{"id":1769,"date":"2025-05-15T10:07:05","date_gmt":"2025-05-15T15:07:05","guid":{"rendered":"https:\/\/staging5.nsd.tech\/?page_id=1769"},"modified":"2025-05-15T10:07:45","modified_gmt":"2025-05-15T15:07:45","slug":"bcfc-ncmi-client-referral-form","status":"publish","type":"page","link":"https:\/\/staging5.nsd.tech\/fr\/bcfc-ncmi-client-referral-form\/","title":{"rendered":"BCFC NCMI Client Referral Form"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div class=\"x-section e1769-e1 m1d5-0\"><div class=\"x-row x-container max width e1769-e2 m1d5-1 m1d5-2\"><div class=\"x-row-inner\"><div class=\"x-col e1769-e3 m1d5-3 NsdSpacerSmallAll\"><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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#112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">BCFC NCMI Client Referral Form<\/h2>\n                            <p class='gform_description'><p>Bilal Community and Family Centre Newcomer Community Mobilization Initiative (NCMI) is a program that aimed at making services accessed by newcomers, immigrants, and refugees with complex needs by bringing together diverse service providers to support clients encountering system barriers. The initiative does this by facilitating regular support team meetings where we develop and implement client-led case plans and setting goals. We prioritize culturally informed, family-centered, and strengths-based approaches alongside trauma informed care.\r\n<br><\/br>Please provide sufficient generalized information to help determining if this referral is a fit.<\/p><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_405' id='gform_405'  action='\/fr\/wp-json\/wp\/v2\/pages\/1769' data-formid='405' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_405' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_405_310\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_310'>URL<\/label><div class='ginput_container'><input name='input_310' id='input_405_310' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_405_310'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><div id=\"field_405_196\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Referral Information<\/h3><\/div><fieldset id=\"field_405_230\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Please identify yourself by answering the following questions:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_405_230'>\n\t\t\t<div class='gchoice gchoice_405_230_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='I am a service provider, referring one of my clients' checked='checked' id='choice_405_230_0' onchange='gformToggleRadioOther( this )'  tabindex='1'  \/>\n\t\t\t\t\t<label for='choice_405_230_0' id='label_405_230_0' class='gform-field-label gform-field-label--type-inline'>I am a service provider, referring one of my clients<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_405_230_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_230' type='radio' value='I am submitting a referral for myself or for a family member or a community member'  id='choice_405_230_1' onchange='gformToggleRadioOther( this )'  tabindex='2'  \/>\n\t\t\t\t\t<label for='choice_405_230_1' id='label_405_230_1' class='gform-field-label gform-field-label--type-inline'>I am submitting a referral for myself or for a family member or a community member<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_405_242\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Referral Source Information<\/h3><\/div><div id=\"field_405_260\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-seven-twelfths REFERCONT_NAME gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_260'>Referral Staff Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_260' id='input_405_260' type='text' value='' class='large' maxlength='50'  tabindex='3'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_198\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-five-twelfths REFERCONT_ORG gf_hide_charleft gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_198'>Name of Referring Agency<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_198' id='input_405_198' type='text' value='' class='large' maxlength='100'  tabindex='4'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_203\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third REFERCONT_TELE1 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_203'>Referring Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_203' id='input_405_203' type='text' value='' class='large'   tabindex='5' placeholder='___-___-____' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_205\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-five-twelfths REFERCONT_EMAIL gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gpev-field\"  data-field-class=\"gpev-field\" ><label class='gfield_label gform-field-label' for='input_405_205'>Referring Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_205' id='input_405_205' type='email' value='' class='large' tabindex='6'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_405_262\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_262'>Date of Referral<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_262' id='input_405_262' type='text' value='26\/04\/2026' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='7'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_405_262_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_405_262_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_405_262' class='gform_hidden' value='https:\/\/staging5.nsd.tech\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_405_67\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Client Information<\/h3><\/div><div id=\"field_405_27\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third FIRST_NAME gf_hide_charleft gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_27'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_405_27' type='text' value='' class='large' maxlength='50'  tabindex='8'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third LAST_NAME gf_hide_charleft gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_30'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_405_30' type='text' value='' class='large' maxlength='50'  tabindex='9'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_15\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third DATE_BIRTH gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_15'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_15' id='input_405_15' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='10'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_405_15_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_405_15_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_405_15' class='gform_hidden' value='https:\/\/staging5.nsd.tech\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_405_264\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third PRIMARYLANG notranslate gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_264'>Preferred Language<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_264' id='input_405_264' class='large gfield_select' tabindex='11'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>\u200e\u2000<\/option><option value='058' >English<\/option><option value='069' >French<\/option><option value='001' >Acholi<\/option><option value='002' >Ada<\/option><option value='003' >Affar<\/option><option value='004' >Afghan<\/option><option value='005' >Afrikaans<\/option><option value='006' >Aka<\/option><option value='007' >Akan<\/option><option value='212' >Aklanon<\/option><option value='008' >Akra<\/option><option value='009' >Albanian<\/option><option value='213' >American Sign Language (ASL)<\/option><option value='010' >Amharic<\/option><option value='011' >Anuak (Anywa)<\/option><option value='013' >Arabic<\/option><option value='214' >Aran<\/option><option value='014' >Armenian<\/option><option value='015' >Ashanti<\/option><option value='215' >Assamese<\/option><option value='016' >Assyrian<\/option><option value='017' >Azeri<\/option><option value='018' >Bahasa Indonesian<\/option><option value='216' >Balochi<\/option><option value='019' >Bambara<\/option><option value='020' >Bantu<\/option><option value='217' >Baule<\/option><option value='218' >Belarusian<\/option><option value='021' >Belen<\/option><option value='022' >Bemba<\/option><option value='023' >Bembe<\/option><option value='024' >Bengali<\/option><option value='025' >Beni<\/option><option value='219' >Benin<\/option><option value='026' >Berber<\/option><option value='027' >Bhari<\/option><option value='220' >Bicol\/Bikol\/Bicolano<\/option><option value='221' >Bijaiya<\/option><option value='222' >Bilen<\/option><option value='028' >Bini<\/option><option value='029' >Bisaya<\/option><option value='030' >Bissa<\/option><option value='223' >Bontok<\/option><option value='224' >Braille (translation only)<\/option><option value='031' >Breton<\/option><option value='032' >Bulgarian<\/option><option value='033' >Burmese<\/option><option value='034' >Busan<\/option><option value='035' >Busango<\/option><option value='036' >Cantonese<\/option><option value='037' >Catalan<\/option><option value='038' >Cebuano<\/option><option value='039' >Chakma<\/option><option value='040' >Chaldean<\/option><option value='041' >Chaocho<\/option><option value='225' >Chavacano<\/option><option value='042' >Chichewa<\/option><option value='043' >Chin<\/option><option value='044' >Chinese<\/option><option value='226' >Chinese - Simplified (TRANSLATION ONLY)<\/option><option value='227' >Chinese - Traditional (TRANSLATION ONLY)<\/option><option value='228' >Chiuchow<\/option><option value='045' >Chiyao<\/option><option value='046' >Chowchau<\/option><option value='229' >Concani<\/option><option value='047' >Creole<\/option><option value='048' >Croatian<\/option><option value='049' >Czech<\/option><option value='050' >Danish<\/option><option value='051' >Dari<\/option><option value='052' >Deaf-mute<\/option><option value='053' >Dinka<\/option><option value='054' >Dioula<\/option><option value='055' >Dutch<\/option><option value='230' >Dzongkha<\/option><option value='056' >Edo<\/option><option value='057' >Efik<\/option><option value='059' >Estonian<\/option><option value='060' >Ewe<\/option><option value='062' >Fang<\/option><option value='063' >Fanti<\/option><option value='064' >Farsi (Persian)<\/option><option value='316' >Filipino<\/option><option value='065' >Finnish<\/option><option value='066' >Flemish<\/option><option value='231' >Foochow<\/option><option value='067' >Fouki<\/option><option value='068' >Foullah<\/option><option value='070' >Fukinese<\/option><option value='071' >Fulani<\/option><option value='072' >Ga<\/option><option value='073' >Gaelic<\/option><option value='232' >Georgian<\/option><option value='074' >German<\/option><option value='075' >Greek<\/option><option value='076' >Guerze<\/option><option value='077' >Gujarati<\/option><option value='233' >Hainam<\/option><option value='234' >Hakha Chin<\/option><option value='078' >Hakka<\/option><option value='235' >Harara<\/option><option value='236' >Harary<\/option><option value='079' >Hargar<\/option><option value='080' >Hassanya<\/option><option value='081' >Hausa<\/option><option value='082' >Hebrew<\/option><option value='237' >Hiligaynon<\/option><option value='083' >Hindi<\/option><option value='084' >Hindko<\/option><option value='085' >Hokkin<\/option><option value='086' >Hungarian<\/option><option value='238' >Ibibio<\/option><option value='087' >Ibo<\/option><option value='239' >Icelandic<\/option><option value='240' >Igbo<\/option><option value='241' >Igorot<\/option><option value='242' >Ijaw<\/option><option value='243' >Ika<\/option><option value='244' >Ilican<\/option><option value='245' >Ilocano<\/option><option value='088' >Ilongo<\/option><option value='246' >Indonesian<\/option><option value='089' >Ishan<\/option><option value='090' >Italian<\/option><option value='247' >Itsekiri<\/option><option value='248' >Ivbiosakon<\/option><option value='091' >Izi<\/option><option value='092' >Japanese<\/option><option value='249' >Jarai<\/option><option value='093' >Javanese<\/option><option value='094' >Jolay<\/option><option value='012' >Juba Arabic<\/option><option value='095' >Kacchi<\/option><option value='250' >Kakwa<\/option><option value='096' >Kanarese<\/option><option value='097' >Kandahari<\/option><option value='098' >Kankani<\/option><option value='251' >Kannada<\/option><option value='252' >Kapampangan<\/option><option value='099' >Karen<\/option><option value='253' >Kashmiri<\/option><option value='254' >Kazakh<\/option><option value='100' >Khmer<\/option><option value='101' >Kifuliru<\/option><option value='102' >Kihavu<\/option><option value='103' >Kikongo<\/option><option value='255' >Kinyamulenge<\/option><option value='104' >Kinyarwanda<\/option><option value='105' >Kirega<\/option><option value='106' >Kirundi<\/option><option value='107' >Kiswahili<\/option><option value='256' >Kituba<\/option><option value='257' >Konkani<\/option><option value='108' >Korean<\/option><option value='109' >Krio<\/option><option value='110' >Kurdish<\/option><option value='313' >Kurmanji<\/option><option value='258' >Kyrgyz<\/option><option value='259' >La langue des signes qu\u00e9b\u00e9coise (LSQ)<\/option><option value='111' >Laotian<\/option><option value='112' >Latvian<\/option><option value='113' >Lebanese<\/option><option value='260' >Lengie<\/option><option value='114' >Lingala<\/option><option value='115' >Lithuanian<\/option><option value='116' >Lowma<\/option><option value='261' >Luganda<\/option><option value='262' >Lugishu<\/option><option value='263' >Lutoro<\/option><option value='117' >Maban<\/option><option value='118' >Macedonian<\/option><option value='264' >Macena<\/option><option value='119' >Macua<\/option><option value='120' >Mahou<\/option><option value='265' >Makonde<\/option><option value='121' >Malagasy<\/option><option value='122' >Malay<\/option><option value='123' >Malayalam<\/option><option value='124' >Maligo<\/option><option value='125' >Malinke<\/option><option value='126' >Maltese<\/option><option value='127' >Mandarin<\/option><option value='128' >Mandingo<\/option><option value='129' >Marathi<\/option><option value='311' >Masalit<\/option><option value='130' >Mashi<\/option><option value='131' >Mende<\/option><option value='132' >Mina<\/option><option value='266' >Mizo<\/option><option value='267' >Moldovan<\/option><option value='268' >Mongolian<\/option><option value='269' >Moore<\/option><option value='270' >Naandi\/Cemual<\/option><option value='271' >Ndebele<\/option><option value='133' >Nepali<\/option><option value='134' >Norwegian<\/option><option value='272' >Nubian<\/option><option value='135' >Nuer<\/option><option value='136' >Nzima<\/option><option value='273' >Oko<\/option><option value='137' >Okpe<\/option><option value='138' >Oriya<\/option><option value='139' >Oromo<\/option><option value='274' >Osal<\/option><option value='140' >Other African Languages<\/option><option value='141' >Other Chinese Dialects<\/option><option value='142' >Other European Languages<\/option><option value='143' >Other Languages<\/option><option value='144' >Other Middle Eastern Languages<\/option><option value='275' >Other Signed Languages<\/option><option value='145' >Other South Asian Languages<\/option><option value='146' >Other South East Asian Lang.<\/option><option value='276' >Otuho<\/option><option value='277' >Pahari<\/option><option value='278' >Pampango<\/option><option value='279' >Pangasinan<\/option><option value='154' >Pashto<\/option><option value='148' >Peul<\/option><option value='280' >Phuockien<\/option><option value='149' >Pidgin<\/option><option value='281' >Plautdietsch<\/option><option value='150' >Polish<\/option><option value='151' >Portuguese<\/option><option value='152' >Poular<\/option><option value='153' >Punjabi<\/option><option value='282' >Rohingya<\/option><option value='283' >Romani<\/option><option value='155' >Romanian<\/option><option value='284' >Rukiga<\/option><option value='285' >Runyankole<\/option><option value='156' >Russian<\/option><option value='286' >Rutooro<\/option><option value='157' >Samoan<\/option><option value='287' >Sango<\/option><option value='288' >Sanskrit<\/option><option value='289' >Sara<\/option><option value='158' >Scoula<\/option><option value='159' >Sechuan<\/option><option value='290' >Senufo<\/option><option value='160' >Serbian<\/option><option value='161' >Serbo-Croatian<\/option><option value='291' >Sesotho<\/option><option value='162' >Seswi<\/option><option value='163' >Seychelles<\/option><option value='292' >Shan<\/option><option value='164' >Shanghai<\/option><option value='165' >Shansai<\/option><option value='166' >Shilluk<\/option><option value='293' >Shona<\/option><option value='167' >Sign Language<\/option><option value='168' >Sindhi<\/option><option value='170' >Sinhalese<\/option><option value='171' >Slovak<\/option><option value='172' >Slovene<\/option><option value='173' >Somali<\/option><option value='312' >Songhai<\/option><option value='174' >Soninke<\/option><option value='314' >Sorani<\/option><option value='294' >Sotho<\/option><option value='175' >Soussou<\/option><option value='295' >Southern Burun<\/option><option value='176' >Spanish<\/option><option value='177' >Suesue<\/option><option value='296' >Sukuma<\/option><option value='178' >Swahili<\/option><option value='179' >Swazai<\/option><option value='180' >Swedish<\/option><option value='317' >Swiss German<\/option><option value='181' >Tagalog<\/option><option value='297' >Taichew<\/option><option value='315' >Tamasheq<\/option><option value='182' >Tamil<\/option><option value='183' >Tari<\/option><option value='298' >Tatar<\/option><option value='184' >Tatshanese<\/option><option value='185' >Telugu<\/option><option value='299' >Temne<\/option><option value='300' >Teochew<\/option><option value='186' >Thai<\/option><option value='187' >Tibetan<\/option><option value='188' >Tichiew<\/option><option value='301' >Tigre<\/option><option value='189' >Tigrigna<\/option><option value='190' >Timini<\/option><option value='191' >Tiv<\/option><option value='302' >Toishan<\/option><option value='192' >Tshiluba<\/option><option value='193' >Tsibula<\/option><option value='194' >Turkish<\/option><option value='195' >Twi<\/option><option value='318' >Uduk<\/option><option value='200' >Uhrobo<\/option><option value='196' >Uigrigma<\/option><option value='197' >Ukrainian<\/option><option value='303' >Umbundu<\/option><option value='304' >Unama<\/option><option value='198' >Unknown<\/option><option value='199' >Urdu<\/option><option value='319' >Uyghur<\/option><option value='201' >Uzbek<\/option><option value='202' >Vietnamese<\/option><option value='305' >Visayan<\/option><option value='306' >Waray<\/option><option value='203' >Welsh<\/option><option value='204' >Western Hemisphere Indian Lang<\/option><option value='205' >Wolof<\/option><option value='206' >Xhosa<\/option><option value='307' >Yako\/Loko\/Lokaa<\/option><option value='308' >Yekhee\/Afenmai\/Afemai<\/option><option value='207' >Yiboe<\/option><option value='208' >Yiddish<\/option><option value='209' >Yoruba<\/option><option value='210' >Zande<\/option><option value='309' >Zshiluba<\/option><option value='310' >Zuganda<\/option><option value='211' >Zulu<\/option><\/select><\/div><\/div><div id=\"field_405_193\" class=\"gfield gfield--type-multiselect gfield--input-type-multiselect gfield--width-third LANGS notranslate field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_193'>Other Languages (type to search)<\/label><div class='ginput_container ginput_container_multiselect'><select multiple='multiple'  size='7' name='input_193[]' id='input_405_193' class='large gfield_select' tabindex='12'  aria-invalid=\"false\"  ><option value='001' >Acholi<\/option><option value='002' >Ada<\/option><option value='003' >Affar<\/option><option value='004' >Afghan<\/option><option value='005' >Afrikaans<\/option><option value='006' >Aka<\/option><option value='007' >Akan<\/option><option value='212' >Aklanon<\/option><option value='008' >Akra<\/option><option value='009' >Albanian<\/option><option value='213' >American Sign Language (ASL)<\/option><option value='010' >Amharic<\/option><option value='011' >Anuak (Anywa)<\/option><option value='013' >Arabic<\/option><option value='214' >Aran<\/option><option value='014' >Armenian<\/option><option value='015' >Ashanti<\/option><option value='215' >Assamese<\/option><option value='016' >Assyrian<\/option><option value='017' >Azeri<\/option><option value='018' >Bahasa Indonesian<\/option><option value='216' >Balochi<\/option><option value='019' >Bambara<\/option><option value='020' >Bantu<\/option><option value='217' >Baule<\/option><option value='218' >Belarusian<\/option><option value='021' >Belen<\/option><option value='022' >Bemba<\/option><option value='023' >Bembe<\/option><option value='024' >Bengali<\/option><option value='025' >Beni<\/option><option value='219' >Benin<\/option><option value='026' >Berber<\/option><option value='027' >Bhari<\/option><option value='220' >Bicol\/Bikol\/Bicolano<\/option><option value='221' >Bijaiya<\/option><option value='222' >Bilen<\/option><option value='028' >Bini<\/option><option value='029' >Bisaya<\/option><option value='030' >Bissa<\/option><option value='223' >Bontok<\/option><option value='224' >Braille (translation only)<\/option><option value='031' >Breton<\/option><option value='032' >Bulgarian<\/option><option value='033' >Burmese<\/option><option value='034' >Busan<\/option><option value='035' >Busango<\/option><option value='036' >Cantonese<\/option><option value='037' >Catalan<\/option><option value='038' >Cebuano<\/option><option value='039' >Chakma<\/option><option value='040' >Chaldean<\/option><option value='041' >Chaocho<\/option><option value='225' >Chavacano<\/option><option value='042' >Chichewa<\/option><option value='043' >Chin<\/option><option value='044' >Chinese<\/option><option value='226' >Chinese - Simplified (TRANSLATION ONLY)<\/option><option value='227' >Chinese - Traditional (TRANSLATION ONLY)<\/option><option value='228' >Chiuchow<\/option><option value='045' >Chiyao<\/option><option value='046' >Chowchau<\/option><option value='229' >Concani<\/option><option value='047' >Creole<\/option><option value='048' >Croatian<\/option><option value='049' >Czech<\/option><option value='050' >Danish<\/option><option value='051' >Dari<\/option><option value='052' >Deaf-mute<\/option><option value='053' >Dinka<\/option><option value='054' >Dioula<\/option><option value='055' >Dutch<\/option><option value='230' >Dzongkha<\/option><option value='056' >Edo<\/option><option value='057' >Efik<\/option><option value='058' >English<\/option><option value='059' >Estonian<\/option><option value='060' >Ewe<\/option><option value='062' >Fang<\/option><option value='063' >Fanti<\/option><option value='064' >Farsi (Persian)<\/option><option value='316' >Filipino<\/option><option value='065' >Finnish<\/option><option value='066' >Flemish<\/option><option value='231' >Foochow<\/option><option value='067' >Fouki<\/option><option value='068' >Foullah<\/option><option value='069' >French<\/option><option value='070' >Fukinese<\/option><option value='071' >Fulani<\/option><option value='072' >Ga<\/option><option value='073' >Gaelic<\/option><option value='232' >Georgian<\/option><option value='074' >German<\/option><option value='075' >Greek<\/option><option value='076' >Guerze<\/option><option value='077' >Gujarati<\/option><option value='233' >Hainam<\/option><option value='234' >Hakha Chin<\/option><option value='078' >Hakka<\/option><option value='235' >Harara<\/option><option value='236' >Harary<\/option><option value='079' >Hargar<\/option><option value='080' >Hassanya<\/option><option value='081' >Hausa<\/option><option value='082' >Hebrew<\/option><option value='237' >Hiligaynon<\/option><option value='083' >Hindi<\/option><option value='084' >Hindko<\/option><option value='085' >Hokkin<\/option><option value='086' >Hungarian<\/option><option value='238' >Ibibio<\/option><option value='087' >Ibo<\/option><option value='239' >Icelandic<\/option><option value='240' >Igbo<\/option><option value='241' >Igorot<\/option><option value='242' >Ijaw<\/option><option value='243' >Ika<\/option><option value='244' >Ilican<\/option><option value='245' >Ilocano<\/option><option value='088' >Ilongo<\/option><option value='246' >Indonesian<\/option><option value='089' >Ishan<\/option><option value='090' >Italian<\/option><option value='247' >Itsekiri<\/option><option value='248' >Ivbiosakon<\/option><option value='091' >Izi<\/option><option value='092' >Japanese<\/option><option value='249' >Jarai<\/option><option value='093' >Javanese<\/option><option value='094' >Jolay<\/option><option value='012' >Juba Arabic<\/option><option value='095' >Kacchi<\/option><option value='250' >Kakwa<\/option><option value='096' >Kanarese<\/option><option value='097' >Kandahari<\/option><option value='098' >Kankani<\/option><option value='251' >Kannada<\/option><option value='252' >Kapampangan<\/option><option value='099' >Karen<\/option><option value='253' >Kashmiri<\/option><option value='254' >Kazakh<\/option><option value='100' >Khmer<\/option><option value='101' >Kifuliru<\/option><option value='102' >Kihavu<\/option><option value='103' >Kikongo<\/option><option value='255' >Kinyamulenge<\/option><option value='104' >Kinyarwanda<\/option><option value='105' >Kirega<\/option><option value='106' >Kirundi<\/option><option value='107' >Kiswahili<\/option><option value='256' >Kituba<\/option><option value='257' >Konkani<\/option><option value='108' >Korean<\/option><option value='109' >Krio<\/option><option value='110' >Kurdish<\/option><option value='313' >Kurmanji<\/option><option value='258' >Kyrgyz<\/option><option value='259' >La langue des signes qu\u00e9b\u00e9coise (LSQ)<\/option><option value='111' >Laotian<\/option><option value='112' >Latvian<\/option><option value='113' >Lebanese<\/option><option value='260' >Lengie<\/option><option value='114' >Lingala<\/option><option value='115' >Lithuanian<\/option><option value='116' >Lowma<\/option><option value='261' >Luganda<\/option><option value='262' >Lugishu<\/option><option value='263' >Lutoro<\/option><option value='117' >Maban<\/option><option value='118' >Macedonian<\/option><option value='264' >Macena<\/option><option value='119' >Macua<\/option><option value='120' >Mahou<\/option><option value='265' >Makonde<\/option><option value='121' >Malagasy<\/option><option value='122' >Malay<\/option><option value='123' >Malayalam<\/option><option value='124' >Maligo<\/option><option value='125' >Malinke<\/option><option value='126' >Maltese<\/option><option value='127' >Mandarin<\/option><option value='128' >Mandingo<\/option><option value='129' >Marathi<\/option><option value='311' >Masalit<\/option><option value='130' >Mashi<\/option><option value='131' >Mende<\/option><option value='132' >Mina<\/option><option value='266' >Mizo<\/option><option value='267' >Moldovan<\/option><option value='268' >Mongolian<\/option><option value='269' >Moore<\/option><option value='270' >Naandi\/Cemual<\/option><option value='271' >Ndebele<\/option><option value='133' >Nepali<\/option><option value='134' >Norwegian<\/option><option value='272' >Nubian<\/option><option value='135' >Nuer<\/option><option value='136' >Nzima<\/option><option value='273' >Oko<\/option><option value='137' >Okpe<\/option><option value='138' >Oriya<\/option><option value='139' >Oromo<\/option><option value='274' >Osal<\/option><option value='140' >Other African Languages<\/option><option value='141' >Other Chinese Dialects<\/option><option value='142' >Other European Languages<\/option><option value='143' >Other Languages<\/option><option value='144' >Other Middle Eastern Languages<\/option><option value='275' >Other Signed Languages<\/option><option value='145' >Other South Asian Languages<\/option><option value='146' >Other South East Asian Lang.<\/option><option value='276' >Otuho<\/option><option value='277' >Pahari<\/option><option value='278' >Pampango<\/option><option value='279' >Pangasinan<\/option><option value='154' >Pashto<\/option><option value='148' >Peul<\/option><option value='280' >Phuockien<\/option><option value='149' >Pidgin<\/option><option value='281' >Plautdietsch<\/option><option value='150' >Polish<\/option><option value='151' >Portuguese<\/option><option value='152' >Poular<\/option><option value='153' >Punjabi<\/option><option value='282' >Rohingya<\/option><option value='283' >Romani<\/option><option value='155' >Romanian<\/option><option value='284' >Rukiga<\/option><option value='285' >Runyankole<\/option><option value='156' >Russian<\/option><option value='286' >Rutooro<\/option><option value='157' >Samoan<\/option><option value='287' >Sango<\/option><option value='288' >Sanskrit<\/option><option value='289' >Sara<\/option><option value='158' >Scoula<\/option><option value='159' >Sechuan<\/option><option value='290' >Senufo<\/option><option value='160' >Serbian<\/option><option value='161' >Serbo-Croatian<\/option><option value='291' >Sesotho<\/option><option value='162' >Seswi<\/option><option value='163' >Seychelles<\/option><option value='292' >Shan<\/option><option value='164' >Shanghai<\/option><option value='165' >Shansai<\/option><option value='166' >Shilluk<\/option><option value='293' >Shona<\/option><option value='167' >Sign Language<\/option><option value='168' >Sindhi<\/option><option value='170' >Sinhalese<\/option><option value='171' >Slovak<\/option><option value='172' >Slovene<\/option><option value='173' >Somali<\/option><option value='312' >Songhai<\/option><option value='174' >Soninke<\/option><option value='314' >Sorani<\/option><option value='294' >Sotho<\/option><option value='175' >Soussou<\/option><option value='295' >Southern Burun<\/option><option value='176' >Spanish<\/option><option value='177' >Suesue<\/option><option value='296' >Sukuma<\/option><option value='178' >Swahili<\/option><option value='179' >Swazai<\/option><option value='180' >Swedish<\/option><option value='317' >Swiss German<\/option><option value='181' >Tagalog<\/option><option value='297' >Taichew<\/option><option value='315' >Tamasheq<\/option><option value='182' >Tamil<\/option><option value='183' >Tari<\/option><option value='298' >Tatar<\/option><option value='184' >Tatshanese<\/option><option value='185' >Telugu<\/option><option value='299' >Temne<\/option><option value='300' >Teochew<\/option><option value='186' >Thai<\/option><option value='187' >Tibetan<\/option><option value='188' >Tichiew<\/option><option value='301' >Tigre<\/option><option value='189' >Tigrigna<\/option><option value='190' >Timini<\/option><option value='191' >Tiv<\/option><option value='302' >Toishan<\/option><option value='192' >Tshiluba<\/option><option value='193' >Tsibula<\/option><option value='194' >Turkish<\/option><option value='195' >Twi<\/option><option value='318' >Uduk<\/option><option value='200' >Uhrobo<\/option><option value='196' >Uigrigma<\/option><option value='197' >Ukrainian<\/option><option value='303' >Umbundu<\/option><option value='304' >Unama<\/option><option value='198' >Unknown<\/option><option value='199' >Urdu<\/option><option value='319' >Uyghur<\/option><option value='201' >Uzbek<\/option><option value='202' >Vietnamese<\/option><option value='305' >Visayan<\/option><option value='306' >Waray<\/option><option value='203' >Welsh<\/option><option value='204' >Western Hemisphere Indian Lang<\/option><option value='205' >Wolof<\/option><option value='206' >Xhosa<\/option><option value='307' >Yako\/Loko\/Lokaa<\/option><option value='308' >Yekhee\/Afenmai\/Afemai<\/option><option value='207' >Yiboe<\/option><option value='208' >Yiddish<\/option><option value='209' >Yoruba<\/option><option value='210' >Zande<\/option><option value='309' >Zshiluba<\/option><option value='310' >Zuganda<\/option><option value='211' >Zulu<\/option><\/select><\/div><\/div><div id=\"field_405_293\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third DEMOGRAPH_ETHNIC field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_293'>Describe your ethnic\/cultural background:<\/label><div class='ginput_container ginput_container_select'><select name='input_293' id='input_405_293' class='large gfield_select' tabindex='13'    aria-invalid=\"false\" ><option value='' ><\/option><option value='0433' >Arab\/African<\/option><option value='0434' >Arab\/West Asian<\/option><option value='0435' >Black (other than African)<\/option><option value='0109' >Black Canadians<\/option><option value='0107' >Canadians<\/option><option value='0436' >Central African<\/option><option value='0437' >Central American<\/option><option value='0438' >Central Asian<\/option><option value='0439' >Chinese<\/option><option value='0440' >East African<\/option><option value='0441' >Egyptian<\/option><option value='0442' >Filipino<\/option><option value='0443' >Japanese<\/option><option value='0444' >Korean<\/option><option value='0445' >Latin American<\/option><option value='0446' >Middle East<\/option><option value='0447' >North African<\/option><option value='0448' >Other, mixed<\/option><option value='0449' >Persian<\/option><option value='0450' >Philipino<\/option><option value='0451' >South African<\/option><option value='0452' >South American<\/option><option value='0426' >South Asian<\/option><option value='0454' >South Central Asian<\/option><option value='0428' >South East Asian<\/option><option value='0456' >South West Asian<\/option><option value='0457' >Thai<\/option><option value='0458' >West African<\/option><option value='0459' >White\/Caucasian<\/option><option value='0460' >Yazidi<\/option><option value='0461' >I prefer not to say<\/option><\/select><\/div><\/div><div id=\"field_405_304\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half CNT_CITIZENSHIP field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_304'>Country of Origin<\/label><div class='ginput_container ginput_container_select'><select name='input_304' id='input_405_304' class='large gfield_select' tabindex='14'    aria-invalid=\"false\" ><option value='' ><\/option><option value='002' >Afghanistan<\/option><option value='003' >Albania<\/option><option value='004' >Alderney<\/option><option value='005' >Algeria<\/option><option value='006' >American Samoa<\/option><option value='007' >Andorra<\/option><option value='008' >Angola<\/option><option value='009' >Anguilla<\/option><option value='010' >Antigua and Barbuda<\/option><option value='011' >Argentina<\/option><option value='012' >Armenia<\/option><option value='014' >Australia<\/option><option value='015' >Austria<\/option><option value='016' >Azerbaijan<\/option><option value='017' >Bahamas<\/option><option value='018' >Bahrain<\/option><option value='019' >Bangladesh<\/option><option value='020' >Barbados<\/option><option value='021' >Belarus<\/option><option value='022' >Belgium<\/option><option value='023' >Belize<\/option><option value='024' >Benin<\/option><option value='025' >Bermuda<\/option><option value='026' >Bhutan<\/option><option value='027' >Bolivia<\/option><option value='028' >Bophuthatswana<\/option><option value='029' >Bosnia and Herzegovina<\/option><option value='030' >Botswana<\/option><option value='031' >Brazil<\/option><option value='033' >British Virgin Islands<\/option><option value='034' >Brunei<\/option><option value='035' >Bulgaria<\/option><option value='036' >Burkina Faso<\/option><option value='037' >Myanmar (formerly Burma)<\/option><option value='038' >Burundi<\/option><option value='039' >Cameroon<\/option><option value='040' >Canada<\/option><option value='041' >Canary Islands<\/option><option value='042' >Cabo Verde<\/option><option value='043' >Cayman Islands<\/option><option value='044' >Central African Republic<\/option><option value='045' >Chad<\/option><option value='047' >Chile<\/option><option value='048' >China (PRC)<\/option><option value='049' >Colombia<\/option><option value='050' >Comoros<\/option><option value='051' >Congo Democratic Republic of<\/option><option value='052' >Congo (Congo Republic)<\/option><option value='054' >Costa Rica<\/option><option value='055' >Croatia<\/option><option value='056' >Cuba<\/option><option value='057' >Cyprus<\/option><option value='058' >Czechia (Czech Republic)<\/option><option value='059' >Denmark<\/option><option value='060' >Djibouti<\/option><option value='061' >Dominican Republic<\/option><option value='062' >Ecuador<\/option><option value='063' >Egypt<\/option><option value='064' >El Salvador<\/option><option value='065' >England<\/option><option value='066' >Equatorial Guinea<\/option><option value='067' >Eritrea<\/option><option value='068' >Estonia<\/option><option value='069' >Ethiopia<\/option><option value='071' >Germany<\/option><option value='072' >Fiji<\/option><option value='073' >Finland<\/option><option value='075' >Fr. Polynesia<\/option><option value='076' >France<\/option><option value='077' >French Guiana<\/option><option value='078' >Gabon<\/option><option value='079' >Gambia<\/option><option value='080' >Georgia<\/option><option value='081' >Ghana<\/option><option value='083' >Greece<\/option><option value='084' >Greenland<\/option><option value='085' >Grenada<\/option><option value='086' >Guadaloupe<\/option><option value='087' >Guam<\/option><option value='088' >Guatemala<\/option><option value='089' >Guinea<\/option><option value='090' >Guinea-bissau<\/option><option value='091' >Guyana<\/option><option value='092' >Haiti<\/option><option value='093' >Honduras<\/option><option value='094' >Hong Kong<\/option><option value='095' >Hungary<\/option><option value='096' >Iceland<\/option><option value='097' >India<\/option><option value='098' >Indonesia<\/option><option value='099' >Iran<\/option><option value='100' >Iraq<\/option><option value='101' >Ireland<\/option><option value='102' >Israel<\/option><option value='103' >Italy<\/option><option value='104' >Cote d Ivoire (Ivory Coast)<\/option><option value='105' >Jamaica<\/option><option value='106' >Japan<\/option><option value='107' >Jordan<\/option><option value='108' >Kampuchea Democratic<\/option><option value='109' >Kazakhstan<\/option><option value='110' >Kenya<\/option><option value='111' >Kerguelen Islands<\/option><option value='112' >Kyrgyzstan<\/option><option value='113' >Kiribati<\/option><option value='114' >Korea, North<\/option><option value='115' >Korea, South<\/option><option value='116' >Kosovo<\/option><option value='117' >Kuwait<\/option><option value='118' >Laos<\/option><option value='119' >Latvia<\/option><option value='120' >Lebanon<\/option><option value='121' >Lesotho<\/option><option value='122' >Liberia<\/option><option value='123' >Libya<\/option><option value='124' >Liechtenstein<\/option><option value='125' >Lithuania<\/option><option value='126' >Luxembourg<\/option><option value='128' >North Macedonia<\/option><option value='129' >Madagascar<\/option><option value='130' >Malawi<\/option><option value='131' >Malaysia<\/option><option value='132' >Maldives<\/option><option value='133' >Mali<\/option><option value='134' >Malta<\/option><option value='135' >Marshall Islands<\/option><option value='137' >Mauritania<\/option><option value='138' >Mauritius<\/option><option value='140' >Mexico<\/option><option value='141' >Moldova<\/option><option value='142' >Monaco<\/option><option value='143' >Mongolia<\/option><option value='144' >Montserrat<\/option><option value='145' >Morocco<\/option><option value='146' >Mozambique<\/option><option value='147' >Namibia<\/option><option value='148' >Nauru<\/option><option value='149' >Nepal<\/option><option value='150' >Netherlands<\/option><option value='153' >New Caledonia<\/option><option value='154' >New Zealand<\/option><option value='155' >Nicaragua<\/option><option value='156' >Niger<\/option><option value='157' >Nigeria<\/option><option value='158' >Northern Ireland<\/option><option value='159' >Norway<\/option><option value='160' >Pakistan<\/option><option value='161' >Palestine<\/option><option value='162' >Panama<\/option><option value='164' >Papua New Guinea<\/option><option value='165' >Paraguay<\/option><option value='166' >Peru<\/option><option value='167' >Philippines<\/option><option value='168' >Pitcairn Islands<\/option><option value='169' >Poland<\/option><option value='170' >Portugal<\/option><option value='171' >Puerto Rico<\/option><option value='172' >Qatar<\/option><option value='173' >Reunion<\/option><option value='174' >Romania<\/option><option value='175' >Russia<\/option><option value='176' >Rwanda<\/option><option value='177' >Samoa<\/option><option value='178' >San Marino<\/option><option value='179' >Sao Tome and Principe<\/option><option value='180' >Saudi Arabia<\/option><option value='181' >Scotland<\/option><option value='182' >Senegal<\/option><option value='183' >Serbia<\/option><option value='184' >Seychelles<\/option><option value='185' >Sierra Leone<\/option><option value='186' >Singapore<\/option><option value='187' >Solomon Islands<\/option><option value='188' >Somalia<\/option><option value='189' >South Africa<\/option><option value='190' >Spain<\/option><option value='191' >Sri Lanka<\/option><option value='192' >St. Helena<\/option><option value='193' >St. Kitts and Nevis<\/option><option value='194' >St. Lucia<\/option><option value='195' >St. Pierre Et Miquelon<\/option><option value='196' >St. Vincent And The Grenadines<\/option><option value='197' >Stateless<\/option><option value='198' >Sudan<\/option><option value='199' >Suriname<\/option><option value='200' >Eswatini (formerly Swaziland)<\/option><option value='201' >Sweden<\/option><option value='202' >Switzerland<\/option><option value='203' >Syria<\/option><option value='204' >Tajikistan<\/option><option value='205' >Tanzania<\/option><option value='206' >Thailand<\/option><option value='207' >Tibet<\/option><option value='208' >Togo<\/option><option value='209' >Tonga<\/option><option value='210' >Trinidad &amp; Tobago<\/option><option value='211' >Tunisia<\/option><option value='212' >Turkey<\/option><option value='213' >Turkmenistan<\/option><option value='214' >Turks &amp; Caicos<\/option><option value='215' >Tuvalu<\/option><option value='216' >U.S. Virgin Islands<\/option><option value='217' >United States of America<\/option><option value='219' >Uganda<\/option><option value='220' >Ukraine<\/option><option value='221' >United Arab Emirates<\/option><option value='223' >Uruguay<\/option><option value='224' >Uzbekistan<\/option><option value='225' >Vanuatu<\/option><option value='226' >Holy See (Vatican City)<\/option><option value='227' >Venezuela<\/option><option value='228' >Vietnam<\/option><option value='231' >Wales<\/option><option value='233' >Western Sahara<\/option><option value='234' >Yemen<\/option><option value='235' >Yugoslavia<\/option><option value='236' >Zaire (now Congo DRC)<\/option><option value='237' >Zambia<\/option><option value='238' >Zimbabwe<\/option><option value='239' >Oman<\/option><option value='240' >Sudan, South<\/option><option value='241' >United Kingdom<\/option><option value='242' >Slovenia<\/option><option value='243' >Slovakia (Slovak Republic)<\/option><option value='244' >Taiwan (ROC)<\/option><option value='245' >Cambodia<\/option><option value='246' >Dominica<\/option><option value='247' >East Timor (Timor-Leste)<\/option><option value='248' >Micronesia<\/option><option value='249' >Montenegro<\/option><option value='250' >Palau<\/option><\/select><\/div><\/div><div id=\"field_405_305\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half CAN_STATUS field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_305'>Status in Canada<\/label><div class='ginput_container ginput_container_select'><select name='input_305' id='input_405_305' class='large gfield_select' tabindex='15'    aria-invalid=\"false\" ><option value='' ><\/option><option value='0001' >Canadian Citizen<\/option><option value='0002' >Government Assisted Refugees (GAR)<\/option><option value='0003' >Permanent Resident<\/option><option value='0005' >Other<\/option><option value='0006' >Refugee Claimant (RC)<\/option><option value='0007' >Student - Study Permit<\/option><option value='0016' >Work Permit<\/option><option value='0022' >Private Sponsored Refugees (PSR)<\/option><\/select><\/div><\/div><div id=\"field_405_266\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-quarter EMAIL field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gpev-field\"  data-field-class=\"gpev-field\" ><label class='gfield_label gform-field-label' for='input_405_266'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_266' id='input_405_266' type='email' value='' class='large' tabindex='16'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_405_263\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter TELE1 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_263'>Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_263' id='input_405_263' type='text' value='' class='large'   tabindex='17' placeholder='___-___-____'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_303\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter PHONENUMBERS show_description gf_hide_charleft field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_303'>International Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_303' id='input_405_303' type='text' value='' class='large' maxlength='20' aria-describedby=\"gfield_description_405_303\" tabindex='18'   aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_405_303'>Please Include Country Code<\/div><\/div><div id=\"field_405_292\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter CONTACT_PREFMODE field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_292'>Preferred Method of Contact<\/label><div class='ginput_container ginput_container_select'><select name='input_292' id='input_405_292' class='large gfield_select' tabindex='19'    aria-invalid=\"false\" ><option value='' ><\/option><option value='0293' >Phone<\/option><option value='0294' >Email<\/option><option value='0420' >Text<\/option><option value='0421' >WhatsApp<\/option><\/select><\/div><\/div><div id=\"field_405_294\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Current Residential Address<\/h3><\/div><div id=\"field_405_295\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-two-thirds ADDRESS1 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_295'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_295' id='input_405_295' type='text' value='' class='large'   tabindex='20'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_296\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third UNIT_NO field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_296'>Apt\/Unit #<\/label><div class='ginput_container ginput_container_text'><input name='input_296' id='input_405_296' type='text' value='' class='large'   tabindex='21'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_290\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third CITY gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_290'>What city do you\/your client live in<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_290' id='input_405_290' class='large gfield_select' tabindex='22'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='0400301188' >Winnipeg<\/option><option value='0400301199' >Anola<\/option><option value='0400301005' >Arborg<\/option><option value='0400301010' >Beausejour<\/option><option value='0400301048' >Eriksdale<\/option><option value='0400301058' >Gimli<\/option><option value='0400301247' >Headingley<\/option><option value='0400301212' >Ile Des Chenes<\/option><option value='0400301194' >La Salle<\/option><option value='0400301193' >Lorette<\/option><option value='0400301219' >Oakbank<\/option><option value='0400301143' >Selkirk<\/option><option value='0400301234' >St. Adolphe<\/option><option value='0400301235' >St. Malo<\/option><option value='0400301236' >Ste. Anne<\/option><option value='0400301167' >Steinbach<\/option><option value='0400301168' >Stonewall<\/option><option value='0400301173' >Teulon<\/option><option value='0400301189' >Winnipeg Beach<\/option><option value='0400301001' >Agassiz Provincial Forest<\/option><option value='0400301002' >Alexander<\/option><option value='0400301003' >Alonsa<\/option><option value='0400301004' >Altona<\/option><option value='0400301200' >Armstrong<\/option><option value='0400301006' >Ashern<\/option><option value='0400301201' >Aubigny<\/option><option value='0400301007' >Austin<\/option><option value='0400301008' >Baldur<\/option><option value='0400301009' >Basswood<\/option><option value='0400301011' >Belmont<\/option><option value='0400301012' >Benito<\/option><option value='0400301013' >Berens River<\/option><option value='0400301014' >Beulah<\/option><option value='0400301015' >Binscarth<\/option><option value='0400301197' >Birnie<\/option><option value='0400301016' >Birtle<\/option><option value='0400301017' >Bissett<\/option><option value='0400301202' >Blumenort<\/option><option value='0400301018' >Boissevain<\/option><option value='0400301019' >Brandon<\/option><option value='0400301020' >Brochet<\/option><option value='0400301021' >Brookdale<\/option><option value='0400301203' >Brunkild<\/option><option value='0400301022' >Camperville<\/option><option value='0400301023' >Carberry<\/option><option value='0400301024' >Carman<\/option><option value='0400301025' >Cartwright<\/option><option value='0400301026' >Churchill<\/option><option value='0400301204' >Cooks Creek<\/option><option value='0400301027' >Cormorant<\/option><option value='0400301028' >Cowan<\/option><option value='0400301029' >Cranberry Portage<\/option><option value='0400301030' >Crandall<\/option><option value='0400301031' >Cross Lake<\/option><option value='0400301032' >Crystal City<\/option><option value='0400301033' >Cypress River<\/option><option value='0400301034' >Darlingford<\/option><option value='0400301035' >Dauphin<\/option><option value='0400301036' >Deloraine<\/option><option value='0400301037' >Dominion City<\/option><option value='0400301192' >Dufresne<\/option><option value='0400301038' >Dugald<\/option><option value='0400301205' >East Braintree<\/option><option value='0400301039' >Easterville<\/option><option value='0400301040' >Eddystone<\/option><option value='0400301198' >Eden<\/option><option value='0400301041' >Edwin<\/option><option value='0400301042' >Elgin<\/option><option value='0400301043' >Elie<\/option><option value='0400301044' >Elkhorn<\/option><option value='0400301045' >Elm Creek<\/option><option value='0400301206' >Elma<\/option><option value='0400301046' >Emerson<\/option><option value='0400301047' >Erickson<\/option><option value='0400301049' >Ethelbert<\/option><option value='0400301050' >Falcon Lake<\/option><option value='0400301051' >Fisher Branch<\/option><option value='0400301052' >Fisher River<\/option><option value='0400301053' >Flin Flon<\/option><option value='0400301054' >Fork River<\/option><option value='0400301055' >Foxwarren<\/option><option value='0400301207' >Fraserwood<\/option><option value='0400301208' >Gardenton<\/option><option value='0400301056' >Gilbert Plains<\/option><option value='0400301057' >Gillam<\/option><option value='0400301209' >Giroux<\/option><option value='0400301059' >Gladstone<\/option><option value='0400301060' >Glenboro<\/option><option value='0400301061' >Glenella<\/option><option value='0400301062' >Gods Lake Narrows<\/option><option value='0400301063' >Grand Beach<\/option><option value='0400301064' >Grand Rapids<\/option><option value='0400301065' >Grandview<\/option><option value='0400301066' >Gretna<\/option><option value='0400301195' >Grunthal<\/option><option value='0400301067' >Gypsumville<\/option><option value='0400301068' >Hadashville<\/option><option value='0400301069' >Hamiota<\/option><option value='0400301070' >Hartney<\/option><option value='0400301210' >Hazelridge<\/option><option value='0400301071' >Hecla<\/option><option value='0400301211' >Hodgson<\/option><option value='0400301072' >Holland<\/option><option value='0400301073' >Ilford<\/option><option value='0400301074' >Inwood<\/option><option value='0400301075' >Island Lake<\/option><option value='0400301076' >Kelwood<\/option><option value='0400301077' >Kenton<\/option><option value='0400301078' >Killarney<\/option><option value='0400301196' >Kleefeld<\/option><option value='0400301245' >Kola<\/option><option value='0400301213' >Komarno<\/option><option value='0400301079' >La Broquerie<\/option><option value='0400301080' >Lac Brochet<\/option><option value='0400301081' >Lac du Bonnet<\/option><option value='0400301214' >Landmark<\/option><option value='0400301082' >Langruth<\/option><option value='0400301083' >Leaf Rapids<\/option><option value='0400301084' >Libau<\/option><option value='0400301215' >Linden<\/option><option value='0400301085' >Little Grand Rapids<\/option><option value='0400301086' >Lockport<\/option><option value='0400301216' >Lowe Farm<\/option><option value='0400301087' >Lundar<\/option><option value='0400301088' >Lynn Lake<\/option><option value='0400301089' >MacGregor<\/option><option value='0400301090' >Mafeking<\/option><option value='0400301091' >Manigotagan<\/option><option value='0400301092' >Manitou<\/option><option value='0400301217' >Marchand<\/option><option value='0400301093' >McAuley<\/option><option value='0400301094' >McCreary<\/option><option value='0400301095' >Melita<\/option><option value='0400301096' >Miami<\/option><option value='0400301218' >Middlebro<\/option><option value='0400301097' >Miniota<\/option><option value='0400301098' >Minnedosa<\/option><option value='0400301099' >Minto<\/option><option value='0400301100' >Moose Lake<\/option><option value='0400301101' >Morden<\/option><option value='0400301102' >Morris<\/option><option value='0400301103' >Neepawa<\/option><option value='0400301104' >Nelson House<\/option><option value='0400301105' >Newdale<\/option><option value='0400301106' >Niverville<\/option><option value='0400301107' >Norway House<\/option><option value='0400301108' >Notre Dame de Lourdes<\/option><option value='0400301109' >Oak Lake<\/option><option value='0400301110' >Oak River<\/option><option value='0400301111' >Oakville<\/option><option value='0400301112' >Ochre River<\/option><option value='0400301220' >Otterburne<\/option><option value='0400301113' >Oxford House<\/option><option value='0400301221' >Pansy<\/option><option value='0400301114' >Peguis<\/option><option value='0400301115' >Pelican Rapids<\/option><option value='0400301116' >Pikwitonei<\/option><option value='0400301117' >Pilot Mound<\/option><option value='0400301118' >Pinawa<\/option><option value='0400301119' >Pine Dock<\/option><option value='0400301120' >Pine Falls<\/option><option value='0400301121' >Pine River<\/option><option value='0400301122' >Piney<\/option><option value='0400301123' >Plum Coulee<\/option><option value='0400301124' >Plumas<\/option><option value='0400301125' >Pointe du Bois<\/option><option value='0400301126' >Poplar River<\/option><option value='0400301127' >Poplarfield<\/option><option value='0400301128' >Portage la Prairie<\/option><option value='0400301222' >Prawda<\/option><option value='0400301223' >Randolph<\/option><option value='0400301129' >Rapid City<\/option><option value='0400301130' >Rathwell<\/option><option value='0400301131' >Red Sucker Lake<\/option><option value='0400301132' >Rennie<\/option><option value='0400301133' >Reston<\/option><option value='0400301224' >Richer<\/option><option value='0400301134' >Rivers<\/option><option value='0400301135' >Riverton<\/option><option value='0400301136' >Roblin<\/option><option value='0400301137' >Roland<\/option><option value='0400301138' >Rorketon<\/option><option value='0400301225' >Rosa<\/option><option value='0400301226' >Roseau River<\/option><option value='0400301227' >Rosenort<\/option><option value='0400301228' >Rosewood<\/option><option value='0400301246' >Ross<\/option><option value='0400301139' >Rossburn<\/option><option value='0400301140' >Russell<\/option><option value='0400301229' >Sandilands<\/option><option value='0400301141' >Sandy Lake<\/option><option value='0400301142' >Sanford<\/option><option value='0400301230' >Sarto<\/option><option value='0400301231' >Schanzenfeld<\/option><option value='0400301232' >Seven Sister Falls<\/option><option value='0400301144' >Shamattawa<\/option><option value='0400301145' >Shilo<\/option><option value='0400301146' >Shoal Lake<\/option><option value='0400301147' >Sidney<\/option><option value='0400301148' >Sifton<\/option><option value='0400301149' >Snow Lake<\/option><option value='0400301150' >Snowflake<\/option><option value='0400301151' >Somerset<\/option><option value='0400301152' >Souris<\/option><option value='0400301153' >South Indian Lake<\/option><option value='0400301233' >South Junction<\/option><option value='0400301154' >Sperling<\/option><option value='0400301155' >Split Lake<\/option><option value='0400301156' >Sprague<\/option><option value='0400301157' >St-Pierre-Jolys<\/option><option value='0400301158' >St. Claude<\/option><option value='0400301159' >St. Francois Xavier<\/option><option value='0400301160' >St. Jean Baptiste<\/option><option value='0400301161' >St. Laurent<\/option><option value='0400301162' >St. Lazare<\/option><option value='0400301163' >Starbuck<\/option><option value='0400301164' >Ste. Agathe<\/option><option value='0400301165' >Ste. Rose du Lac<\/option><option value='0400301166' >Steep Rock<\/option><option value='0400301169' >Strathclair<\/option><option value='0400301237' >Sundown<\/option><option value='0400301170' >Swan Lake<\/option><option value='0400301171' >Swan River<\/option><option value='0400301172' >Tadoule Lake<\/option><option value='0400301174' >The Pas<\/option><option value='0400301175' >Thicket Portage<\/option><option value='0400301176' >Thompson<\/option><option value='0400301238' >Tolstoi<\/option><option value='0400301239' >Tourond<\/option><option value='0400301177' >Treherne<\/option><option value='0400301240' >Tyndale<\/option><option value='0400301241' >Vassar<\/option><option value='0400301178' >Virden<\/option><option value='0400301179' >Vita<\/option><option value='0400301180' >Waasagomach<\/option><option value='0400301181' >Wabowden<\/option><option value='0400301182' >Wanless<\/option><option value='0400301183' >Wasagaming<\/option><option value='0400301184' >Waterhen<\/option><option value='0400301185' >Wawanesa<\/option><option value='0400301186' >Whitemouth<\/option><option value='0400301187' >Winkler<\/option><option value='0400301190' >Winnipegosis<\/option><option value='0400301242' >Woodlands<\/option><option value='0400301243' >Woodmore<\/option><option value='0400301191' >Woodridge<\/option><option value='0400301244' >Zhoda<\/option><\/select><\/div><\/div><div id=\"field_405_300\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third DurationInCanada gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_300'>Duration in Winnipeg<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_300' id='input_405_300' class='large gfield_select' tabindex='23'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='0462' >Winnipeg-Born<\/option><option value='0463' >&lt;1 yr<\/option><option value='0464' >1-3 years<\/option><option value='0465' >3-5 years<\/option><option value='0466' >5-10 years<\/option><option value='0467' >&gt;10 years<\/option><option value='0468' >I prefer not to say<\/option><\/select><\/div><\/div><div id=\"field_405_297\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third POSTALCODE gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_297'>Postal Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_297' id='input_405_297' type='text' value='' class='large'   tabindex='24'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_299\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_405_283\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_405_268\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_401 field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_268'>The Bilal NCMI process from referral to start can take several weeks. If there are immediate safety concerns do not continue with the referral, seek appropriate crisis resources. Please consider a referral once the immediate crisis has been stabilized. I.e., will an individual or child be harmed if action does not occur immediately? Are there any immediate safety concerns?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_268' id='input_405_268' class='textarea small' tabindex='25' aria-describedby=\"gfield_description_405_268\" maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_405_268'>Are there any immediate safety concerns?<\/div><\/div><fieldset id=\"field_405_309\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full Z_TBL_4132.F_401 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is your relation with this client?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_405_309'>\n\t\t\t<div class='gchoice gchoice_405_309_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_309' type='radio' value='Family Member'  id='choice_405_309_0' onchange='gformToggleRadioOther( this )'  tabindex='26'  \/>\n\t\t\t\t\t<label for='choice_405_309_0' id='label_405_309_0' class='gform-field-label gform-field-label--type-inline'>Family Member<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_405_309_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_309' type='radio' value='Community Member'  id='choice_405_309_1' onchange='gformToggleRadioOther( this )'  tabindex='27'  \/>\n\t\t\t\t\t<label for='choice_405_309_1' id='label_405_309_1' class='gform-field-label gform-field-label--type-inline'>Community Member<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_405_309_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_309' type='radio' value='Self'  id='choice_405_309_2' onchange='gformToggleRadioOther( this )'  tabindex='28'  \/>\n\t\t\t\t\t<label for='choice_405_309_2' id='label_405_309_2' class='gform-field-label gform-field-label--type-inline'>Self<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_405_271\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_402 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_271'>Tell us a little about you\/your client&#039;s situation and any problems that are getting worse. (E.g., a single mother of two kids, aged 7 and 13, facing housing issues and the oldest child has stopped going to school)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_271' id='input_405_271' class='textarea small' tabindex='29'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_272\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_403 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_272'>Do you\/your client currently involved with any services or systems? If yes, please tell us about them and whether they&#039;re positive or causing conflicts.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_272' id='input_405_272' class='textarea small' tabindex='30'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_273\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_404 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_273'>What strengths you\/your client have?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_273' id='input_405_273' class='textarea small' tabindex='31'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_274\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_405 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_274'>Do you\/your client need an interpreter to communicate with the Bilal NCMI Support Team? If yes, what is their primary language:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_274' id='input_405_274' class='textarea small' tabindex='32'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_275\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_406 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_275'>What are some of the goals (or \u2018need\u2019 areas) you\/your client are working on?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_275' id='input_405_275' class='textarea small' tabindex='33'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_276\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_407 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_276'>Tell us about some challenges or barriers that are making it hard to achieve these goals. (For example, services not returning calls, a difficult landlord, or transportation problems for children&#039;s medical appointments)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_276' id='input_405_276' class='textarea small' tabindex='34'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_277\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_408 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_277'>What have you (or your client) done to try to overcome these barriers? (E.g., Stronger advocacy work, elevated the issue to a supervisor, contacted RTB etc.)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_277' id='input_405_277' class='textarea small' tabindex='35'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_279\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full Z_TBL_4132.M_409 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_279'>Did any strategies work for you\/your client?<\/label><div class='ginput_container ginput_container_text'><input name='input_279' id='input_405_279' type='text' value='' class='large' maxlength='1000'  tabindex='36'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_280\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full Z_TBL_4132.M_410 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_280'>Bilal NCMI asks participants to actively take part in their support teams. Do you think you\/your client is ready to engage in the process?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_280' id='input_405_280' class='textarea small' tabindex='37'  maxlength='1000'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_405_287\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full DOCUMENT_FIELD11 nsd-gravity-upload nsd-fileupload-single gf_inline exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_405_287'>Documents<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_405_287' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_405_287&quot;,&quot;container&quot;:&quot;gform_multifile_upload_405_287&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_405_287&quot;,&quot;filelist&quot;:&quot;gform_preview_405_287&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging5.nsd.tech\\\/?gf_page=f8eaeb02f5fcc9f&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging5.nsd.tech\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging5.nsd.tech\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;pdf,docx,doc,jpg,gif,tiff&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:405,&quot;field_id&quot;:287,&quot;_gform_file_upload_nonce_405_287&quot;:&quot;aa61dc93c0&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;1&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_405_287&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_405_287' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9poser les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_405_287' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_405_287\" tabindex='38' >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_405_287'>Types de fichier accept\u00e9s\u00a0: pdf, docx, doc, jpg, gif, tiff, Taille maximum des fichiers : 10 MB, Nombre maximum de fichiers : 1.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_405_287'><\/ul> <div id='gform_preview_405_287' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_405_259\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_405_259'>CAPTCHA<\/label><div id='input_405_259' class='ginput_container ginput_recaptcha' data-sitekey='6LdQ_KQqAAAAAOZ5dT_twxSmxS7Hk-VjwJnkXATw'  data-theme='light' data-tabindex='39'  data-badge=''><\/div><\/div><div id=\"field_405_227\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter REASON exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_405_227'>Program (Admin Only)<\/label><div class='ginput_container ginput_container_text'><input name='input_227' id='input_405_227' type='text' value='0009' class='large'   tabindex='40'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_45\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-quarter DATE_VISITED exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_405_45'>Date Visited (Admin Only)<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_45' id='input_405_45' type='text' value='26\/04\/2026' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='41'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_405_45_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_405_45_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_405_45' class='gform_hidden' value='https:\/\/staging5.nsd.tech\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_405_228\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter CurrentJobStatus exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_405_228'>Employment Status (Admin Only)<\/label><div class='ginput_container ginput_container_text'><input name='input_228' id='input_405_228' type='text' value='0005' class='large'   tabindex='42'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_257\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter OF_LANG exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_405_257'>Official Language (Admin Only)<\/label><div class='ginput_container ginput_container_text'><input name='input_257' id='input_405_257' type='text' value='1' class='large'   tabindex='43'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_405_307\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-quarter Z_TBL_4132.START_DATE exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_405_307'>Assessment Date (Admin Only)<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_307' id='input_405_307' type='text' value='26\/04\/2026' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='44'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_405_307_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_405_307_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_405_307' class='gform_hidden' value='https:\/\/staging5.nsd.tech\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div data-fieldId=\"307\" class=\"spacer gfield\" style=\"grid-column: span 9;\" data-groupId=\"c3cddb17\"><\/div><div id=\"field_405_301\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full DOCUMENT_TYPE11 exclude field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_405_301'>DOC_1 TYPE<\/label><div class='ginput_container ginput_container_text'><input name='input_301' id='input_405_301' type='text' value='0007' class='large'   tabindex='45'   aria-invalid=\"false\"   \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_405' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit' tabindex='46' \/> <input type='hidden' name='gform_ajax' value='form_id=405&amp;title=1&amp;description=1&amp;tabindex=1&amp;theme=orbital&amp;styles=[]&amp;hash=e2a85c140d103bf529bcabbce73f0264' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_405' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' 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clients encountering system barriers. The initiative does this by facilitating regular support team meetings where we develop and implement client-led &#8230; <\/p>\n<div><a href=\"https:\/\/staging5.nsd.tech\/fr\/bcfc-ncmi-client-referral-form\/\" class=\"more-link\">Read More<\/a><\/div>","protected":false},"author":15,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-1769","page","type-page","status-publish","hentry","no-post-thumbnail"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>BCFC NCMI Client Referral Form - Staging 5<\/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:\/\/staging5.nsd.tech\/fr\/bcfc-ncmi-client-referral-form\/\" \/>\n<meta property=\"og:locale\" content=\"fr_CA\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"BCFC NCMI Client Referral Form - Staging 5\" \/>\n<meta property=\"og:description\" content=\"BCFC NCMI Client Referral Form Bilal Community and Family Centre Newcomer Community Mobilization Initiative (NCMI) is a program that aimed at making services accessed by newcomers, immigrants, and refugees with complex needs by bringing together diverse service providers to support clients encountering system barriers. The initiative does this by facilitating regular support team meetings where we develop and implement client-led ... 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