci\u00f3n personal \/ datos demogr\u00e1ficos<\/h3><div class='gsection_description' id='gfield_description_4_59'>Cu\u00e9ntenos un poco m\u00e1s sobre usted para que podamos ayudarle mejor:<\/div><\/div><fieldset id=\"field_4_60\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Etnia<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_4_60'><div class='gchoice gchoice_4_60_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.1' type='checkbox'  value='5'  id='choice_4_60_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_1' id='label_4_60_1' class='gform-field-label gform-field-label--type-inline'>Latinx<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.2' type='checkbox'  value='3'  id='choice_4_60_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_2' id='label_4_60_2' class='gform-field-label gform-field-label--type-inline'>Blanco<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.3' type='checkbox'  value='1'  id='choice_4_60_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_3' id='label_4_60_3' class='gform-field-label gform-field-label--type-inline'>Negro \/ Afroamericano<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.4' type='checkbox'  value='30'  id='choice_4_60_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_4' id='label_4_60_4' class='gform-field-label gform-field-label--type-inline'>Asi\u00e1tico<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.5' type='checkbox'  value='31'  id='choice_4_60_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_5' id='label_4_60_5' class='gform-field-label gform-field-label--type-inline'>Nativo de Haw\u00e1i u otra isla del Pac\u00edfico<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.6' type='checkbox'  value='32'  id='choice_4_60_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_6' id='label_4_60_6' class='gform-field-label gform-field-label--type-inline'>Indio americano o nativo de Alaska<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.7' type='checkbox'  value='26'  id='choice_4_60_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_7' id='label_4_60_7' class='gform-field-label gform-field-label--type-inline'>De Oriente Medio<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.8' type='checkbox'  value='22'  id='choice_4_60_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_8' id='label_4_60_8' class='gform-field-label gform-field-label--type-inline'>Multirracial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.9' type='checkbox'  value='27'  id='choice_4_60_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_9' id='label_4_60_9' class='gform-field-label gform-field-label--type-inline'>Prefiero no decirlo<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_4_60_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.11' type='checkbox'  value=''  id='choice_4_60_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_60_11' id='label_4_60_11' class='gform-field-label gform-field-label--type-inline'>Otro<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_121\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_121'>Idioma preferido<\/label><div class='ginput_container ginput_container_select'><select name='input_121' id='input_4_121' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='en' >Ingl\u00e9s<\/option><option value='es' >Spanish<\/option><option value='ru' >Russian<\/option><option value='af' >Afrikaans<\/option><option value='sq' >Albanian<\/option><option value='ar' >Arabic<\/option><option value='bg' >Bulgarian<\/option><option value='ca' >Catalan; Valencian<\/option><option value='zh' >Chinese<\/option><option value='cs' >Czech<\/option><option value='da' >Danish<\/option><option value='nl' >Dutch<\/option><option value='et' >Estonian<\/option><option value='fi' >Finnish<\/option><option value='fr' >French (Canada)<\/option><option value='fr' >French (France)<\/option><option value='de' >German<\/option><option value='el' >Greek, Modern<\/option><option value='he' >Hebrew<\/option><option value='hi' >Hindi<\/option><option value='hu' >Hungarian<\/option><option value='id' >Indonesian<\/option><option value='it' >Italian<\/option><option value='ja' >Japanese<\/option><option value='km' >Khmer<\/option><option value='lt' >Lithuanian<\/option><option value='nb' >Norwegian<\/option><option value='pl' >Polish<\/option><option value='pt' >Portuguese<\/option><option value='ro' >Romanian, Moldavian, Moldovan<\/option><option value='sk' >Slovak<\/option><option value='sl' >Slovene<\/option><option value='sv' >Sueco<\/option><option value='te' >Telugu<\/option><option value='th' >Tailand\u00e9s<\/option><option value='tr' >Turco<\/option><option value='vi' >Vietnamita<\/option><option value='oth' >Otro<\/option><\/select><\/div><\/div><div id=\"field_4_62\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_62'>Identidad de g\u00e9nero<\/label><div class='ginput_container ginput_container_select'><select name='input_62' id='input_4_62' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Mujer<\/option><option value='2' >Hombre<\/option><option value='7' >Mujer transg\u00e9nero (MTF)<\/option><option value='8' >Hombre transg\u00e9nero (FTM)<\/option><option value='9' >No binario \/ Genderqueer \/ No conforme con el g\u00e9nero<\/option><option value='12' >Intersexual<\/option><option value='13' >En duda<\/option><option value='10' >Prefiero no decirlo<\/option><option value='' >Otro<\/option><\/select><\/div><\/div><div id=\"field_4_124\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_124'>Pronombres<\/label><div class='ginput_container ginput_container_select'><select name='input_124' id='input_4_124' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Ella \/ Su<\/option><option value='2' >\u00c9l \/ Su<\/option><option value='3' >Elle \/ Elles<\/option><option value='4' >Ze \/ Hir<\/option><option value='5' >Otro<\/option><\/select><\/div><\/div><div id=\"field_4_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_66'>Si es &quot;Otro&quot;, explique:<\/label><div class='gfield_description' id='gfield_description_4_66'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_66' id='input_4_66' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_66\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_67\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_67'>Orientaci\u00f3n sexual<\/label><div class='ginput_container ginput_container_select'><select name='input_67' id='input_4_67' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='5' >Lesbiana<\/option><option value='6' >Gay<\/option><option value='2' >Bisexual<\/option><option value='3' >Heterosexual<\/option><option value='7' >Queer<\/option><option value='11' >Otro<\/option><option value='14' >Prefiero no decirlo<\/option><\/select><\/div><\/div><div id=\"field_4_69\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_69'>\u00bfEs usted una persona con discapacidad?<\/label><div class='ginput_container ginput_container_select'><select name='input_69' id='input_4_69' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >S\u00ed<\/option><option value='0' >No<\/option><option value='' >Prefiero no decirlo<\/option><\/select><\/div><\/div><fieldset id=\"field_4_128\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfNecesita adaptaciones?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_128'>\n\t\t\t<div class='gchoice gchoice_4_128_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='1'  id='choice_4_128_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_128_0' id='label_4_128_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_128_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_128' type='radio' value='0'  id='choice_4_128_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_128_1' id='label_4_128_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_129\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_129'>Ind\u00edquenos qu\u00e9 adaptaciones necesita:<\/label><div class='ginput_container ginput_container_text'><input name='input_129' id='input_4_129' type='text' value='' class='large' maxlength='255'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_71\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_71'>Estado civil\/relaci\u00f3n<\/label><div class='ginput_container ginput_container_select'><select name='input_71' id='input_4_71' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='2' >Soltero\/a<\/option><option value='1' >Saliendo con alguien<\/option><option value='3' >Casado\/a<\/option><option value='4' >Divorciado\/a<\/option><option value='5' >Separado\/a<\/option><option value='6' >Viudo \/ viuda<\/option><option value='8' >Pareja de hecho<\/option><option value='7' >Prefiero no decirlo<\/option><\/select><\/div><\/div><div id=\"field_4_74\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_74'>Fuente de ingresos<\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_4_74' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='17' >A tiempo completo<\/option><option value='18' >A tiempo parcial<\/option><option value='7' >Ninguna<\/option><option value='19' >Prefiero no decirlo<\/option><option value='8' >Otro<\/option><\/select><\/div><\/div><div id=\"field_4_76\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_76'>Otra fuente de ingresos<\/label><div class='gfield_description' id='gfield_description_4_76'>Si es \u00abOtro\u00bb, explique:<\/div><div class='ginput_container ginput_container_text'><input name='input_76' id='input_4_76' type='text' value='' class='large' maxlength='255' aria-describedby=\"gfield_description_4_76\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_107\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_107'>Indique sus ingresos mensuales estimados:<\/label><div class='ginput_container ginput_container_number'><input name='input_107' id='input_4_107' type='text' step='any' min='0'  value='' class='large'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_4_107\" \/><div class='gfield_description instruction ' id='gfield_instruction_4_107'>Por favor, escribe un n\u00famero mayor o igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_4_99\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_99'>Nivel de estudios m\u00e1s alto completado<\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_4_99' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='1' >Ninguno o no complet\u00f3 la escuela primaria<\/option><option value='2' >Escuela primaria completada<\/option><option value='3' >Algo de escuela secundaria<\/option><option value='4' >Escuela secundaria completada<\/option><option value='5' >Algo de universidad<\/option><option value='6' >Universidad completada<\/option><option value='7' >Escuela de posgrado completada<\/option><option value='8' >Prefiero no decirlo<\/option><\/select><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_4' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Enviar'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_4' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_4' id='gform_theme_4' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_4' id='gform_style_settings_4' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='fMjRD3uLNxa0DnONsm166dQcFbWA1wUTYwaGrV1U7bL00z0YspGkDdVW69ynN1jP3emQDfb8TKxfvtpuWMoVhPVkYurIjyeYuEYT2n2U0i9db9w=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_4' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_4' id='gform_target_page_number_4' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_4' id='gform_source_page_number_4' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 4, 'https:\/\/legalservices.lalgbtcenter.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_4').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_4');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_4').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_4').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_4').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_4').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_4').val();gformInitSpinner( 4, 'https:\/\/legalservices.lalgbtcenter.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [4, current_page]);window['gf_submitting_4'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_4').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [4]);window['gf_submitting_4'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_4').text());}else{jQuery('#gform_4').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"4\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_4\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_4\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_4\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 4, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-146","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/pages\/146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/comments?post=146"}],"version-history":[{"count":2,"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/pages\/146\/revisions"}],"predecessor-version":[{"id":148,"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/pages\/146\/revisions\/148"}],"wp:attachment":[{"href":"https:\/\/legalservices.lalgbtcenter.org\/es\/wp-json\/wp\/v2\/media?parent=146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}