{"id":6719,"date":"2022-12-05T17:14:50","date_gmt":"2022-12-05T23:14:50","guid":{"rendered":"https:\/\/www.in2action.org\/?page_id=6719"},"modified":"2022-12-05T19:23:41","modified_gmt":"2022-12-06T01:23:41","slug":"online-application","status":"publish","type":"page","link":"https:\/\/in2action.org\/in2action\/online-application\/","title":{"rendered":"Online Application"},"content":{"rendered":"[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row admin_label=&#8221;row&#8221; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Text&#8221; _builder_version=&#8221;4.19.0&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; custom_margin=&#8221;|75px||75px|false|false&#8221; global_colors_info=&#8221;{}&#8221;]<p><div class=\"frm_forms  with_frm_style frm_style_in2action-form-style\" id=\"frm_form_3_container\" data-token=\"b9d7251370d7c39a6cf11b5ae63740a1\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_onlineapplication\" data-token=\"b9d7251370d7c39a6cf11b5ae63740a1\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Online Application<\/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=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"onlineapplication\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"37f5352abd\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/in2action\/wp-json\/wp\/v2\/pages\/6719\" \/><div id=\"frm_field_13_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<h1>in2Action Online Application<\/h1>\n<hr \/>\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>in2Action is a faith-based program created to help people successfully and permanently transition from prison back into our community. <strong>Per District-6 P&#038;P, you must be from or have direct ties to Boone, Audrain, Cooper, Howard, Cole, Randolph, Callaway, or Monteau counties to be considered for admission. You must be on felony supervision with at least 6 months remaining on your sentence on the day of admittance to in2Action.<\/strong> If you can verify you are from one of these counties, complete this form, and return it when you are <strong>less than 120 days<\/strong> from your outdate.<\/h5>\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<hr \/>\n<p><strong>Please check the county you are from, that your current case was adjudicated, or that you have a strong family tie in:<\/strong><\/div>\n<div id=\"frm_field_70_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_two_col\">\n\t<div  id=\"field_olb4z_label\" class=\"frm_primary_label\">County\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_olb4z_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-0\">\t\t\t<label  for=\"field_olb4z-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-0\" value=\"Boone\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   aria-required=\"true\"  \/> Boone<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-1\">\t\t\t<label  for=\"field_olb4z-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-1\" value=\"Audrain\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Audrain<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-6\">\t\t\t<label  for=\"field_olb4z-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-6\" value=\"Calloway\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Calloway<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-5\">\t\t\t<label  for=\"field_olb4z-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-5\" value=\"Cole\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Cole<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-2\">\t\t\t<label  for=\"field_olb4z-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-2\" value=\"Cooper\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Cooper<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-3\">\t\t\t<label  for=\"field_olb4z-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-3\" value=\"Howard\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Howard<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-7\">\t\t\t<label  for=\"field_olb4z-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-7\" value=\"Moniteau\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Moniteau<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-4\">\t\t\t<label  for=\"field_olb4z-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-4\" value=\"Randolph\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Randolph<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_73_container\" class=\"frm_form_field  frm_html_container form-field\">\n<hr \/>\n<\/div>\n<div id=\"frm_field_72_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h3><span style=\"color: red;\"><br \/>\nAcceptance is contingent upon approval by in2Action and District 6 P&#038;P<\/span><\/h3>\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_t0a3a\" id=\"field_t0a3a_label\" class=\"frm_primary_label\">Out Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_t0a3a\" name=\"item_meta[42]\" value=\"\"  data-reqmsg=\"Out Date 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_32_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_d8giv\" id=\"field_d8giv_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_d8giv\" name=\"item_meta[32]\" value=\"\"  data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 vertical_radio\">\r\n    <div  id=\"field_6k5bf_label\" class=\"frm_primary_label\">Sex Offender\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_6k5bf_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_34-1\">\t\t\t<label  for=\"field_6k5bf-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[34]\" id=\"field_6k5bf-1\" value=\"No\"\n\t\t data-reqmsg=\"Sex Offender cannot be blank.\" data-invmsg=\"Sex Offender is invalid\"   \/> No<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_34-0\">\t\t\t<label  for=\"field_6k5bf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[34]\" id=\"field_6k5bf-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Sex Offender cannot be blank.\" data-invmsg=\"Sex Offender is invalid\"   \/> Yes<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h3><span style=\"color: red;\"><br \/>\nSORRY, WE ARE UNABLE TO ACCEPT SEX OFFENDERS or MH-4\u2019s<\/span><\/h3>\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first frm_half\">\r\n    <label for=\"field_r7stv\" id=\"field_r7stv_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_r7stv\" name=\"item_meta[16]\" value=\"\"  data-reqmsg=\"Name 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_17_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm6 frm12\">\r\n    <label for=\"field_ynd6k\" id=\"field_ynd6k_label\" class=\"frm_primary_label\">DOC #\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ynd6k\" name=\"item_meta[17]\" value=\"\"  data-reqmsg=\"DOC # 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_18_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_firs frm6 t frm_first\">\r\n    <label for=\"field_3rgb4\" id=\"field_3rgb4_label\" class=\"frm_primary_label\">Institution\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_3rgb4\" name=\"item_meta[18]\" value=\"\"  data-reqmsg=\"Institution 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_19_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_7ohvg\" id=\"field_7ohvg_label\" class=\"frm_primary_label\">PO\/Case Worker\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_7ohvg\" name=\"item_meta[19]\" value=\"\"  data-reqmsg=\"PO\/Case Worker 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_33_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_nas5m_label\" class=\"frm_primary_label\">Do you intend (and are able) to work fulltime upon release?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nas5m_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_33-0\">\t\t\t<label  for=\"field_nas5m-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_nas5m-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Do you intend (and are able) to work fulltime upon release? cannot be blank.\" data-invmsg=\"Do you intend (and are able) to work fulltime upon release? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_33-1\">\t\t\t<label  for=\"field_nas5m-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_nas5m-1\" value=\"No\"\n\t\t data-reqmsg=\"Do you intend (and are able) to work fulltime upon release? cannot be blank.\" data-invmsg=\"Do you intend (and are able) to work fulltime upon release? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_74_container\" class=\"frm_form_field  frm_html_container form-field\"><strong><u>THIS IS NOT AN ACCEPTANCE LETTER!!!<\/u><\/strong><\/p>\n<p><strong>If we have an open bed when you submit this letter, in2Action will schedule a phone interview with you through your<br \/>\nPO. Please know we will likely NOT have an open bed. You will likely NOT hear back from us. Please use in2Action as<br \/>\nonly a Plan-B.<\/strong><\/p>\n<p>***Requestssubmitted before 120 daysfrom release will be discarded as will requests with false out-dates.<br \/>\nIt is important to remember yoursuccess does not depend on your participation in our program. It depends on your commitment to follow our Lord Jesus. Please keep us in prayer as we keep you in prayer. Let God&#8217;s will be done.<\/p>\n<p><strong>RETURN THIS FORM TO IN2ACTION WHEN YOU ARE LESS THAN 120 DAYS FROM RELEASE<\/strong><\/p>\n<p><strong>New residents must test NEGATIVE on drug screen at intake to be admitted into the program<\/strong><\/p>\n<p>The form can be mailed to the address above, or your institutional staff can scan and email the form to<br \/>\ndaver@in2action.org<\/p>\n<p><strong>IF YOU DO NOT RECEIVE A RESPONSE, it means we do not have any open beds.<\/strong><\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_75_container\">\n\t\t\t<label for=\"field_3cjr4\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_3cjr4\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[75]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"YomxdZaKv1g2x68a6ZBl8vBk5IMj4JJjwXyIPBpUecKd73QEMqBWy\/3X2q43ThAs\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<\/p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]","protected":false},"excerpt":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_in2action-form-style\" id=\"frm_form_3_container\" data-token=\"b9d7251370d7c39a6cf11b5ae63740a1\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_onlineapplication\" data-token=\"b9d7251370d7c39a6cf11b5ae63740a1\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Online Application<\/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=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"onlineapplication\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"37f5352abd\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/in2action\/wp-json\/wp\/v2\/pages\/6719\" \/><div id=\"frm_field_13_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<h1>in2Action Online Application<\/h1>\n<hr \/>\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h5>in2Action is a faith-based program created to help people successfully and permanently transition from prison back into our community. <strong>Per District-6 P&P, you must be from or have direct ties to Boone, Audrain, Cooper, Howard, Cole, Randolph, Callaway, or Monteau counties to be considered for admission. You must be on felony supervision with at least 6 months remaining on your sentence on the day of admittance to in2Action.<\/strong> If you can verify you are from one of these counties, complete this form, and return it when you are <strong>less than 120 days<\/strong> from your outdate.<\/h5>\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field  frm12 frm_first frm_html_container form-field\">\n<hr \/>\n<p><strong>Please check the county you are from, that your current case was adjudicated, or that you have a strong family tie in:<\/strong><\/div>\n<div id=\"frm_field_70_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_two_col\">\n\t<div  id=\"field_olb4z_label\" class=\"frm_primary_label\">County\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_olb4z_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-0\">\t\t\t<label  for=\"field_olb4z-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-0\" value=\"Boone\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   aria-required=\"true\"  \/> Boone<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-1\">\t\t\t<label  for=\"field_olb4z-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-1\" value=\"Audrain\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Audrain<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-6\">\t\t\t<label  for=\"field_olb4z-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-6\" value=\"Calloway\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Calloway<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-5\">\t\t\t<label  for=\"field_olb4z-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-5\" value=\"Cole\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Cole<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-2\">\t\t\t<label  for=\"field_olb4z-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-2\" value=\"Cooper\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Cooper<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-3\">\t\t\t<label  for=\"field_olb4z-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-3\" value=\"Howard\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Howard<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-7\">\t\t\t<label  for=\"field_olb4z-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-7\" value=\"Moniteau\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Moniteau<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_70-4\">\t\t\t<label  for=\"field_olb4z-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[70][]\" id=\"field_olb4z-4\" value=\"Randolph\"  data-reqmsg=\"County cannot be blank.\" data-invmsg=\"County is invalid\"   \/> Randolph<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_73_container\" class=\"frm_form_field  frm_html_container form-field\">\n<hr \/>\n<\/div>\n<div id=\"frm_field_72_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h3><span style=\"color: red;\"><br \/>\nAcceptance is contingent upon approval by in2Action and District 6 P&P<\/span><\/h3>\n<\/div>\n<div id=\"frm_field_42_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n    <label for=\"field_t0a3a\" id=\"field_t0a3a_label\" class=\"frm_primary_label\">Out Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_t0a3a\" name=\"item_meta[42]\" value=\"\"  data-reqmsg=\"Out Date 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_32_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_d8giv\" id=\"field_d8giv_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_d8giv\" name=\"item_meta[32]\" value=\"\"  data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 vertical_radio\">\r\n    <div  id=\"field_6k5bf_label\" class=\"frm_primary_label\">Sex Offender\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_6k5bf_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_34-1\">\t\t\t<label  for=\"field_6k5bf-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[34]\" id=\"field_6k5bf-1\" value=\"No\"\n\t\t data-reqmsg=\"Sex Offender cannot be blank.\" data-invmsg=\"Sex Offender is invalid\"   \/> No<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_34-0\">\t\t\t<label  for=\"field_6k5bf-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[34]\" id=\"field_6k5bf-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Sex Offender cannot be blank.\" data-invmsg=\"Sex Offender is invalid\"   \/> Yes<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field  frm_html_container form-field\">\n<h3><span style=\"color: red;\"><br \/>\nSORRY, WE ARE UNABLE TO ACCEPT SEX OFFENDERS or MH-4\u2019s<\/span><\/h3>\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first frm_half\">\r\n    <label for=\"field_r7stv\" id=\"field_r7stv_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_r7stv\" name=\"item_meta[16]\" value=\"\"  data-reqmsg=\"Name 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_17_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm6 frm12\">\r\n    <label for=\"field_ynd6k\" id=\"field_ynd6k_label\" class=\"frm_primary_label\">DOC #\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ynd6k\" name=\"item_meta[17]\" value=\"\"  data-reqmsg=\"DOC # 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_18_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_firs frm6 t frm_first\">\r\n    <label for=\"field_3rgb4\" id=\"field_3rgb4_label\" class=\"frm_primary_label\">Institution\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_3rgb4\" name=\"item_meta[18]\" value=\"\"  data-reqmsg=\"Institution 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_19_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_7ohvg\" id=\"field_7ohvg_label\" class=\"frm_primary_label\">PO\/Case Worker\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_7ohvg\" name=\"item_meta[19]\" value=\"\"  data-reqmsg=\"PO\/Case Worker 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_33_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_nas5m_label\" class=\"frm_primary_label\">Do you intend (and are able) to work fulltime upon release?\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_nas5m_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_33-0\">\t\t\t<label  for=\"field_nas5m-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_nas5m-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Do you intend (and are able) to work fulltime upon release? cannot be blank.\" data-invmsg=\"Do you intend (and are able) to work fulltime upon release? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_33-1\">\t\t\t<label  for=\"field_nas5m-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[33]\" id=\"field_nas5m-1\" value=\"No\"\n\t\t data-reqmsg=\"Do you intend (and are able) to work fulltime upon release? cannot be blank.\" data-invmsg=\"Do you intend (and are able) to work fulltime upon release? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_74_container\" class=\"frm_form_field  frm_html_container form-field\"><strong><u>THIS IS NOT AN ACCEPTANCE LETTER!!!<\/u><\/strong><\/p>\n<p><strong>If we have an open bed when you submit this letter, in2Action will schedule a phone interview with you through your<br \/>\nPO. Please know we will likely NOT have an open bed. You will likely NOT hear back from us. Please use in2Action as<br \/>\nonly a Plan-B.<\/strong><\/p>\n<p>***Requestssubmitted before 120 daysfrom release will be discarded as will requests with false out-dates.<br \/>\nIt is important to remember yoursuccess does not depend on your participation in our program. It depends on your commitment to follow our Lord Jesus. Please keep us in prayer as we keep you in prayer. Let God's will be done.<\/p>\n<p><strong>RETURN THIS FORM TO IN2ACTION WHEN YOU ARE LESS THAN 120 DAYS FROM RELEASE<\/strong><\/p>\n<p><strong>New residents must test NEGATIVE on drug screen at intake to be admitted into the program<\/strong><\/p>\n<p>The form can be mailed to the address above, or your institutional staff can scan and email the form to<br \/>\ndaver@in2action.org<\/p>\n<p><strong>IF YOU DO NOT RECEIVE A RESPONSE, it means we do not have any open beds.<\/strong><\/div>\n<div id=\"frm_field_44_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_76_container\">\n\t\t\t<label for=\"field_9z4d\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_9z4d\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[76]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"YomxdZaKv1g2x68a6ZBl8vBk5IMj4JJjwXyIPBpUecLoe56oRebk0HWFIyhSQy\/L\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<!-- wp:formidable\/simple-form {\"formId\":\"3\"} -->\r\n<div>[formidable id=\"3\"]<\/div>\r\n<!-- \/wp:formidable\/simple-form -->","_et_gb_content_width":"","ngg_post_thumbnail":0,"footnotes":""},"class_list":["post-6719","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - 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