{"id":10069,"date":"2024-09-17T23:30:51","date_gmt":"2024-09-17T23:30:51","guid":{"rendered":"https:\/\/mountainmediationcenter.org\/?page_id=10069"},"modified":"2024-12-11T19:19:25","modified_gmt":"2024-12-11T19:19:25","slug":"intake-form","status":"publish","type":"page","link":"https:\/\/mountainmediationcenter.org\/es\/intake-form\/","title":{"rendered":"Formulario de admisi\u00f3n"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"10069\" class=\"elementor elementor-10069\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a2e04d2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a2e04d2\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2104041\" data-id=\"2104041\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cd3ef49 elementor-widget elementor-widget-spacer\" data-id=\"cd3ef49\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-7d2ba72 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7d2ba72\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-1cd59ba\" data-id=\"1cd59ba\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3cc88b2 elementor-widget elementor-widget-heading\" data-id=\"3cc88b2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Formulario de admisi\u00f3n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-e74f8fc elementor-widget elementor-widget-spacer\" data-id=\"e74f8fc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-cad23f0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cad23f0\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-eaed9d1\" data-id=\"eaed9d1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2a6a4a1 elementor-widget elementor-widget-text-editor\" data-id=\"2a6a4a1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>En la mediaci\u00f3n, las personas que est\u00e1n trabajando en un conflicto cuentan su historia y luego crean un acuerdo para satisfacer sus necesidades con la ayuda de un mediador neutral. La mediaci\u00f3n es voluntaria y confidencial.<\/p><p>Complete el formulario a continuaci\u00f3n para solicitar una mediaci\u00f3n con Mountain Mediation. Si est\u00e1 buscando mediaci\u00f3n y conferencias para su grupo u organizaci\u00f3n, complete nuestro formulario. <a href=\"https:\/\/mountainmediationcenter.org\/es\/org-intake-form\/\">Formulario de admisi\u00f3n de la organizaci\u00f3n<\/a> en cambio.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-796a1f7 elementor-widget elementor-widget-formidable\" data-id=\"796a1f7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_15_container\" data-token=\"33c0731c2470340fd773dd2788ed54a1\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form\" id=\"form_intake\" data-token=\"33c0731c2470340fd773dd2788ed54a1\">\n<div class=\"frm_form_fields\">\n<fieldset>\n<legend class=\"frm_screen_reader\">Formulario de admisi\u00f3n<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"15\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_15\" id=\"frm_hide_fields_15\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"intake\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_15\" name=\"frm_submit_entry_15\" value=\"9e6bcaeafb\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/10069\" \/><div id=\"frm_field_406_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n\t<div  id=\"field_nww5e_label\" class=\"frm_primary_label\">Nombre\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_nww5e_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tNombre\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_406\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_406-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_nww5e_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tPrimero\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_nww5e_first\" value=\"\" name=\"item_meta[406][first]\" autocomplete=\"given-name\" data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name no es v\u00e1lido\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_406_first_desc\">Primero<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_406-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_nww5e_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\t\u00daltimo\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_nww5e_last\" value=\"\" name=\"item_meta[406][last]\" autocomplete=\"family-name\" data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name no es v\u00e1lido\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_406_last_desc\">\u00daltimo<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_371_container\" class=\"frm_form_field form-field  frm_required_field frm_inside_container frm6 frm_first\">\r\n    <label for=\"field_voivf2\" id=\"field_voivf2_label\" class=\"frm_primary_label\">N\u00famero de tel\u00e9fono\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_voivf2\" name=\"item_meta[371]\" value=\"\"  data-reqmsg=\"Phone Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_395_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_gyaz1\" id=\"field_gyaz1_label\" class=\"frm_primary_label\">Correo electr\u00f3nico\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_gyaz1\" name=\"item_meta[395]\" value=\"\" autocomplete=\"email\" data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_372_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <div  id=\"field_2j1882_label\" class=\"frm_primary_label\">DIRECCI\u00d3N\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_2j1882_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tDIRECCI\u00d3N<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_372-line1_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_2j1882_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tDIRECCI\u00d3N\t<\/label>\n\t\t<input type=\"text\" id=\"field_2j1882_line1\" value=\"\" name=\"item_meta[372][line1]\"  data-invmsg=\"Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_372-line2_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_2j1882_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tDIRECCI\u00d3N\t<\/label>\n\t\t<input type=\"text\" id=\"field_2j1882_line2\" value=\"\" name=\"item_meta[372][line2]\"  data-invmsg=\"Address no es v\u00e1lido\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_372-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_2j1882_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCiudad\t<\/label>\n\t\t<input type=\"text\" id=\"field_2j1882_city\" value=\"\" name=\"item_meta[372][city]\"  data-invmsg=\"Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">Ciudad<\/div><\/div>\n<div id=\"frm_field_372-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_2j1882_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tEstado\/Provincia\t<\/label>\n\t\t<input type=\"text\" id=\"field_2j1882_state\" value=\"\" name=\"item_meta[372][state]\"  data-invmsg=\"Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">Estado\/Provincia<\/div><\/div>\n<div id=\"frm_field_372-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_2j1882_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tC\u00f3digo postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_2j1882_zip\" value=\"\" name=\"item_meta[372][zip]\"  data-invmsg=\"Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">C\u00f3digo postal<\/div><\/div>\n<div id=\"frm_field_372-country_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_2j1882_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tPa\u00eds\t<\/label>\n\t\t\t<select name=\"item_meta[372][country]\" id=\"field_2j1882_country\"  data-invmsg=\"Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\" data-code=\"AL\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\" data-code=\"AD\">Andorra<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtida<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\" data-code=\"AR\">Argentina<\/option><option  value=\"Armenia\" data-code=\"AM\">Armenia<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australia\" data-code=\"AU\">Australia<\/option><option  value=\"Austria\" data-code=\"AT\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">azerbaiyan<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Banglad\u00e9s<\/option><option  value=\"Barbados\" data-code=\"BB\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\" data-code=\"BZ\">Belice<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\" data-code=\"BO\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brunei<\/option><option  value=\"Bulgaria\" data-code=\"BG\">Bulgaria<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Cambi\u00f3<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\" data-code=\"TD\">Chad<\/option><option  value=\"Chile\" data-code=\"CL\">Chile<\/option><option  value=\"China\" data-code=\"CN\">Porcelana<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\" data-code=\"CO\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\" data-code=\"DM\">Dominica<\/option><option  value=\"Ecuador\" data-code=\"EC\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\" data-code=\"SV\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\" data-code=\"ER\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\" data-code=\"EE\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\" data-code=\"FJ\">Fiyi<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\" data-code=\"GM\">Gambia<\/option><option  value=\"Georgia\" data-code=\"GE\">Georgia<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\" data-code=\"GU\">Guam<\/option><option  value=\"Guatemala\" data-code=\"GT\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\" data-code=\"GG\">Guernsey<\/option><option  value=\"Guinea\" data-code=\"GN\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea Bis\u00e1u<\/option><option  value=\"Guyana\" data-code=\"GY\">Guayana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\" data-code=\"IN\">India<\/option><option  value=\"Indonesia\" data-code=\"ID\">Indonesia<\/option><option  value=\"Iraq\" data-code=\"IQ\">Irak<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Iran<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\" data-code=\"IL\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\" data-code=\"JM\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kuwait\" data-code=\"KW\">Kuwait<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\" data-code=\"LR\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\" data-code=\"ML\">Mal\u00ed<\/option><option  value=\"Malta\" data-code=\"MT\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\" data-code=\"MR\">Mauritania<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Micronesia\" data-code=\"FM\">Micronesia<\/option><option  value=\"Moldava\">Moldavia<\/option><option  value=\"Mongolia\" data-code=\"MN\">Mongolia<\/option><option  value=\"Montenegro\" data-code=\"ME\">Montenegro<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Birmania<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\" data-code=\"NA\">Namibia<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nepal\" data-code=\"NP\">Nepal<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Nigeria\" data-code=\"NG\">Nigeria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda \">Nueva Zelanda <\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\" data-code=\"PW\">Palaos<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Islas Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"Puerto Rico\" data-code=\"PR\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica \">Rep\u00fablica Central de \u00c1frica <\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Rep\u00fablica de Macedonia\">Rep\u00fablica de Macedonia<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Rumania<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">San Crist\u00f3bal y Nieves<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\" data-code=\"SM\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas \">San Vicente y las Granadinas <\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Arabia Saudita<\/option><option  value=\"Senegal\" data-code=\"SN\">Senegal<\/option><option  value=\"Serbia\" data-code=\"RS\">Serbia<\/option><option  value=\"Seychelles\" data-code=\"SC\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\" data-code=\"SO\">Somalia<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del Sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\" data-code=\"TZ\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Taikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\" data-code=\"TG\">Ir<\/option><option  value=\"Tokelau\" data-code=\"TK\">Tokelau<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\" data-code=\"UG\">Uganda<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Venezuela\" data-code=\"VE\">Venezuela<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\" data-code=\"YE\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\" data-code=\"ZM\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Pa\u00eds<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_391_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 vertical_radio frm_other_container\">\r\n\t<div  id=\"field_mediationtype_label\" class=\"frm_primary_label\">\u00bfQu\u00e9 te lleva a la mediaci\u00f3n?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_mediationtype_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-0\">\t\t\t<label  for=\"field_mediationtype-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-0\" value=\"Landlord \/ Tenant\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   aria-required=\"true\"  \/> Propietario \/ Inquilino<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-1\">\t\t\t<label  for=\"field_mediationtype-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-1\" value=\"Business\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Negocio<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-7\">\t\t\t<label  for=\"field_mediationtype-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-7\" value=\"Divorce\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Divorcio<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-8\">\t\t\t<label  for=\"field_mediationtype-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-8\" value=\"Child Support\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Manutenci\u00f3n de los hijos<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-9\">\t\t\t<label  for=\"field_mediationtype-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-9\" value=\"Child Custody\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Custodia de menores<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-10\">\t\t\t<label  for=\"field_mediationtype-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-10\" value=\"Modify Divorce Terms\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Modificar los t\u00e9rminos del divorcio<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-2\">\t\t\t<label  for=\"field_mediationtype-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-2\" value=\"Neighbor\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Vecino<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-3\">\t\t\t<label  for=\"field_mediationtype-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-3\" value=\"Roommate\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Compa\u00f1ero de cuarto<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-4\">\t\t\t<label  for=\"field_mediationtype-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-4\" value=\"Debt\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Deuda<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-5\">\t\t\t<label  for=\"field_mediationtype-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-5\" value=\"Employment\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Empleo<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-6\">\t\t\t<label  for=\"field_mediationtype-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][]\" id=\"field_mediationtype-6\" value=\"Property\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Propiedad<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_391-other_11\">\t\t\t<label  for=\"field_mediationtype-other_11\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[391][other_11]\" id=\"field_mediationtype-other_11\" value=\"Other\"  data-reqmsg=\"What brings you to mediation? cannot be blank.\" data-invmsg=\"What brings you to mediation? no es v\u00e1lido\"   \/> Otro<\/label><label for=\"field_mediationtype-other_11-otext\" class=\"frm_screen_reader frm_hidden\">Otro<\/label><input type=\"text\" id=\"field_mediationtype-other_11-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][391][other_11]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_540_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_s8ot1\" id=\"field_s8ot1_label\" class=\"frm_primary_label\">\u00bfCu\u00e1ntas personas hay en su hogar, incluido usted?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_s8ot1\" name=\"item_meta[540]\" value=\"\"  data-reqmsg=\"How many people are in your household, including you? cannot be blank.\" aria-required=\"true\" data-invmsg=\"How many people are in your household, including you? is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_396_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first vertical_radio frm_other_container\">\r\n\t<div  id=\"field_9merr_label\" class=\"frm_primary_label\">\u00bfCu\u00e1l es tu relaci\u00f3n jur\u00eddica actual con la otra parte?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_9merr_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_396-3\">\t\t\t<label  for=\"field_9merr-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[396]\" id=\"field_9merr-3\" value=\"Never Married\"\n\t\t data-invmsg=\"What is your current legal relationship with the other party? no es v\u00e1lido\"   \/> Nunca casado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_396-0\">\t\t\t<label  for=\"field_9merr-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[396]\" id=\"field_9merr-0\" value=\"Married\"\n\t\t data-invmsg=\"What is your current legal relationship with the other party? no es v\u00e1lido\"   \/> Casado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_396-6\">\t\t\t<label  for=\"field_9merr-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[396]\" id=\"field_9merr-6\" value=\"Separated\"\n\t\t data-invmsg=\"What is your current legal relationship with the other party? no es v\u00e1lido\"   \/> Apartado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_396-1\">\t\t\t<label  for=\"field_9merr-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[396]\" id=\"field_9merr-1\" value=\"Divorced\"\n\t\t data-invmsg=\"What is your current legal relationship with the other party? no es v\u00e1lido\"   \/> Divorciado<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_396-other_5\">\t\t\t<label  for=\"field_9merr-other_5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[396]\" id=\"field_9merr-other_5\" value=\"Other\"\n\t\t data-invmsg=\"What is your current legal relationship with the other party? no es v\u00e1lido\"   \/> Otro<\/label><label for=\"field_9merr-other_5-otext\" class=\"frm_screen_reader frm_hidden\">Otro<\/label><input type=\"text\" id=\"field_9merr-other_5-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][396]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_397_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_ll7we_label\" class=\"frm_primary_label\">\u00bfTienes hijos?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ll7we_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_397-0\">\t\t\t<label  for=\"field_ll7we-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[397]\" id=\"field_ll7we-0\" value=\"Yes\"\n\t\t data-invmsg=\"Do you have any children? no es v\u00e1lido\"   \/> S\u00ed<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_397-1\">\t\t\t<label  for=\"field_ll7we-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[397]\" id=\"field_ll7we-1\" value=\"No\"\n\t\t data-invmsg=\"Do you have any children? no es v\u00e1lido\"   \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_399_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_59dsp\" id=\"field_59dsp_label\" class=\"frm_primary_label\">\u00bfNombre(s) y fecha(s) de nacimiento de tu(s) hijo(s)?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_59dsp\" name=\"item_meta[399]\" value=\"\"  data-invmsg=\"Name(s) and date(s) of birth of your child(ren)? is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_376_container\" class=\"frm_form_field frm_section_heading form-field\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Informaci\u00f3n de contacto de la otra parte<\/h3>\r\n\r\n\r\n<div id=\"frm_field_403_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<div  id=\"field_3qr9b_label\" class=\"frm_primary_label\">Nombre de la otra parte\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_3qr9b_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tNombre de la otra parte\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_403\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_403-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_3qr9b_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tPrimero\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_3qr9b_first\" value=\"\" name=\"item_meta[403][first]\" data-sectionid=\"376\" data-reqmsg=\"Other Party&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Other Party&#039;s Name no es v\u00e1lido\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_403_first_desc\">Primero<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_403-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_3qr9b_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\t\u00daltimo\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_3qr9b_last\" value=\"\" name=\"item_meta[403][last]\" data-sectionid=\"376\" data-reqmsg=\"Other Party&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Other Party&#039;s Name no es v\u00e1lido\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_403_last_desc\">\u00daltimo<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_405_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_kj5hv\" id=\"field_kj5hv_label\" class=\"frm_primary_label\">Tel\u00e9fono de la otra parte\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_kj5hv\" name=\"item_meta[405]\" value=\"\"  data-sectionid=\"376\" data-reqmsg=\"Other Party&#039;s Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Other Party&#039;s Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_404_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_yriy8\" id=\"field_yriy8_label\" class=\"frm_primary_label\">Correo electr\u00f3nico de la otra parte\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_yriy8\" name=\"item_meta[404]\" value=\"\"  data-sectionid=\"376\"autocomplete=\"email\" data-invmsg=\"Other Party&#039;s Email is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_402_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<div  id=\"field_emgyb_label\" class=\"frm_primary_label\">Direcci\u00f3n de la otra parte\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_emgyb_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tDirecci\u00f3n de la otra parte<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_402-line1_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_emgyb_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tDirecci\u00f3n de la otra parte\t<\/label>\n\t\t<input type=\"text\" id=\"field_emgyb_line1\" value=\"\" name=\"item_meta[402][line1]\"  data-sectionid=\"376\" data-invmsg=\"Other Party&#039;s Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_402-line2_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_emgyb_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tDirecci\u00f3n de la otra parte\t<\/label>\n\t\t<input type=\"text\" id=\"field_emgyb_line2\" value=\"\" name=\"item_meta[402][line2]\"  data-sectionid=\"376\" data-invmsg=\"Other Party&#039;s Address no es v\u00e1lido\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_402-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_emgyb_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCiudad\t<\/label>\n\t\t<input type=\"text\" id=\"field_emgyb_city\" value=\"\" name=\"item_meta[402][city]\"  data-sectionid=\"376\" data-invmsg=\"Other Party&#039;s Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">Ciudad<\/div><\/div>\n<div id=\"frm_field_402-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_emgyb_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tEstado\/Provincia\t<\/label>\n\t\t<input type=\"text\" id=\"field_emgyb_state\" value=\"\" name=\"item_meta[402][state]\"  data-sectionid=\"376\" data-invmsg=\"Other Party&#039;s Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">Estado\/Provincia<\/div><\/div>\n<div id=\"frm_field_402-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_emgyb_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tC\u00f3digo postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_emgyb_zip\" value=\"\" name=\"item_meta[402][zip]\"  data-sectionid=\"376\" data-invmsg=\"Other Party&#039;s Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">C\u00f3digo postal<\/div><\/div>\n<div id=\"frm_field_402-country_container\" class=\"frm_form_field form-field\">\n\t<label for=\"field_emgyb_country\" class=\"frm_screen_reader frm_hidden\">\n\t\tPa\u00eds\t<\/label>\n\t\t\t<select name=\"item_meta[402][country]\" id=\"field_emgyb_country\"  data-sectionid=\"376\" data-invmsg=\"Other Party&#039;s Address no es v\u00e1lido\" aria-invalid=\"false\"   autocomplete=\"country-name\">\n\t\t\t<option value=\"\">\n\t\t\t\t \t\t\t<\/option>\n\t\t\t<option  value=\"Afganist\u00e1n\">Afganist\u00e1n<\/option><option  value=\"Albania\" data-code=\"AL\">Albania<\/option><option  value=\"Alemania\">Alemania<\/option><option  value=\"Andorra\" data-code=\"AD\">Andorra<\/option><option  value=\"Angola\" data-code=\"AO\">Angola<\/option><option  value=\"Anguila\">Anguila<\/option><option  value=\"Antigua y Barbuda\">Antigua y Barbuda<\/option><option  value=\"Ant\u00e1rtica\">Ant\u00e1rtida<\/option><option  value=\"Argelia\">Argelia<\/option><option  value=\"Argentina\" data-code=\"AR\">Argentina<\/option><option  value=\"Armenia\" data-code=\"AM\">Armenia<\/option><option  value=\"Aruba\" data-code=\"AW\">Aruba<\/option><option  value=\"Australia\" data-code=\"AU\">Australia<\/option><option  value=\"Austria\" data-code=\"AT\">Austria<\/option><option  value=\"Azerbaiy\u00e1n\">azerbaiyan<\/option><option  value=\"Bahamas\" data-code=\"BS\">Bahamas<\/option><option  value=\"Bangladesh\" data-code=\"BD\">Banglad\u00e9s<\/option><option  value=\"Barbados\" data-code=\"BB\">Barbados<\/option><option  value=\"Bar\u00e9in\">Bar\u00e9in<\/option><option  value=\"Belize\" data-code=\"BZ\">Belice<\/option><option  value=\"Ben\u00edn\">Ben\u00edn<\/option><option  value=\"Bermudas\">Bermudas<\/option><option  value=\"Bielorrusia\">Bielorrusia<\/option><option  value=\"Bolivia\" data-code=\"BO\">Bolivia<\/option><option  value=\"Bonaire, San Eustaquio y Saba\">Bonaire, San Eustaquio y Saba<\/option><option  value=\"Bosnia y Herzegovina\">Bosnia y Herzegovina<\/option><option  value=\"Botsuana\">Botsuana<\/option><option  value=\"Brasil\">Brasil<\/option><option  value=\"Brun\u00e9i\">Brunei<\/option><option  value=\"Bulgaria\" data-code=\"BG\">Bulgaria<\/option><option  value=\"Burkina Faso\" data-code=\"BF\">Burkina Faso<\/option><option  value=\"Burundi\" data-code=\"BI\">Burundi<\/option><option  value=\"But\u00e1n\">But\u00e1n<\/option><option  value=\"B\u00e9lgica\">B\u00e9lgica<\/option><option  value=\"Cabo Verde\">Cabo Verde<\/option><option  value=\"Camboya\">Cambi\u00f3<\/option><option  value=\"Camer\u00fan\">Camer\u00fan<\/option><option  value=\"Canad\u00e1\">Canad\u00e1<\/option><option  value=\"Chad\" data-code=\"TD\">Chad<\/option><option  value=\"Chile\" data-code=\"CL\">Chile<\/option><option  value=\"China\" data-code=\"CN\">Porcelana<\/option><option  value=\"Chipre\">Chipre<\/option><option  value=\"Ciudad del Vaticano\">Ciudad del Vaticano<\/option><option  value=\"Colombia\" data-code=\"CO\">Colombia<\/option><option  value=\"Comoras\">Comoras<\/option><option  value=\"Congo\">Congo<\/option><option  value=\"Corea del Norte\">Corea del Norte<\/option><option  value=\"Corea del Sur\">Corea del Sur<\/option><option  value=\"Costa Rica\" data-code=\"CR\">Costa Rica<\/option><option  value=\"Costa de Marfil\">Costa de Marfil<\/option><option  value=\"Croacia\">Croacia<\/option><option  value=\"Cuba\" data-code=\"CU\">Cuba<\/option><option  value=\"Curazao\">Curazao<\/option><option  value=\"Dinamarca\">Dinamarca<\/option><option  value=\"Dominica\" data-code=\"DM\">Dominica<\/option><option  value=\"Ecuador\" data-code=\"EC\">Ecuador<\/option><option  value=\"Egipto\">Egipto<\/option><option  value=\"El Salvador\" data-code=\"SV\">El Salvador<\/option><option  value=\"Emiratos \u00c1rabes Unidos\">Emiratos \u00c1rabes Unidos<\/option><option  value=\"Eritrea\" data-code=\"ER\">Eritrea<\/option><option  value=\"Eslovaquia\">Eslovaquia<\/option><option  value=\"Eslovenia\">Eslovenia<\/option><option  value=\"Espa\u00f1a\">Espa\u00f1a<\/option><option  value=\"Estados Unidos\">Estados Unidos<\/option><option  value=\"Estonia\" data-code=\"EE\">Estonia<\/option><option  value=\"Etiop\u00eda\">Etiop\u00eda<\/option><option  value=\"Fiji\" data-code=\"FJ\">Fiyi<\/option><option  value=\"Filipinas\">Filipinas<\/option><option  value=\"Finlandia\">Finlandia<\/option><option  value=\"Francia\">Francia<\/option><option  value=\"Gab\u00f3n\">Gab\u00f3n<\/option><option  value=\"Gambia\" data-code=\"GM\">Gambia<\/option><option  value=\"Georgia\" data-code=\"GE\">Georgia<\/option><option  value=\"Ghana\" data-code=\"GH\">Ghana<\/option><option  value=\"Gibraltar\" data-code=\"GI\">Gibraltar<\/option><option  value=\"Granada\">Granada<\/option><option  value=\"Grecia\">Grecia<\/option><option  value=\"Groenlandia\">Groenlandia<\/option><option  value=\"Guadalupe\">Guadalupe<\/option><option  value=\"Guam\" data-code=\"GU\">Guam<\/option><option  value=\"Guatemala\" data-code=\"GT\">Guatemala<\/option><option  value=\"Guayana Francesa\">Guayana Francesa<\/option><option  value=\"Guernsey\" data-code=\"GG\">Guernsey<\/option><option  value=\"Guinea\" data-code=\"GN\">Guinea<\/option><option  value=\"Guinea Ecuatorial\">Guinea Ecuatorial<\/option><option  value=\"Guinea-Bis\u00e1u\">Guinea Bis\u00e1u<\/option><option  value=\"Guyana\" data-code=\"GY\">Guayana<\/option><option  value=\"Hait\u00ed\">Hait\u00ed<\/option><option  value=\"Honduras\" data-code=\"HN\">Honduras<\/option><option  value=\"Hong Kong\" data-code=\"HK\">Hong Kong<\/option><option  value=\"Hungr\u00eda\">Hungr\u00eda<\/option><option  value=\"India\" data-code=\"IN\">India<\/option><option  value=\"Indonesia\" data-code=\"ID\">Indonesia<\/option><option  value=\"Iraq\" data-code=\"IQ\">Irak<\/option><option  value=\"Irlanda\">Irlanda<\/option><option  value=\"Ir\u00e1n\">Iran<\/option><option  value=\"Isla Bouvet\">Isla Bouvet<\/option><option  value=\"Isla Norfolk\">Isla Norfolk<\/option><option  value=\"Isla de Man\">Isla de Man<\/option><option  value=\"Isla de Navidad\">Isla de Navidad<\/option><option  value=\"Islandia\">Islandia<\/option><option  value=\"Islas Aland\">Islas Aland<\/option><option  value=\"Islas Caim\u00e1n\">Islas Caim\u00e1n<\/option><option  value=\"Islas Cocos (Keeling)\">Islas Cocos (Keeling)<\/option><option  value=\"Islas Cook\">Islas Cook<\/option><option  value=\"Islas Feroe\">Islas Feroe<\/option><option  value=\"Islas Georgias del Sur y Sandwich del Sur\">Islas Georgias del Sur y Sandwich del Sur<\/option><option  value=\"Islas Heard y McDonald\">Islas Heard y McDonald<\/option><option  value=\"Islas Malvinas (Falkland)\">Islas Malvinas (Falkland)<\/option><option  value=\"Islas Marianas del Norte\">Islas Marianas del Norte<\/option><option  value=\"Islas Marshall\">Islas Marshall<\/option><option  value=\"Islas Salom\u00f3n\">Islas Salom\u00f3n<\/option><option  value=\"Islas Turcas y Caicos\">Islas Turcas y Caicos<\/option><option  value=\"Islas Ultramarinas Menores de los Estados Unidos\">Islas Ultramarinas Menores de los Estados Unidos<\/option><option  value=\"Islas V\u00edrgenes  EE.UU.\">Islas V\u00edrgenes EE.UU.<\/option><option  value=\"Islas V\u00edrgenes Brit\u00e1nicas\">Islas V\u00edrgenes Brit\u00e1nicas<\/option><option  value=\"Israel\" data-code=\"IL\">Israel<\/option><option  value=\"Italia\">Italia<\/option><option  value=\"Jamaica\" data-code=\"JM\">Jamaica<\/option><option  value=\"Jap\u00f3n\">Jap\u00f3n<\/option><option  value=\"Jersey\" data-code=\"JE\">Jersey<\/option><option  value=\"Jordania\">Jordania<\/option><option  value=\"Katar\">Katar<\/option><option  value=\"Kazajist\u00e1n\">Kazajist\u00e1n<\/option><option  value=\"Kenia\">Kenia<\/option><option  value=\"Kirguist\u00e1n\">Kirguist\u00e1n<\/option><option  value=\"Kiribati\" data-code=\"KI\">Kiribati<\/option><option  value=\"Kosovo\" data-code=\"XK\">Kosovo<\/option><option  value=\"Kuwait\" data-code=\"KW\">Kuwait<\/option><option  value=\"Laos\" data-code=\"LA\">Laos<\/option><option  value=\"Lesoto\">Lesoto<\/option><option  value=\"Letonia\">Letonia<\/option><option  value=\"Liberia\" data-code=\"LR\">Liberia<\/option><option  value=\"Libia\">Libia<\/option><option  value=\"Liechtenstein\" data-code=\"LI\">Liechtenstein<\/option><option  value=\"Lituania\">Lituania<\/option><option  value=\"Luxemburgo\">Luxemburgo<\/option><option  value=\"L\u00edbano\">L\u00edbano<\/option><option  value=\"Macao\" data-code=\"MO\">Macao<\/option><option  value=\"Madagascar\" data-code=\"MG\">Madagascar<\/option><option  value=\"Malasia\">Malasia<\/option><option  value=\"Malaui\">Malaui<\/option><option  value=\"Maldivas\">Maldivas<\/option><option  value=\"Mali\" data-code=\"ML\">Mal\u00ed<\/option><option  value=\"Malta\" data-code=\"MT\">Malta<\/option><option  value=\"Marruecos\">Marruecos<\/option><option  value=\"Martinica\">Martinica<\/option><option  value=\"Mauricio\">Mauricio<\/option><option  value=\"Mauritania\" data-code=\"MR\">Mauritania<\/option><option  value=\"Mayotte\" data-code=\"YT\">Mayotte<\/option><option  value=\"Micronesia\" data-code=\"FM\">Micronesia<\/option><option  value=\"Moldava\">Moldavia<\/option><option  value=\"Mongolia\" data-code=\"MN\">Mongolia<\/option><option  value=\"Montenegro\" data-code=\"ME\">Montenegro<\/option><option  value=\"Montserrat\" data-code=\"MS\">Montserrat<\/option><option  value=\"Mozambique\" data-code=\"MZ\">Mozambique<\/option><option  value=\"Myanmar\" data-code=\"MM\">Birmania<\/option><option  value=\"M\u00e9xico\">M\u00e9xico<\/option><option  value=\"M\u00f3naco\">M\u00f3naco<\/option><option  value=\"Namibia\" data-code=\"NA\">Namibia<\/option><option  value=\"Nauru\" data-code=\"NR\">Nauru<\/option><option  value=\"Nepal\" data-code=\"NP\">Nepal<\/option><option  value=\"Nicaragua\" data-code=\"NI\">Nicaragua<\/option><option  value=\"Nigeria\" data-code=\"NG\">Nigeria<\/option><option  value=\"Niue\" data-code=\"NU\">Niue<\/option><option  value=\"Noruega\">Noruega<\/option><option  value=\"Nueva Caledonia\">Nueva Caledonia<\/option><option  value=\"Nueva Zelanda \">Nueva Zelanda <\/option><option  value=\"N\u00edger\">N\u00edger<\/option><option  value=\"Om\u00e1n\">Om\u00e1n<\/option><option  value=\"Pakist\u00e1n\">Pakist\u00e1n<\/option><option  value=\"Palau\" data-code=\"PW\">Palaos<\/option><option  value=\"Palestina\">Palestina<\/option><option  value=\"Panam\u00e1\">Panam\u00e1<\/option><option  value=\"Pap\u00faa Nueva Guinea\">Pap\u00faa Nueva Guinea<\/option><option  value=\"Paraguay\" data-code=\"PY\">Paraguay<\/option><option  value=\"Pa\u00edses Bajos\">Pa\u00edses Bajos<\/option><option  value=\"Per\u00fa\">Per\u00fa<\/option><option  value=\"Pitcairn\" data-code=\"PN\">Islas Pitcairn<\/option><option  value=\"Polinesia Francesa\">Polinesia Francesa<\/option><option  value=\"Polonia\">Polonia<\/option><option  value=\"Portugal\" data-code=\"PT\">Portugal<\/option><option  value=\"Puerto Rico\" data-code=\"PR\">Puerto Rico<\/option><option  value=\"Reino Unido\">Reino Unido<\/option><option  value=\"Rep\u00fablica Central de \u00c1frica \">Rep\u00fablica Central de \u00c1frica <\/option><option  value=\"Rep\u00fablica Checa\">Rep\u00fablica Checa<\/option><option  value=\"Rep\u00fablica Dominicana\">Rep\u00fablica Dominicana<\/option><option  value=\"Rep\u00fablica de Macedonia\">Rep\u00fablica de Macedonia<\/option><option  value=\"Reuni\u00f3n\">Reuni\u00f3n<\/option><option  value=\"Ruanda\">Ruanda<\/option><option  value=\"Ruman\u00eda\">Rumania<\/option><option  value=\"Rusia\">Rusia<\/option><option  value=\"Sahara Occidental\">Sahara Occidental<\/option><option  value=\"Saint Kitts y Nevis\">San Crist\u00f3bal y Nieves<\/option><option  value=\"Samoa\" data-code=\"WS\">Samoa<\/option><option  value=\"Samoa Americana\">Samoa Americana<\/option><option  value=\"San Bartolom\u00e9\">San Bartolom\u00e9<\/option><option  value=\"San Marino\" data-code=\"SM\">San Marino<\/option><option  value=\"San Mart\u00edn (parte francesa)\">San Mart\u00edn (parte francesa)<\/option><option  value=\"San Mart\u00edn\u200b (parte holandesa)\">San Mart\u00edn\u200b (parte holandesa)<\/option><option  value=\"San Pedro y Miquel\u00f3n\">San Pedro y Miquel\u00f3n<\/option><option  value=\"San Vicente y las Granadinas \">San Vicente y las Granadinas <\/option><option  value=\"Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a\">Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option  value=\"Santa Luc\u00eda\">Santa Luc\u00eda<\/option><option  value=\"Santa Sede\">Santa Sede<\/option><option  value=\"Santo Tom\u00e9 y Pr\u00edncipe\">Santo Tom\u00e9 y Pr\u00edncipe<\/option><option  value=\"Saud\u00ed Arabia\">Arabia Saudita<\/option><option  value=\"Senegal\" data-code=\"SN\">Senegal<\/option><option  value=\"Serbia\" data-code=\"RS\">Serbia<\/option><option  value=\"Seychelles\" data-code=\"SC\">Seychelles<\/option><option  value=\"Sierra Leona\">Sierra Leona<\/option><option  value=\"Singapur\">Singapur<\/option><option  value=\"Siria\">Siria<\/option><option  value=\"Somalia\" data-code=\"SO\">Somalia<\/option><option  value=\"Sri Lanka\" data-code=\"LK\">Sri Lanka<\/option><option  value=\"Suazilandia\">Suazilandia<\/option><option  value=\"Sud\u00e1frica\">Sud\u00e1frica<\/option><option  value=\"Sud\u00e1n\">Sud\u00e1n<\/option><option  value=\"Sud\u00e1n del sur\">Sud\u00e1n del Sur<\/option><option  value=\"Suecia\">Suecia<\/option><option  value=\"Suiza\">Suiza<\/option><option  value=\"Surinam\">Surinam<\/option><option  value=\"Svalbard y Jan Mayen\">Svalbard y Jan Mayen<\/option><option  value=\"Tailandia\">Tailandia<\/option><option  value=\"Taiw\u00e1n\">Taiw\u00e1n<\/option><option  value=\"Tanzania\" data-code=\"TZ\">Tanzania<\/option><option  value=\"Tayikist\u00e1n\">Taikist\u00e1n<\/option><option  value=\"Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico\">Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option  value=\"Territorios Australes Franceses\">Territorios Australes Franceses<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Timor Oriental\">Timor Oriental<\/option><option  value=\"Togo\" data-code=\"TG\">Ir<\/option><option  value=\"Tokelau\" data-code=\"TK\">Tokelau<\/option><option  value=\"Tonga\" data-code=\"TO\">Tonga<\/option><option  value=\"Trinidad y Tobago\">Trinidad y Tobago<\/option><option  value=\"Turkmenist\u00e1n\">Turkmenist\u00e1n<\/option><option  value=\"Turqu\u00eda\">Turqu\u00eda<\/option><option  value=\"Tuvalu\" data-code=\"TV\">Tuvalu<\/option><option  value=\"T\u00fanez\">T\u00fanez<\/option><option  value=\"Ucrania\">Ucrania<\/option><option  value=\"Uganda\" data-code=\"UG\">Uganda<\/option><option  value=\"Uruguay\" data-code=\"UY\">Uruguay<\/option><option  value=\"Uzbekist\u00e1n\">Uzbekist\u00e1n<\/option><option  value=\"Vanuatu\" data-code=\"VU\">Vanuatu<\/option><option  value=\"Venezuela\" data-code=\"VE\">Venezuela<\/option><option  value=\"Vietnam\" data-code=\"VN\">Vietnam<\/option><option  value=\"Wallis y Futuna\">Wallis y Futuna<\/option><option  value=\"Yemen\" data-code=\"YE\">Yemen<\/option><option  value=\"Yibuti\">Yibuti<\/option><option  value=\"Zambia\" data-code=\"ZM\">Zambia<\/option><option  value=\"Zimbabue\">Zimbabue<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Pa\u00eds<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_407_container\" class=\"frm_form_field form-field  frm_top_container frm_other_container\">\r\n\t<label for=\"field_yugt8\" id=\"field_yugt8_label\" class=\"frm_primary_label\">Relaci\u00f3n de la otra parte con usted\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[407]\" id=\"field_yugt8\"  data-sectionid=\"376\" data-invmsg=\"Other Party&#039;s Relationship to You no es v\u00e1lido\" aria-invalid=\"false\"  >\n\t\t<option  value=\"\" selected='selected'> <\/option><option  value=\"Landlord\">Propietario<\/option><option  value=\"Property Manager\">Administrador de la propiedad<\/option><option  value=\"Tenant\">Arrendatario<\/option><option  value=\"Other\" class=\"frm_other_trigger\">Otro<\/option>\t<\/select>\n\t<label for=\"field_yugt8-otext\" class=\"frm_screen_reader frm_hidden\">Relaci\u00f3n de la otra parte con usted<\/label><input type=\"text\" id=\"field_yugt8-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][407]\" value=\"\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_381_container\" class=\"frm_form_field form-field  frm_inside_container frm12 frm_first\">\r\n    <label for=\"field_dl0cr2\" id=\"field_dl0cr2_label\" class=\"frm_primary_label\">Nombre del complejo de apartamentos\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_dl0cr2\" name=\"item_meta[381]\" value=\"\"  data-sectionid=\"376\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_400_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Informaci\u00f3n del abogado<\/h3>\r\n\r\n\r\n<div id=\"frm_field_374_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first vertical_radio frm_other_container\">\r\n    <div  id=\"field_qb24j2_label\" class=\"frm_primary_label\">\u00bfUtilizar\u00e1s un abogado en la mediaci\u00f3n?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qb24j2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_374-400-0\">\t\t\t<label  for=\"field_qb24j2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[374][]\" id=\"field_qb24j2-0\" value=\"Yes\"  data-sectionid=\"400\" data-invmsg=\"Will you be using an attorney at mediation? no es v\u00e1lido\"   \/> S\u00ed<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_374-400-1\">\t\t\t<label  for=\"field_qb24j2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[374][]\" id=\"field_qb24j2-1\" value=\"No\"  data-sectionid=\"400\" data-invmsg=\"Will you be using an attorney at mediation? no es v\u00e1lido\"   \/> No<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_374-400-2\">\t\t\t<label  for=\"field_qb24j2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[374][]\" id=\"field_qb24j2-2\" value=\"Maybe\"  data-sectionid=\"400\" data-invmsg=\"Will you be using an attorney at mediation? no es v\u00e1lido\"   \/> Tal vez<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_374-400-other_3\">\t\t\t<label  for=\"field_qb24j2-other_3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[374][other_3]\" id=\"field_qb24j2-other_3\" value=\"Other\"  data-sectionid=\"400\" data-invmsg=\"Will you be using an attorney at mediation? no es v\u00e1lido\"   \/> Otro<\/label><label for=\"field_qb24j2-other_3-otext\" class=\"frm_screen_reader frm_hidden\">Otro<\/label><input type=\"text\" id=\"field_qb24j2-other_3-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][374][other_3]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_394_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<div  id=\"field_attorneyname_label\" class=\"frm_primary_label\">Nombre del abogado\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_attorneyname_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tNombre del abogado\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_394\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_394-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_attorneyname_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tPrimero\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_attorneyname_first\" value=\"\" name=\"item_meta[394][first]\" data-sectionid=\"400\" data-invmsg=\"Attorney&#039;s Name no es v\u00e1lido\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_394_first_desc\">Primero<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_394-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_attorneyname_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\t\u00daltimo\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_attorneyname_last\" value=\"\" name=\"item_meta[394][last]\" data-sectionid=\"400\" data-invmsg=\"Attorney&#039;s Name no es v\u00e1lido\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_394_last_desc\">\u00daltimo<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_393_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_attorneyphone\" id=\"field_attorneyphone_label\" class=\"frm_primary_label\">N\u00famero de tel\u00e9fono del abogado\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_attorneyphone\" name=\"item_meta[393]\" value=\"\"  data-sectionid=\"400\" data-invmsg=\"Attorney&#039;s Phone Number is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_382_container\" class=\"frm_form_field frm_section_heading form-field\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Informaci\u00f3n de mediaci\u00f3n<\/h3>\r\n\r\n\r\n<div id=\"frm_field_384_container\" class=\"frm_form_field form-field  frm_top_container frm12 vertical_radio frm_other_container\">\r\n    <div  id=\"field_tpw0f2_label\" class=\"frm_primary_label\">\u00bfTipo de arrendamiento?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_tpw0f2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_384-382-0\">\t\t\t<label  for=\"field_tpw0f2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[384][]\" id=\"field_tpw0f2-0\" value=\"Month to Month\"  data-sectionid=\"382\" data-invmsg=\"Type of lease? no es v\u00e1lido\"   \/> Mes a mes<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_384-382-1\">\t\t\t<label  for=\"field_tpw0f2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[384][]\" id=\"field_tpw0f2-1\" value=\"Term Lease (ie 6 months, 1 year, or other period)\"  data-sectionid=\"382\" data-invmsg=\"Type of lease? no es v\u00e1lido\"   \/> Contrato de arrendamiento a plazo (es decir, 6 meses, 1 a\u00f1o u otro per\u00edodo)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_384-382-other_2\">\t\t\t<label  for=\"field_tpw0f2-other_2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[384][other_2]\" id=\"field_tpw0f2-other_2\" value=\"Other\"  data-sectionid=\"382\" data-invmsg=\"Type of lease? no es v\u00e1lido\"   \/> Otro<\/label><label for=\"field_tpw0f2-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Otro<\/label><input type=\"text\" id=\"field_tpw0f2-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][384][other_2]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_428_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_ntmx_label\" class=\"frm_primary_label\">\u00bfTienes preocupaciones por tu seguridad si te re\u00fanes con la otra parte en mediaci\u00f3n?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ntmx_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_428-382-0\">\t\t\t<label  for=\"field_ntmx-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[428]\" id=\"field_ntmx-0\" value=\"Yes\"\n\t\t data-sectionid=\"382\" data-invmsg=\"Do you have concerns for your safety if you meet with the other party in mediation? no es v\u00e1lido\"   \/> S\u00ed<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_428-382-1\">\t\t\t<label  for=\"field_ntmx-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[428]\" id=\"field_ntmx-1\" value=\"No\"\n\t\t data-sectionid=\"382\" data-invmsg=\"Do you have concerns for your safety if you meet with the other party in mediation? no es v\u00e1lido\"   \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_410_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first vertical_radio\">\r\n\t<div  id=\"field_yvbcu_label\" class=\"frm_primary_label\">\u00bfExiste actualmente una orden de protecci\u00f3n vigente?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_yvbcu_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_410-382-0\">\t\t\t<label  for=\"field_yvbcu-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[410]\" id=\"field_yvbcu-0\" value=\"Yes\"\n\t\t data-sectionid=\"382\" data-invmsg=\"Is there a protective order currently in place? no es v\u00e1lido\"   \/> S\u00ed<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_410-382-1\">\t\t\t<label  for=\"field_yvbcu-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[410]\" id=\"field_yvbcu-1\" value=\"No\"\n\t\t data-sectionid=\"382\" data-invmsg=\"Is there a protective order currently in place? no es v\u00e1lido\"   \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_411_container\" class=\"frm_form_field form-field  frm_top_container frm6 vertical_radio\">\r\n\t<div  id=\"field_6shi1_label\" class=\"frm_primary_label\">\u00bfEsta orden de protecci\u00f3n te proh\u00edbe reunirse con la otra parte en mediaci\u00f3n?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_6shi1_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_411-382-0\">\t\t\t<label  for=\"field_6shi1-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[411]\" id=\"field_6shi1-0\" value=\"Yes\"\n\t\t data-sectionid=\"382\" data-invmsg=\"Does this protective order prohibit you from meeting with the other party in mediation? no es v\u00e1lido\"   \/> S\u00ed<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_411-382-1\">\t\t\t<label  for=\"field_6shi1-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[411]\" id=\"field_6shi1-1\" value=\"No\"\n\t\t data-sectionid=\"382\" data-invmsg=\"Does this protective order prohibit you from meeting with the other party in mediation? no es v\u00e1lido\"   \/> No<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_385_container\" class=\"frm_form_field form-field  frm_inside_container\">\r\n    <label for=\"field_wmki42\" id=\"field_wmki42_label\" class=\"frm_primary_label\">\u00bfCu\u00e1les son los principales temas que deseas tratar en la mediaci\u00f3n? Descr\u00edbelos a continuaci\u00f3n\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[385]\" id=\"field_wmki42\" rows=\"5\"  data-sectionid=\"382\" data-invmsg=\"What are the main issues you wish to discuss in mediation? Please describe below is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_413_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_rwi0r\" id=\"field_rwi0r_label\" class=\"frm_primary_label\">\u00bfQu\u00e9 esperas lograr a trav\u00e9s de la mediaci\u00f3n?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[413]\" id=\"field_rwi0r\" rows=\"5\"  data-sectionid=\"382\" data-invmsg=\"What do you hope to accomplish through mediation? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_386_container\" class=\"frm_form_field form-field  frm_inside_container frm12 frm_first\">\r\n    <label for=\"field_61w7q2\" id=\"field_61w7q2_label\" class=\"frm_primary_label\">\u00bfQu\u00e9 d\u00edas de la semana y horarios le resultan m\u00e1s convenientes para mediar? (Ejemplo: normalmente estoy libre el lunes despu\u00e9s de las 4:00 p. m. o el viernes antes de las 11:00 a. m.) Utilice el espacio a continuaci\u00f3n para proporcionar cualquier informaci\u00f3n adicional que desee que sepamos.\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[386]\" id=\"field_61w7q2\" rows=\"5\"  data-sectionid=\"382\" data-invmsg=\"What days of the week and times usually work best for you to mediate? (Example: I am usually free on Monday after 4pm or Friday before 11am.) Please use space below to provide any additional information you would like us to know. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_408_container\" class=\"frm_form_field frm_section_heading form-field\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">informaci\u00f3n adicional<\/h3>\r\n\r\n\r\n<div id=\"frm_field_387_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first vertical_radio\">\r\n    <div  id=\"field_lbb3q2_label\" class=\"frm_primary_label\">\u00bfHay otras organizaciones que te ayuden a ti o al inquilino con tu problema de vivienda?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_lbb3q2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_387-408-0\">\t\t\t<label  for=\"field_lbb3q2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[387][]\" id=\"field_lbb3q2-0\" value=\"Yes\"  data-sectionid=\"408\" data-invmsg=\"Are other organizations assisting you or the tenant with your housing issue? no es v\u00e1lido\"   \/> S\u00ed<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_387-408-1\">\t\t\t<label  for=\"field_lbb3q2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[387][]\" id=\"field_lbb3q2-1\" value=\"No\"  data-sectionid=\"408\" data-invmsg=\"Are other organizations assisting you or the tenant with your housing issue? no es v\u00e1lido\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_388_container\" class=\"frm_form_field form-field  frm_inside_container frm6\">\r\n    <label for=\"field_6g50s2\" id=\"field_6g50s2_label\" class=\"frm_primary_label\">\u00bfQu\u00e9 otras organizaciones est\u00e1n ayud\u00e1ndole a ti o al inquilino?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6g50s2\" name=\"item_meta[388]\" value=\"\"  data-sectionid=\"408\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_389_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n    <div  id=\"field_l9rew2_label\" class=\"frm_primary_label\">\u00bfC\u00f3mo te enteraste de Mountain Mediation?\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_l9rew2_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_389-408-0\">\t\t\t<label  for=\"field_l9rew2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_l9rew2-0\" value=\"Word of Mouth\"\n\t\t data-sectionid=\"408\" data-invmsg=\"How did you hear about Mountain Mediation? no es v\u00e1lido\"   \/> Palabra de boca<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_389-408-1\">\t\t\t<label  for=\"field_l9rew2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_l9rew2-1\" value=\"Website\"\n\t\t data-sectionid=\"408\" data-invmsg=\"How did you hear about Mountain Mediation? no es v\u00e1lido\"   \/> Sitio web<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_389-408-2\">\t\t\t<label  for=\"field_l9rew2-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_l9rew2-2\" value=\"Social Media\"\n\t\t data-sectionid=\"408\" data-invmsg=\"How did you hear about Mountain Mediation? no es v\u00e1lido\"   \/> Redes sociales<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_389-408-other_3\">\t\t\t<label  for=\"field_l9rew2-other_3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[389]\" id=\"field_l9rew2-other_3\" value=\"Other\"\n\t\t data-sectionid=\"408\" data-invmsg=\"How did you hear about Mountain Mediation? no es v\u00e1lido\"   \/> Otro<\/label><label for=\"field_l9rew2-other_3-otext\" class=\"frm_screen_reader frm_hidden\">Otro<\/label><input type=\"text\" id=\"field_l9rew2-other_3-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][389]\" value=\"\" \/><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_416_container\" class=\"frm_form_field frm_section_heading form-field\">\r\n<h3 class=\"frm_pos_top\">Informaci\u00f3n demogr\u00e1fica<\/h3>\r\n<div id=\"frm_desc_field_9kx7k\" class=\"frm_description frm_section_spacing\">Las preguntas de esta secci\u00f3n se utilizan para recopilar estad\u00edsticas \u00fanicamente para fines de subvenci\u00f3n.<\/div>\r\n\r\n<div id=\"frm_field_418_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_njmdh_label\" class=\"frm_primary_label\">\u00bfCual es tu genero?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_njmdh_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_418-416-4\">\t\t\t<label  for=\"field_njmdh-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[418]\" id=\"field_njmdh-4\" value=\"Female\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your gender? no es v\u00e1lido\"   \/> Femenino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_418-416-5\">\t\t\t<label  for=\"field_njmdh-5\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[418]\" id=\"field_njmdh-5\" value=\"Male\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your gender? no es v\u00e1lido\"   \/> Masculino<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_418-416-6\">\t\t\t<label  for=\"field_njmdh-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[418]\" id=\"field_njmdh-6\" value=\"Non-binary\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your gender? no es v\u00e1lido\"   \/> No binario<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_418-416-other_2\">\t\t\t<label  for=\"field_njmdh-other_2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[418]\" id=\"field_njmdh-other_2\" value=\"Other, please specify:\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your gender? no es v\u00e1lido\"   \/> Otros, por favor especificar:<\/label><label for=\"field_njmdh-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Otros, por favor especificar:<\/label><input type=\"text\" id=\"field_njmdh-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][418]\" value=\"\" \/><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_418-416-3\">\t\t\t<label  for=\"field_njmdh-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[418]\" id=\"field_njmdh-3\" value=\"I prefer not to disclose.\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your gender? no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_420_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_6d8jy_label\" class=\"frm_primary_label\">\u00bfCual es tu edad en a\u00f1os?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_6d8jy_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_420-416-3\">\t\t\t<label  for=\"field_6d8jy-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[420]\" id=\"field_6d8jy-3\" value=\"18 or younger\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your age in years? no es v\u00e1lido\"   \/> 18 a\u00f1os o menos<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_420-416-8\">\t\t\t<label  for=\"field_6d8jy-8\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[420]\" id=\"field_6d8jy-8\" value=\"19-25\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your age in years? no es v\u00e1lido\"   \/> 19-25<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_420-416-4\">\t\t\t<label  for=\"field_6d8jy-4\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[420]\" id=\"field_6d8jy-4\" value=\"25-49\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your age in years? no es v\u00e1lido\"   \/> 25-49<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_420-416-6\">\t\t\t<label  for=\"field_6d8jy-6\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[420]\" id=\"field_6d8jy-6\" value=\"50-64\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your age in years? no es v\u00e1lido\"   \/> 50-64<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_420-416-7\">\t\t\t<label  for=\"field_6d8jy-7\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[420]\" id=\"field_6d8jy-7\" value=\"65 or older\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your age in years? no es v\u00e1lido\"   \/> 65 a\u00f1os o m\u00e1s<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_420-416-1\">\t\t\t<label  for=\"field_6d8jy-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[420]\" id=\"field_6d8jy-1\" value=\"I prefer not to disclose.\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What is your age in years? no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_419_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_b9fmh_label\" class=\"frm_primary_label\">\u00bfQu\u00e9 categor\u00edas te describen? Selecciona todas las que correspondan a tu caso:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_b9fmh_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-0\">\t\t\t<label  for=\"field_b9fmh-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-0\" value=\"American Indian or Alaskan Native\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Indio americano o nativo de Alaska<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-1\">\t\t\t<label  for=\"field_b9fmh-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-1\" value=\"Asian\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> asi\u00e1tico<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-2\">\t\t\t<label  for=\"field_b9fmh-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-2\" value=\"Black or African American\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Negro o afroamericano<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-3\">\t\t\t<label  for=\"field_b9fmh-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-3\" value=\"Hispanic, Latino, or Spanish Origin\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Origen hispano, latino o espa\u00f1ol<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-4\">\t\t\t<label  for=\"field_b9fmh-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-4\" value=\"Middle Eastern or North African\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Oriente Medio o \u00c1frica del Norte<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-5\">\t\t\t<label  for=\"field_b9fmh-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-5\" value=\"Native Hawaiian or Other Pacific Islander\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Nativo de Haw\u00e1i o de otras islas del Pac\u00edfico<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-8\">\t\t\t<label  for=\"field_b9fmh-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-8\" value=\"White\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Blanco<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-other_6\">\t\t\t<label  for=\"field_b9fmh-other_6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][other_6]\" id=\"field_b9fmh-other_6\" value=\"Some other race, ethnicity, or origin, please specify:\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Alguna otra raza, etnia u origen, por favor especifique:<\/label><label for=\"field_b9fmh-other_6-otext\" class=\"frm_screen_reader frm_hidden\">Alguna otra raza, etnia u origen, por favor especifique:<\/label><input type=\"text\" id=\"field_b9fmh-other_6-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][419][other_6]\" value=\"\" \/><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_419-416-7\">\t\t\t<label  for=\"field_b9fmh-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[419][]\" id=\"field_b9fmh-7\" value=\"I prefer not to disclose.\"  data-sectionid=\"416\" data-invmsg=\"Which categories describe you?  Select all that apply to you: no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_422_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_1p4yn_label\" class=\"frm_primary_label\">\u00bfCu\u00e1l es el nivel m\u00e1s alto de escuela que has completado o el t\u00edtulo m\u00e1s alto que has recibido?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1p4yn_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-0\">\t\t\t<label  for=\"field_1p4yn-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-0\" value=\"Some high school\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Algunos estudiantes de secundaria<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-1\">\t\t\t<label  for=\"field_1p4yn-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-1\" value=\"High school diploma or equivalent\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Diploma de escuela secundaria o equivalente<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-2\">\t\t\t<label  for=\"field_1p4yn-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-2\" value=\"Vocational training\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Formaci\u00f3n profesional<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-3\">\t\t\t<label  for=\"field_1p4yn-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-3\" value=\"Some college\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Un poco de universidad<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-4\">\t\t\t<label  for=\"field_1p4yn-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-4\" value=\"Associate&#039;s degree (e.g., AA, AE, AFA, AS, ASN)\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> T\u00edtulo de asociado (por ejemplo, AA, AE, AFA, AS, ASN)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-5\">\t\t\t<label  for=\"field_1p4yn-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-5\" value=\"Bachelor&#039;s degree (e.g., BA, BBA, BFA, BS)\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Licenciatura (por ejemplo, BA, BBA, BFA, BS)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-6\">\t\t\t<label  for=\"field_1p4yn-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-6\" value=\"Some post undergraduate work\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Algunos trabajos de postgrado<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-7\">\t\t\t<label  for=\"field_1p4yn-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-7\" value=\"Master&#039;s degree (e.g., MA, MBA, MFA, MS, MSW)\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> T\u00edtulo de maestr\u00eda (por ejemplo, MA, MBA, MFA, MS, MSW)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-8\">\t\t\t<label  for=\"field_1p4yn-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-8\" value=\"Specialist degree (e.g. EdS)\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> T\u00edtulo de especialista (por ejemplo, EdS)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-9\">\t\t\t<label  for=\"field_1p4yn-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-9\" value=\"Applied or professional doctorate degree (e.g., MD, DDC, DDS, JD, PharmD)\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> T\u00edtulo de doctorado aplicado o profesional (por ejemplo, MD, DDC, DDS, JD, PharmD)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-10\">\t\t\t<label  for=\"field_1p4yn-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-10\" value=\"Doctorate degree (e.g., EdD, PhD)\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> T\u00edtulo de doctorado (por ejemplo, EdD, PhD)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-other_11\">\t\t\t<label  for=\"field_1p4yn-other_11\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][other_11]\" id=\"field_1p4yn-other_11\" value=\"Other, please specify:\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Otros, por favor especificar:<\/label><label for=\"field_1p4yn-other_11-otext\" class=\"frm_screen_reader frm_hidden\">Otros, por favor especificar:<\/label><input type=\"text\" id=\"field_1p4yn-other_11-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][422][other_11]\" value=\"\" \/><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_422-416-12\">\t\t\t<label  for=\"field_1p4yn-12\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[422][]\" id=\"field_1p4yn-12\" value=\"I prefer not to disclose.\"  data-sectionid=\"416\" data-invmsg=\"What is the highest level of school you have completed or the highest degree you have received? no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_423_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_3vtb7_label\" class=\"frm_primary_label\">\u00bfCu\u00e1l de las siguientes categor\u00edas describe mejor tu situaci\u00f3n laboral?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_3vtb7_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-0\">\t\t\t<label  for=\"field_3vtb7-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][]\" id=\"field_3vtb7-0\" value=\"Employed part time\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Empleado a tiempo parcial<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-1\">\t\t\t<label  for=\"field_3vtb7-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][]\" id=\"field_3vtb7-1\" value=\"Employed full time\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Empleado a tiempo completo<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-2\">\t\t\t<label  for=\"field_3vtb7-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][]\" id=\"field_3vtb7-2\" value=\"Not employed, looking for work\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Sin empleo, buscando trabajo<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-3\">\t\t\t<label  for=\"field_3vtb7-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][]\" id=\"field_3vtb7-3\" value=\"Not employed, not looking for work\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Sin empleo, sin buscar trabajo<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-4\">\t\t\t<label  for=\"field_3vtb7-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][]\" id=\"field_3vtb7-4\" value=\"Retired\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Jubilado<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-5\">\t\t\t<label  for=\"field_3vtb7-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][]\" id=\"field_3vtb7-5\" value=\"Disabled, not able to work\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Discapacitado, no puede trabajar<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-other_7\">\t\t\t<label  for=\"field_3vtb7-other_7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][other_7]\" id=\"field_3vtb7-other_7\" value=\"Other, please specify:\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Otros, por favor especificar:<\/label><label for=\"field_3vtb7-other_7-otext\" class=\"frm_screen_reader frm_hidden\">Otros, por favor especificar:<\/label><input type=\"text\" id=\"field_3vtb7-other_7-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][423][other_7]\" value=\"\" \/><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_423-416-6\">\t\t\t<label  for=\"field_3vtb7-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[423][]\" id=\"field_3vtb7-6\" value=\"I prefer not to disclose.\"  data-sectionid=\"416\" data-invmsg=\"Which of the following categories best describes your employment status? no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_424_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_cpqxd_label\" class=\"frm_primary_label\">\u00bfCu\u00e1l fue el ingreso familiar combinado durante el \u00faltimo a\u00f1o?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_cpqxd_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_424-416-1\">\t\t\t<label  for=\"field_cpqxd-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[424]\" id=\"field_cpqxd-1\" value=\"$0 - $25,819\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What was your combined household income in the last year? no es v\u00e1lido\"   \/> $0 - $25,819<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_424-416-2\">\t\t\t<label  for=\"field_cpqxd-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[424]\" id=\"field_cpqxd-2\" value=\"$25,820 - $38,729\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What was your combined household income in the last year? no es v\u00e1lido\"   \/> $25,820 - $38,729<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_424-416-3\">\t\t\t<label  for=\"field_cpqxd-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[424]\" id=\"field_cpqxd-3\" value=\"$38,730 - $51,639\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What was your combined household income in the last year? no es v\u00e1lido\"   \/> $38,730 - $51,639<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_424-416-10\">\t\t\t<label  for=\"field_cpqxd-10\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[424]\" id=\"field_cpqxd-10\" value=\"$51,640 or more\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What was your combined household income in the last year? no es v\u00e1lido\"   \/> $51,640 o m\u00e1s<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_424-416-11\">\t\t\t<label  for=\"field_cpqxd-11\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[424]\" id=\"field_cpqxd-11\" value=\"I prefer not to disclose.\"\n\t\t data-sectionid=\"416\" data-invmsg=\"What was your combined household income in the last year? no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_425_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_7l2cy_label\" class=\"frm_primary_label\">\u00bfCu\u00e1l de las siguientes opciones describe tu situaci\u00f3n de vida actual?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_7l2cy_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_425-416-0\">\t\t\t<label  for=\"field_7l2cy-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[425]\" id=\"field_7l2cy-0\" value=\"Own my home\"\n\t\t data-sectionid=\"416\" data-invmsg=\"Which of the following describes your current living situation? no es v\u00e1lido\"   \/> Soy due\u00f1o de mi casa<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_425-416-1\">\t\t\t<label  for=\"field_7l2cy-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[425]\" id=\"field_7l2cy-1\" value=\"Rent my home\"\n\t\t data-sectionid=\"416\" data-invmsg=\"Which of the following describes your current living situation? no es v\u00e1lido\"   \/> Alquilo mi casa<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_425-416-other_2\">\t\t\t<label  for=\"field_7l2cy-other_2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[425]\" id=\"field_7l2cy-other_2\" value=\"Other, please specify:\"\n\t\t data-sectionid=\"416\" data-invmsg=\"Which of the following describes your current living situation? no es v\u00e1lido\"   \/> Otros, por favor especificar:<\/label><label for=\"field_7l2cy-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Otros, por favor especificar:<\/label><input type=\"text\" id=\"field_7l2cy-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][425]\" value=\"\" \/><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_425-416-3\">\t\t\t<label  for=\"field_7l2cy-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[425]\" id=\"field_7l2cy-3\" value=\"I prefer not to disclose.\"\n\t\t data-sectionid=\"416\" data-invmsg=\"Which of the following describes your current living situation? no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_427_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_489ee_label\" class=\"frm_primary_label\">\u00bfQu\u00e9 idioma(s) hablas principalmente en casa?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_489ee_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_427-416-0\">\t\t\t<label  for=\"field_489ee-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[427][]\" id=\"field_489ee-0\" value=\"English\"  data-sectionid=\"416\" data-invmsg=\"What language(s) do you mainly speak at home? no es v\u00e1lido\"   \/> Ingl\u00e9s<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_427-416-1\">\t\t\t<label  for=\"field_489ee-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[427][]\" id=\"field_489ee-1\" value=\"Spanish\"  data-sectionid=\"416\" data-invmsg=\"What language(s) do you mainly speak at home? no es v\u00e1lido\"   \/> Espa\u00f1ol<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_427-416-2\">\t\t\t<label  for=\"field_489ee-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[427][]\" id=\"field_489ee-2\" value=\"French\"  data-sectionid=\"416\" data-invmsg=\"What language(s) do you mainly speak at home? no es v\u00e1lido\"   \/> Franc\u00e9s<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_427-416-3\">\t\t\t<label  for=\"field_489ee-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[427][]\" id=\"field_489ee-3\" value=\"Chinese\"  data-sectionid=\"416\" data-invmsg=\"What language(s) do you mainly speak at home? no es v\u00e1lido\"   \/> Chino<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_427-416-other_4\">\t\t\t<label  for=\"field_489ee-other_4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[427][other_4]\" id=\"field_489ee-other_4\" value=\"Other, please specify:\"  data-sectionid=\"416\" data-invmsg=\"What language(s) do you mainly speak at home? no es v\u00e1lido\"   \/> Otros, por favor especificar:<\/label><label for=\"field_489ee-other_4-otext\" class=\"frm_screen_reader frm_hidden\">Otros, por favor especificar:<\/label><input type=\"text\" id=\"field_489ee-other_4-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][427][other_4]\" value=\"\" \/><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_427-416-5\">\t\t\t<label  for=\"field_489ee-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[427][]\" id=\"field_489ee-5\" value=\"I prefer not to disclose.\"  data-sectionid=\"416\" data-invmsg=\"What language(s) do you mainly speak at home? no es v\u00e1lido\"   \/> Prefiero no revelarlo.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_390_container\" class=\"frm_form_field form-field\">\r\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Entregar<\/button>\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_551_container\">\n\t\t\t<label for=\"field_weatb\" >\n\t\t\t\tSi eres humano, deja este campo en blanco.\t\t\t<\/label>\n\t\t\t<input  id=\"field_weatb\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[551]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"oz5Sfl7Zz1yvPwfwEwQiwUzxnNZ7CEG\/c9waj3qJPfmGGPLteVXKlpfWbv3I8lpK\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"113\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Intake Form In mediation, people who are working through a conflict each tell their story, then create an agreement to meet their needs with assistance from a neutral mediator. \u00a0Mediation is voluntary and confidential. Please fill out the form below to request a mediation with Mountain Mediation. If you are looking for mediation and conferencing [&hellip;]<\/p>","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-10069","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Intake Form - Mountain Mediation Center<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/mountainmediationcenter.org\/es\/intake-form\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Intake Form - Mountain Mediation Center\" \/>\n<meta property=\"og:description\" content=\"Intake Form In mediation, people who are working through a conflict each tell their story, then create an agreement to meet their needs with assistance from a neutral mediator. \u00a0Mediation is voluntary and confidential. Please fill out the form below to request a mediation with Mountain Mediation. If you are looking for mediation and conferencing [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/mountainmediationcenter.org\/es\/intake-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Mountain Mediation Center\" \/>\n<meta property=\"article:modified_time\" content=\"2024-12-11T19:19:25+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data1\" content=\"7 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/mountainmediationcenter.org\/intake-form\/\",\"url\":\"https:\/\/mountainmediationcenter.org\/intake-form\/\",\"name\":\"Intake Form - Mountain Mediation Center\",\"isPartOf\":{\"@id\":\"https:\/\/mountainmediationcenter.org\/#website\"},\"datePublished\":\"2024-09-17T23:30:51+00:00\",\"dateModified\":\"2024-12-11T19:19:25+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/mountainmediationcenter.org\/intake-form\/#breadcrumb\"},\"inLanguage\":\"es\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/mountainmediationcenter.org\/intake-form\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/mountainmediationcenter.org\/intake-form\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/mountainmediationcenter.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Intake Form\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/mountainmediationcenter.org\/#website\",\"url\":\"https:\/\/mountainmediationcenter.org\/\",\"name\":\"Mountain Mediation Center\",\"description\":\"Bringing people together to prevent conflict, resolve disputes, and build a more inclusive community.\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/mountainmediationcenter.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"es\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Intake Form - Mountain Mediation Center","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/mountainmediationcenter.org\/es\/intake-form\/","og_locale":"es_ES","og_type":"article","og_title":"Intake Form - Mountain Mediation Center","og_description":"Intake Form In mediation, people who are working through a conflict each tell their story, then create an agreement to meet their needs with assistance from a neutral mediator. \u00a0Mediation is voluntary and confidential. Please fill out the form below to request a mediation with Mountain Mediation. 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