{"id":5009,"date":"2026-07-23T13:37:51","date_gmt":"2026-07-23T20:37:51","guid":{"rendered":"https:\/\/uwm211.org\/?page_id=5009"},"modified":"2026-07-23T13:37:51","modified_gmt":"2026-07-23T20:37:51","slug":"211-nebraska-warmline-online-referral-form","status":"publish","type":"page","link":"https:\/\/uwm211.org\/zh\/211-nebraska-warmline-online-referral-form\/","title":{"rendered":"211 Nebraska Warmline Online Referral Form"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_9_container\" data-token=\"3ba9f0329d85a028610fc77a8820cc4d\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_6dz7k\" data-token=\"3ba9f0329d85a028610fc77a8820cc4d\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">211 Nebraska Warmline Referral Form<\/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=\"9\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_9\" id=\"frm_hide_fields_9\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"6dz7k\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_9\" name=\"frm_submit_entry_9\" value=\"b9421b0cea\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/zh\/wp-json\/wp\/v2\/pages\/5009\" \/><div id=\"frm_field_94_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<div  id=\"field_ijkmq_label\" class=\"frm_primary_label\">Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_ijkmq_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tName\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_94\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_94-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_ijkmq_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_ijkmq_first\" value=\"\" name=\"item_meta[94][first]\" autocomplete=\"given-name\" data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name \u65e0\u6548\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_94_first_desc\">First Name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_94-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_ijkmq_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_ijkmq_last\" value=\"\" name=\"item_meta[94][last]\" autocomplete=\"family-name\" data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name \u65e0\u6548\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_94_last_desc\">Last Name<\/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_95_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_ur634\" id=\"field_ur634_label\" class=\"frm_primary_label\">Phone\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_ur634\" name=\"item_meta[95]\" value=\"\"  data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_96_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_l63jb\" id=\"field_l63jb_label\" class=\"frm_primary_label\">Gender\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_l63jb\" name=\"item_meta[96]\" value=\"\"  data-invmsg=\"Gender is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_97_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_ts40m\" id=\"field_ts40m_label\" class=\"frm_primary_label\">Age\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<div class=\"frm_with_box\"><input  type=\"text\" id=\"field_ts40m\" name=\"item_meta[97]\" value=\"\"  data-invmsg=\"Age is invalid\" class=\"frm-has-number-format\" aria-invalid=\"false\"   \/><\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_98_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<div  id=\"field_whgrt_label\" class=\"frm_primary_label\">Address\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_whgrt_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_98-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_whgrt_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_whgrt_line1\" value=\"\" name=\"item_meta[98][line1]\"  data-invmsg=\"Address \u65e0\u6548\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_98-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_whgrt_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_whgrt_line2\" value=\"\" name=\"item_meta[98][line2]\"  data-invmsg=\"Address \u65e0\u6548\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_98-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_whgrt_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_whgrt_city\" value=\"\" name=\"item_meta[98][city]\"  data-invmsg=\"Address \u65e0\u6548\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_98-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_whgrt_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_whgrt_state\" value=\"\" name=\"item_meta[98][state]\"  data-invmsg=\"Address \u65e0\u6548\" aria-invalid=\"false\"   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value=\"\u9999\u6e2f\">\u9999\u6e2f<\/option><option  value=\"\u9a6c\u5176\u987f\">\u9a6c\u5176\u987f<\/option><option  value=\"\u9a6c\u5c14\u4ee3\u592b\">\u9a6c\u5c14\u4ee3\u592b<\/option><option  value=\"\u9a6c\u6069\u5c9b\">\u9a6c\u6069\u5c9b<\/option><option  value=\"\u9a6c\u62c9\u7ef4\">\u9a6c\u62c9\u7ef4<\/option><option  value=\"\u9a6c\u63d0\u5c3c\u514b\">\u9a6c\u63d0\u5c3c\u514b<\/option><option  value=\"\u9a6c\u6765\u897f\u4e9a\">\u9a6c\u6765\u897f\u4e9a<\/option><option  value=\"\u9a6c\u7ea6\u7279\u5c9b\">\u9a6c\u7ea6\u7279\u5c9b<\/option><option  value=\"\u9a6c\u7ecd\u5c14\u7fa4\u5c9b\">\u9a6c\u7ecd\u5c14\u7fa4\u5c9b<\/option><option  value=\"\u9a6c\u8033\u4ed6\">\u9a6c\u8033\u4ed6<\/option><option  value=\"\u9a6c\u8fbe\u52a0\u65af\u52a0\">\u9a6c\u8fbe\u52a0\u65af\u52a0<\/option><option  value=\"\u9a6c\u91cc\">\u9a6c\u91cc<\/option><option  value=\"\u9ece\u5df4\u5ae9\">\u9ece\u5df4\u5ae9<\/option><option  value=\"\u9ed1\u5c71\">\u9ed1\u5c71<\/option>\t\t<\/select>\n\t<div class=\"frm_description\">Country<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_99_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_r387r\" id=\"field_r387r_label\" class=\"frm_primary_label\">Please Provide a Brief Description of Need\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[99]\" id=\"field_r387r\" rows=\"5\"  data-reqmsg=\"Please Provide a Brief Description of Need cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please Provide a Brief Description of Need is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_100_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n\t<div  id=\"field_76m98_label\" class=\"frm_primary_label\">Who is Filling Out this Form?\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_76m98_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_100-0\">\t\t\t<label  for=\"field_76m98-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[100][]\" id=\"field_76m98-0\" value=\"Myself\"  data-invmsg=\"Who is Filling Out this Form? is invalid\"   \/> Myself<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_100-1\">\t\t\t<label  for=\"field_76m98-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[100][]\" id=\"field_76m98-1\" value=\"Other (Family, Friend, Community Worker, etc.)\"  data-invmsg=\"Who is Filling Out this Form? is invalid\"   \/> Other (Family, Friend, Community Worker, etc.)<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_93_container\" class=\"frm_form_field form-field  frm12 frm_first\">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n\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_101_container\">\n\t\t\t<label for=\"field_trxu3\" >\n\t\t\t\t\u5982\u679c\u4f60\u662f\u4eba\u7c7b\uff0c\u8be5\u5b57\u6bb5\u8bf7\u7559\u7a7a\u3002\t\t\t<\/label>\n\t\t\t<input  id=\"field_trxu3\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[101]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"Me57AtOcHfCtcii7VXqpCCps+sGtX8h5UKl7ToRQS1s98opAQsZIrGSQKk1taDqS\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"page_tag":[],"class_list":["post-5009","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/pages\/5009","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/comments?post=5009"}],"version-history":[{"count":1,"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/pages\/5009\/revisions"}],"predecessor-version":[{"id":5010,"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/pages\/5009\/revisions\/5010"}],"wp:attachment":[{"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/media?parent=5009"}],"wp:term":[{"taxonomy":"page_tag","embeddable":true,"href":"https:\/\/uwm211.org\/zh\/wp-json\/wp\/v2\/page_tag?post=5009"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}