{"id":964,"date":"2014-01-28T14:29:51","date_gmt":"2014-01-28T19:29:51","guid":{"rendered":"http:\/\/gcfbportal.wpengine.com\/programs\/?page_id=964"},"modified":"2023-02-17T12:34:36","modified_gmt":"2023-02-17T17:34:36","slug":"produce-distribution-app","status":"publish","type":"page","link":"https:\/\/portal.clevelandfoodbank.org\/programs\/mobilepantry\/produce-distribution-app\/","title":{"rendered":"Produce Distribution Application and Agreement"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_99' style='display:none'><div id='gf_99' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_99' id='gform_99'  action='\/programs\/wp-json\/wp\/v2\/pages\/964#gf_99' data-formid='99' ><div id='gf_page_steps_99' class='gf_page_steps'><div id='gf_step_99_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Application<\/span><\/div><div id='gf_step_99_2' class='gf_step gf_step_last gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Requirements Agreement<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_99_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_99' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_99_2\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_2\"><h2 class=\"gsection_title\" id=\"section-i-general-information\" >Section I: General Information<\/h2><\/li><li id=\"field_99_61\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_61\"><label class='gfield_label gform-field-label'  >Which Produce Distribution Program is your organization applying for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_61'>\n\t\t\t<li class='gchoice gchoice_99_61_0'>\n\t\t\t\t<input name='input_61' type='radio' value='Mobile Pantry'  id='choice_99_61_0'    \/>\n\t\t\t\t<label for='choice_99_61_0' id='label_99_61_0' class='gform-field-label gform-field-label--type-inline'>Mobile Pantry<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_61_1'>\n\t\t\t\t<input name='input_61' type='radio' value='Senior Market'  id='choice_99_61_1'    \/>\n\t\t\t\t<label for='choice_99_61_1' id='label_99_61_1' class='gform-field-label gform-field-label--type-inline'>Senior Market<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_61_2'>\n\t\t\t\t<input name='input_61' type='radio' value='Food as Medicine'  id='choice_99_61_2'    \/>\n\t\t\t\t<label for='choice_99_61_2' id='label_99_61_2' class='gform-field-label gform-field-label--type-inline'>Food as Medicine<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_61_3'>\n\t\t\t\t<input name='input_61' type='radio' value='School Market'  id='choice_99_61_3'    \/>\n\t\t\t\t<label for='choice_99_61_3' id='label_99_61_3' class='gform-field-label gform-field-label--type-inline'>School Market<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_91\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_91\"><br><\/li><li id=\"field_99_90\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_90\">Thank you for your interest in becoming a produce distribution partner with The Greater Cleveland Food Bank. Currently, we are not accepting applications for new partners at this time. If you have any questions about the application process, please reach out to:<br><br>\nVince Cushman, Produce Partnerships Manager:\nvcushman@clevelandfoodbank.org<\/li><li id=\"field_99_1\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_1\"><label class='gfield_label gform-field-label' for='input_99_1' >Organization Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_99_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_8\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_8\"><label class='gfield_label gform-field-label'  >Is your organization an affiliate of another organization?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_8'>\n\t\t\t<li class='gchoice gchoice_99_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Yes'  id='choice_99_8_0'    \/>\n\t\t\t\t<label for='choice_99_8_0' id='label_99_8_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='No'  id='choice_99_8_1'    \/>\n\t\t\t\t<label for='choice_99_8_1' id='label_99_8_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_9\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_9\"><label class='gfield_label gform-field-label' for='input_99_9' >If yes, name of umbrella \/ parent organization<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_99_9'>(Parent organization is programmatically, legally and fiscally responsible for the operation and liabilities of your program)<\/div><div class='ginput_container ginput_container_text'><input name='input_9' id='input_99_9' type='text' value='' class='medium'  aria-describedby=\"gfield_description_99_9\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_3\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_3\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Site Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_99_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_99_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_99_3_1' value=''    aria-required='true'    \/>\n                                        <label for='input_99_3_1' id='input_99_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_99_3_2_container' >\n                                        <input type='text' name='input_3.2' id='input_99_3_2' value=''     aria-required='false'   \/>\n                                        <label for='input_99_3_2' id='input_99_3_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_99_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_99_3_3' value=''    aria-required='true'    \/>\n                                    <label for='input_99_3_3' id='input_99_3_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_3.4' id='input_99_3_4' value='Ohio'\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_99_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_99_3_5' value=''    aria-required='true'    \/>\n                                    <label for='input_99_3_5' id='input_99_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_99_3_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_99_79\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_79\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label'  >County<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_79'>\n\t\t\t<li class='gchoice gchoice_99_79_0'>\n\t\t\t\t<input name='input_79' type='radio' value='Ashland'  id='choice_99_79_0'    \/>\n\t\t\t\t<label for='choice_99_79_0' id='label_99_79_0' class='gform-field-label gform-field-label--type-inline'>Ashland<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_79_1'>\n\t\t\t\t<input name='input_79' type='radio' value='Ashtabula'  id='choice_99_79_1'    \/>\n\t\t\t\t<label for='choice_99_79_1' id='label_99_79_1' class='gform-field-label gform-field-label--type-inline'>Ashtabula<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_79_2'>\n\t\t\t\t<input name='input_79' type='radio' value='Cuyahoga'  id='choice_99_79_2'    \/>\n\t\t\t\t<label for='choice_99_79_2' id='label_99_79_2' class='gform-field-label gform-field-label--type-inline'>Cuyahoga<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_79_3'>\n\t\t\t\t<input name='input_79' type='radio' value='Geauga'  id='choice_99_79_3'    \/>\n\t\t\t\t<label for='choice_99_79_3' id='label_99_79_3' class='gform-field-label gform-field-label--type-inline'>Geauga<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_79_4'>\n\t\t\t\t<input name='input_79' type='radio' value='Lake'  id='choice_99_79_4'    \/>\n\t\t\t\t<label for='choice_99_79_4' id='label_99_79_4' class='gform-field-label gform-field-label--type-inline'>Lake<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_79_5'>\n\t\t\t\t<input name='input_79' type='radio' value='Richland'  id='choice_99_79_5'    \/>\n\t\t\t\t<label for='choice_99_79_5' id='label_99_79_5' class='gform-field-label gform-field-label--type-inline'>Richland<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_4\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_4\"><label class='gfield_label gform-field-label'  >Is the billing address the same?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_4'>\n\t\t\t<li class='gchoice gchoice_99_4_0'>\n\t\t\t\t<input name='input_4' type='radio' value='Yes'  id='choice_99_4_0'    \/>\n\t\t\t\t<label for='choice_99_4_0' id='label_99_4_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_4_1'>\n\t\t\t\t<input name='input_4' type='radio' value='No'  id='choice_99_4_1'    \/>\n\t\t\t\t<label for='choice_99_4_1' id='label_99_4_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_5\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_5\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Billing Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_99_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_99_5_1_container' >\n                                        <input type='text' name='input_5.1' id='input_99_5_1' value=''    aria-required='true'    \/>\n                                        <label for='input_99_5_1' id='input_99_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_99_5_2_container' >\n                                        <input type='text' name='input_5.2' id='input_99_5_2' value=''     aria-required='false'   \/>\n                                        <label for='input_99_5_2' id='input_99_5_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_99_5_3_container' >\n                                    <input type='text' name='input_5.3' id='input_99_5_3' value=''    aria-required='true'    \/>\n                                    <label for='input_99_5_3' id='input_99_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_5.4' id='input_99_5_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_99_5_5_container' >\n                                    <input type='text' name='input_5.5' id='input_99_5_5' value=''    aria-required='true'    \/>\n                                    <label for='input_99_5_5' id='input_99_5_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_99_5_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_99_6\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_6\"><label class='gfield_label gform-field-label' for='input_99_6' >Main contact phone number:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_99_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_46\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_46\"><label class='gfield_label gform-field-label' for='input_99_46' >Phone number for the organization:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_99_46' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_47\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_47\"><label class='gfield_label gform-field-label' for='input_99_47' >Phone number listed for the public:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_99_47' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_7\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_7\"><label class='gfield_label gform-field-label'  >Does your organization have a 501c3 status (Non-profit)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_7'>\n\t\t\t<li class='gchoice gchoice_99_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='Yes'  id='choice_99_7_0'    \/>\n\t\t\t\t<label for='choice_99_7_0' id='label_99_7_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='No'  id='choice_99_7_1'    \/>\n\t\t\t\t<label for='choice_99_7_1' id='label_99_7_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_80\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_80\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label'  >Is your program at \/ in a school?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_80'>\n\t\t\t<li class='gchoice gchoice_99_80_0'>\n\t\t\t\t<input name='input_80' type='radio' value='Yes'  id='choice_99_80_0'    \/>\n\t\t\t\t<label for='choice_99_80_0' id='label_99_80_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_80_1'>\n\t\t\t\t<input name='input_80' type='radio' value='No'  id='choice_99_80_1'    \/>\n\t\t\t\t<label for='choice_99_80_1' id='label_99_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_81\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_81\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_99_81' >If yes, please provide the name of the school:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_99_81' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_82\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_82\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_99_82' >Type of school:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_99_82'>Example: Elementary, Middle School, High School, Early Learning, etc.<\/div><div class='ginput_container ginput_container_text'><input name='input_82' id='input_99_82' type='text' value='' class='medium'  aria-describedby=\"gfield_description_99_82\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_83\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_83\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_99_83' >If no, please list the closest elementary, middle and high school buildings:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_99_83' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_70\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_70\"><label class='gfield_label gform-field-label' for='input_99_70' >If no, is your organization a Property Management Company or Senior High Rise?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_99_70' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_71\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_71\"><label class='gfield_label gform-field-label'  >Will your organization utilize staff or volunteers for the Senior Market?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_71'>\n\t\t\t<li class='gchoice gchoice_99_71_0'>\n\t\t\t\t<input name='input_71' type='radio' value='Staff'  id='choice_99_71_0'    \/>\n\t\t\t\t<label for='choice_99_71_0' id='label_99_71_0' class='gform-field-label gform-field-label--type-inline'>Staff<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_71_1'>\n\t\t\t\t<input name='input_71' type='radio' value='Volunteers'  id='choice_99_71_1'    \/>\n\t\t\t\t<label for='choice_99_71_1' id='label_99_71_1' class='gform-field-label gform-field-label--type-inline'>Volunteers<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_71_2'>\n\t\t\t\t<input name='input_71' type='radio' value='Both'  id='choice_99_71_2'    \/>\n\t\t\t\t<label for='choice_99_71_2' id='label_99_71_2' class='gform-field-label gform-field-label--type-inline'>Both<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_11\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_11\"><label class='gfield_label gform-field-label' for='input_99_11' >Number of volunteers involved in program(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_99_11' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_72\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_72\"><label class='gfield_label gform-field-label' for='input_99_72' >Number of staff involved in program(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_99_72' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_12\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_12\"><label class='gfield_label gform-field-label' for='input_99_12' >Number of volunteers able to lift 40 pounds<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_99_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_74\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_74\"><label class='gfield_label gform-field-label' for='input_99_74' >Number of staff able to lift 40 pounds<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_99_74' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_13\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_13\"><label class='gfield_label gform-field-label' for='input_99_13' >Geographic service boundaries (if any)<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_99_13' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_14\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_14\"><label class='gfield_label gform-field-label' for='input_99_14' >Client restrictions (if any)<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_99_14' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_75\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_75\"><label class='gfield_label gform-field-label' for='input_99_75' >What specific population will you program serve?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_99_75'>For example: seniors, children, patients, etc.<\/div><div class='ginput_container ginput_container_text'><input name='input_75' id='input_99_75' type='text' value='' class='medium'  aria-describedby=\"gfield_description_99_75\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_76\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_76\"><label class='gfield_label gform-field-label' for='input_99_76' >Please briefly describe your program and client base.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_76' id='input_99_76' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_99_48\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_48\"><label class='gfield_label gform-field-label'  >Does your organization have consistent, reliable access to the internet and a device in which to access it?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_48'>\n\t\t\t<li class='gchoice gchoice_99_48_0'>\n\t\t\t\t<input name='input_48' type='radio' value='Yes, we have internet and a device'  id='choice_99_48_0'    \/>\n\t\t\t\t<label for='choice_99_48_0' id='label_99_48_0' class='gform-field-label gform-field-label--type-inline'>Yes, we have internet and a device<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_48_1'>\n\t\t\t\t<input name='input_48' type='radio' value='No, we have a device but no internet access'  id='choice_99_48_1'    \/>\n\t\t\t\t<label for='choice_99_48_1' id='label_99_48_1' class='gform-field-label gform-field-label--type-inline'>No, we have a device but no internet access<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_48_2'>\n\t\t\t\t<input name='input_48' type='radio' value='No, we have internet access but no device'  id='choice_99_48_2'    \/>\n\t\t\t\t<label for='choice_99_48_2' id='label_99_48_2' class='gform-field-label gform-field-label--type-inline'>No, we have internet access but no device<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_48_3'>\n\t\t\t\t<input name='input_48' type='radio' value='No, we do not have internet access or a device'  id='choice_99_48_3'    \/>\n\t\t\t\t<label for='choice_99_48_3' id='label_99_48_3' class='gform-field-label gform-field-label--type-inline'>No, we do not have internet access or a device<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_51\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_51\"><label class='gfield_label gform-field-label' for='input_99_51' >If no, is there a plan in place to acquire access to both the internet and a device?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_99_51' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_39\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_39\"><br><\/li><li id=\"field_99_15\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_15\"><h2 class=\"gsection_title\" id=\"section-ii-scheduling\" >Section II: Scheduling<\/h2><\/li><li id=\"field_99_16\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_16\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Anticipated\/Requested Months of Programming (check all that apply)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_16'><li class='gchoice gchoice_99_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='January'  id='choice_99_16_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_1' id='label_99_16_1' class='gform-field-label gform-field-label--type-inline'>January<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.2' type='checkbox'  value='February'  id='choice_99_16_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_2' id='label_99_16_2' class='gform-field-label gform-field-label--type-inline'>February<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.3' type='checkbox'  value='March'  id='choice_99_16_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_3' id='label_99_16_3' class='gform-field-label gform-field-label--type-inline'>March<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.4' type='checkbox'  value='April'  id='choice_99_16_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_4' id='label_99_16_4' class='gform-field-label gform-field-label--type-inline'>April<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.5' type='checkbox'  value='May'  id='choice_99_16_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_5' id='label_99_16_5' class='gform-field-label gform-field-label--type-inline'>May<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.6' type='checkbox'  value='June'  id='choice_99_16_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_6' id='label_99_16_6' class='gform-field-label gform-field-label--type-inline'>June<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.7' type='checkbox'  value='July'  id='choice_99_16_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_7' id='label_99_16_7' class='gform-field-label gform-field-label--type-inline'>July<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.8' type='checkbox'  value='August'  id='choice_99_16_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_8' id='label_99_16_8' class='gform-field-label gform-field-label--type-inline'>August<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.9' type='checkbox'  value='September'  id='choice_99_16_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_9' id='label_99_16_9' class='gform-field-label gform-field-label--type-inline'>September<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.11' type='checkbox'  value='October'  id='choice_99_16_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_11' id='label_99_16_11' class='gform-field-label gform-field-label--type-inline'>October<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.12' type='checkbox'  value='November'  id='choice_99_16_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_12' id='label_99_16_12' class='gform-field-label gform-field-label--type-inline'>November<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_16_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.13' type='checkbox'  value='December'  id='choice_99_16_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_16_13' id='label_99_16_13' class='gform-field-label gform-field-label--type-inline'>December<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_17\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_17\"><label class='gfield_label gform-field-label'  >Anticipated frequency of programming<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_17'>\n\t\t\t<li class='gchoice gchoice_99_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Weekly'  id='choice_99_17_0'    \/>\n\t\t\t\t<label for='choice_99_17_0' id='label_99_17_0' class='gform-field-label gform-field-label--type-inline'>Weekly<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='Twice per month'  id='choice_99_17_1'    \/>\n\t\t\t\t<label for='choice_99_17_1' id='label_99_17_1' class='gform-field-label gform-field-label--type-inline'>Twice per month<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_17_2'>\n\t\t\t\t<input name='input_17' type='radio' value='Monthly'  id='choice_99_17_2'    \/>\n\t\t\t\t<label for='choice_99_17_2' id='label_99_17_2' class='gform-field-label gform-field-label--type-inline'>Monthly<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_17_3'>\n\t\t\t\t<input name='input_17' type='radio' value='gf_other_choice'  id='choice_99_17_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_99_17_other' name='input_17_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_32\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_32\"><br><\/li><li id=\"field_99_18\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_18\"><h4 id=\"available-days-times-for-delivery-drop-off\" >Available days \/ times for delivery drop-off<\/h4>\n(Morning is 8-9:00am, Afternoon is 2-3:00pm)<\/li><li id=\"field_99_19\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_19\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >MONDAY<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_19'><li class='gchoice gchoice_99_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Morning'  id='choice_99_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_19_1' id='label_99_19_1' class='gform-field-label gform-field-label--type-inline'>Morning<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_19_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.2' type='checkbox'  value='Afternoon'  id='choice_99_19_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_19_2' id='label_99_19_2' class='gform-field-label gform-field-label--type-inline'>Afternoon<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_20\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_20\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >TUESDAY<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_20'><li class='gchoice gchoice_99_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Morning'  id='choice_99_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_20_1' id='label_99_20_1' class='gform-field-label gform-field-label--type-inline'>Morning<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Afternoon'  id='choice_99_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_20_2' id='label_99_20_2' class='gform-field-label gform-field-label--type-inline'>Afternoon<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_21\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_21\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >WEDNESDAY<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_21'><li class='gchoice gchoice_99_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Morning'  id='choice_99_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_21_1' id='label_99_21_1' class='gform-field-label gform-field-label--type-inline'>Morning<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Afternoon'  id='choice_99_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_21_2' id='label_99_21_2' class='gform-field-label gform-field-label--type-inline'>Afternoon<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_22\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_22\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >THURSDAY<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_22'><li class='gchoice gchoice_99_22_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.1' type='checkbox'  value='Morning'  id='choice_99_22_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_22_1' id='label_99_22_1' class='gform-field-label gform-field-label--type-inline'>Morning<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_22_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.2' type='checkbox'  value='Afternoon'  id='choice_99_22_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_22_2' id='label_99_22_2' class='gform-field-label gform-field-label--type-inline'>Afternoon<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_23\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_23\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >FRIDAY<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_23'><li class='gchoice gchoice_99_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Morning'  id='choice_99_23_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_23_1' id='label_99_23_1' class='gform-field-label gform-field-label--type-inline'>Morning<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Afternoon'  id='choice_99_23_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_23_2' id='label_99_23_2' class='gform-field-label gform-field-label--type-inline'>Afternoon<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_24\"  class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_24\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >SATURDAY<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_24'><li class='gchoice gchoice_99_24_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='Morning'  id='choice_99_24_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_24_1' id='label_99_24_1' class='gform-field-label gform-field-label--type-inline'>Morning<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_38\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_38\"><br><\/li><li id=\"field_99_26\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_26\"><h2 class=\"gsection_title\" id=\"section-iii-contact-information\" >Section III: Contact Information<\/h2><\/li><li id=\"field_99_27\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_27\"><label class='gfield_label gform-field-label' for='input_99_27' >Main Program Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_99_27' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_28\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_28\"><label class='gfield_label gform-field-label' for='input_99_28' >Phone (Home)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_99_28' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_29\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_29\"><label class='gfield_label gform-field-label' for='input_99_29' >Phone (Work)<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_99_29' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_30\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_30\"><label class='gfield_label gform-field-label' for='input_99_30' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_30' id='input_99_30' type='text' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_99_52\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_52\"><label class='gfield_label gform-field-label' for='input_99_52' >Alternate Program Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_99_52' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_53\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_53\"><label class='gfield_label gform-field-label' for='input_99_53' >Phone (Home)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_99_53' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_54\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_54\"><label class='gfield_label gform-field-label' for='input_99_54' >Phone (Work)<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_99_54' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_55\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_55\"><label class='gfield_label gform-field-label' for='input_99_55' >Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_55' id='input_99_55' type='text' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_99_31\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_31\"><hr><\/li><li id=\"field_99_33\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_33\"><label class='gfield_label gform-field-label' for='input_99_33' >Director\/Administrator\/Pastor Name (if different than above)<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_99_33' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_34\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_34\"><label class='gfield_label gform-field-label' for='input_99_34' >Phone (Director\/Pastor\/Etc)<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_99_34' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_35\"  class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_35\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Authorized people to sign the invoice upon delivery:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><style type=\"text\/css\">\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons {\n\t\t\t\t\t\t\tvertical-align: middle !important;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons img {\n\t\t\t\t\t\t\tbackground-color: transparent !important;\n\t\t\t\t\t\t\tbackground-position: 0 0;\n\t\t\t\t\t\t\tbackground-size: 16px 16px !important;\n\t\t\t\t\t\t\tbackground-repeat: no-repeat;\n\t\t\t\t\t\t\tborder: none !important;\n\t\t\t\t\t\t\twidth: 16px !important;\n\t\t\t\t\t\t\theight: 16px !important;\n\t\t\t\t\t\t\topacity: 0.5;\n\t\t\t\t\t\t\ttransition: opacity .5s ease-out;\n\t\t\t\t\t\t    -moz-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -webkit-transition: opacity .5s ease-out;\n\t\t\t\t\t\t    -o-transition: opacity .5s ease-out;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\tbody .ginput_container_list table.gfield_list tbody tr td.gfield_list_icons a:hover img {\n\t\t\t\t\t\t\topacity: 1.0;\n\t\t\t\t\t\t}\n\n\t\t\t\t\t\t<\/style><div class='ginput_container ginput_container_list ginput_list'><table class='gfield_list gfield_list_container'><colgroup><col id='gfield_list_35_col_1' class='gfield_list_col_odd' \/><col id='gfield_list_35_col_2' class='gfield_list_col_even' \/><col id='gfield_list_35_col_3' class='gfield_list_col_odd' \/><\/colgroup><thead><tr><th scope=\"col\">Name<\/th><th scope=\"col\">Phone<\/th><td>&nbsp;<\/td><\/tr><\/thead><tbody><tr class='gfield_list_row_odd gfield_list_group'><td class='gfield_list_cell gfield_list_35_cell1' data-label='Name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_99_35\" aria-label='Name, Row ' data-aria-label-template='Name, Row {0}' type='text' name='input_35[]' value=''   \/><\/td><td class='gfield_list_cell gfield_list_35_cell2' data-label='Phone'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_99_35\" aria-label='Phone, Row ' data-aria-label-template='Phone, Row {0}' type='text' name='input_35[]' value=''   \/><\/td><td class='gfield_list_icons'>   <a href='javascript:void(0);' class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 10)' onkeypress='gformAddListItem(this, 10)'><img src='https:\/\/portal.clevelandfoodbank.org\/programs\/wp-content\/plugins\/gravityforms\/images\/list-add.svg' alt='' title='Add a new row' \/><\/a>   <a href='javascript:void(0);' class='delete_list_item' aria-label='Remove this row' onclick='gformDeleteListItem(this, 10)' onkeypress='gformDeleteListItem(this, 10)' style=\"visibility:hidden;\"><img src='https:\/\/portal.clevelandfoodbank.org\/programs\/wp-content\/plugins\/gravityforms\/images\/list-remove.svg' alt='' title='Remove this row' \/><\/a><\/td><\/tr><\/tbody><\/table><\/div><div class='gfield_description' id='gfield_description_99_35'>(Click the \"+\" to the right of the field to add more than one name)<\/div><\/li><li id=\"field_99_56\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_56\"><h2 class=\"gsection_title\" id=\"section-iv-community-connections\" >Section IV: Community Connections<\/h2><\/li><li id=\"field_99_77\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_77\"><label class='gfield_label gform-field-label' for='input_99_77' >Why are you interested in becoming a produce partner?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_77' id='input_99_77' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_99_58\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_58\"><label class='gfield_label gform-field-label'  >Are you currently connected with any community resources or wraparound services?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_58'>\n\t\t\t<li class='gchoice gchoice_99_58_0'>\n\t\t\t\t<input name='input_58' type='radio' value='Yes'  id='choice_99_58_0'    \/>\n\t\t\t\t<label for='choice_99_58_0' id='label_99_58_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_99_58_1'>\n\t\t\t\t<input name='input_58' type='radio' value='No'  id='choice_99_58_1'    \/>\n\t\t\t\t<label for='choice_99_58_1' id='label_99_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_59\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_59\"><label class='gfield_label gform-field-label' for='input_99_59' >If yes, please list below.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_99_59' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_60\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_60\"><label class='gfield_label gform-field-label' for='input_99_60' >What type of programming\/resources would your community benefit from?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_99_60' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_40\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_40\"><hr><\/li><li id=\"field_99_36\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_36\"><label class='gfield_label gform-field-label'  >To the best of my knowledge the above information is correct.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_36'>\n\t\t\t<li class='gchoice gchoice_99_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='Yes'  id='choice_99_36_0'    \/>\n\t\t\t\t<label for='choice_99_36_0' id='label_99_36_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_37\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_37\"><label class='gfield_label gform-field-label' for='input_99_37' >Name of person filling out this form:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_99_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_62\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_62\"><h2 class=\"gsection_title\" id=\"section-iv-food-as-medicine\" >Section IV: Food as Medicine<\/h2><\/li><li id=\"field_99_63\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_63\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >What type of Food as Medicine Program are you interested in?<\/label><div class='gfield_description' id='gfield_description_99_63'>Check all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_63'><li class='gchoice gchoice_99_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='Produce Prescription'  id='choice_99_63_1'   aria-describedby=\"gfield_description_99_63\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_99_63_1' id='label_99_63_1' class='gform-field-label gform-field-label--type-inline'>Produce Prescription<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_63_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.2' type='checkbox'  value='Produce Distribution\/Mobile Pantry'  id='choice_99_63_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_63_2' id='label_99_63_2' class='gform-field-label gform-field-label--type-inline'>Produce Distribution\/Mobile Pantry<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_63_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.3' type='checkbox'  value='Healthy Shelf &amp; On-Site Pantry'  id='choice_99_63_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_63_3' id='label_99_63_3' class='gform-field-label gform-field-label--type-inline'>Healthy Shelf &amp; On-Site Pantry<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_63_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.4' type='checkbox'  value='Nutrition Education'  id='choice_99_63_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_63_4' id='label_99_63_4' class='gform-field-label gform-field-label--type-inline'>Nutrition Education<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_63_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.5' type='checkbox'  value='Other'  id='choice_99_63_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_63_5' id='label_99_63_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_64\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_64\"><label class='gfield_label gform-field-label' for='input_99_64' >If other, please list.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_99_64' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_65\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_65\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Other than food, what type of services do you plan to provide?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_99_65'>Check all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_99_65'><li class='gchoice gchoice_99_65_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.1' type='checkbox'  value='Health Screenings'  id='choice_99_65_1'   aria-describedby=\"gfield_description_99_65\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_99_65_1' id='label_99_65_1' class='gform-field-label gform-field-label--type-inline'>Health Screenings<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_65_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.2' type='checkbox'  value='Health &amp; Nutrition Information (may include information about the clinic, recipes, handouts, etc.)'  id='choice_99_65_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_65_2' id='label_99_65_2' class='gform-field-label gform-field-label--type-inline'>Health &amp; Nutrition Information (may include information about the clinic, recipes, handouts, etc.)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_65_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.3' type='checkbox'  value='Assistance with Health Insurance'  id='choice_99_65_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_65_3' id='label_99_65_3' class='gform-field-label gform-field-label--type-inline'>Assistance with Health Insurance<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_65_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.4' type='checkbox'  value='Cooking Demonstrations'  id='choice_99_65_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_65_4' id='label_99_65_4' class='gform-field-label gform-field-label--type-inline'>Cooking Demonstrations<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_99_65_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_65.5' type='checkbox'  value='Other'  id='choice_99_65_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_99_65_5' id='label_99_65_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_66\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_66\"><label class='gfield_label gform-field-label' for='input_99_66' >If other, please describe.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_99_66' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_67\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_67\"><hr><\/li><li id=\"field_99_68\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_68\"><label class='gfield_label gform-field-label'  >To the best of my knowledge the above information is correct.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_68'>\n\t\t\t<li class='gchoice gchoice_99_68_0'>\n\t\t\t\t<input name='input_68' type='radio' value='Yes'  id='choice_99_68_0'    \/>\n\t\t\t\t<label for='choice_99_68_0' id='label_99_68_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_69\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_69\"><label class='gfield_label gform-field-label' for='input_99_69' >Name of person filling out this form:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_99_69' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_99_41' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_99\").val(\"2\");  jQuery(\"#gform_99\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_99\").val(\"2\");  jQuery(\"#gform_99\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_99_2' class='gform_page' data-js='page-field-id-41' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_99_2' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_99_88\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_88\"><h3 id=\"general-requirements-for-produce-distribution-programs-fy2025\" >General Requirements for Produce Distribution Programs FY2025<\/h3>\n<br>\n<b><i>Please read the following requirements and agree to the terms at the bottom of this page.<\/i><\/b><br>\n<br>\nThe Greater Cleveland Food Bank works with over 200 Produce Distribution partners. Each partner is different in size and function, but they are all held to a set of requirements and responsibilities. \n<br><br>\n<strong>Physical Requirements<\/strong>\n<br>\n<br>\n\u00b7\tPaved parking lot or indoor space for distribution<br><br>\n\u00b7\tSpace for up to a 32 foot box-truck to maneuver<br><br>\n\u00b7\tFlat space for 4 to 12 pallets <br><br>\n\u00b7\tClear path to pallet area: no steps, curbs, steep inclines, grass, gravel, snow, ice or soft surfaces<br><br>\n\u00b7\tSpace to discard recyclables, trash, and unusable produce<br><br>\n\u00b7\tSpace to store empty pallets until next distribution or a plan to discard pallets<br><br>\n\u00b7\tThe organization must pass a site evaluation prior to programming and be subject to annual site visits during distributions<br><br>\n\u00b7\tAccess to internet (wifi), laptops, tablets, or smart phones<br><br>\n\u00b7\tTables for distribution and bags to pack produce <br><br>\n\u00b7\tStorage area for required paperwork (invoices, training documents, stats receipts, and TEFAP forms) for five years <br><br>\n\n<br>\n<h4 id=\"organizational-requirements\" >Organizational Requirements<\/h4>\n<ul>\n<li> The organization must :<br><br>\n\n\u00b7\tThe organization must submit the appropriate distribution online application: https:\/\/portal.clevelandfoodbank.org\/programs\/mobilepantry\/produce-distribution-app\/<br>  <br> \n\u00b7\tThe organization must complete an online Food Safety Training Course<br><br> \n\u00b7\tThe organization cannot require, accept fees, or solicit donations for produce.  All produce must be distributed at no charge<br><br> \n\u00b7\tThe organization cannot require or imply participation or attendance in religious service, ministry, or political event in order to receive produce<br><br> \n\u00b7\tThe organization must commit to at least six (6) months of monthly distributions scheduled and agreed upon by the Food Bank<br><br> \n\u00b7\tFood Bank product must only be distributed\/used for the approved program\u2019s clients.  It must not be distributed to another agency, group, or organization, or used for any other purpose (ex: fundraisers, block parties, funeral meals)<br><br> \n\u00b7\tThe organization must publish, promote, and adhere to regular hours and dates of distributions to the public<br><br> \n\u00b7\tThe organization must recruit volunteers for the distribution (10-20 is recommended for most distributions)<br><br> \n\n<\/ul>\n<br>\n<h4 id=\"distribution-requirements\" >Distribution Requirements<\/h4>\n<ul>\n<li> The organization must :<br><br>\n\n\u00b7\tThe organization must attend an annual USDA\/Civil Rights training with at least one (1) representative<br><br> \n\u00b7\tThe organization must administer USDA Civil Rights Training to all volunteers and volunteers must sign the training sheet on an annual basis<br><br> \n\u00b7\t\u201cAnd Justice For All\u201d, \u201cApply for SNAP\u201d, \u201cHousehold Eligibility Guideline\u201d and \u201cWritten Notice of Beneficiary Rights\u201d posters must all be displayed during all distributions<br><br> \n\u00b7\tThe organization must comply with the client intake process of utilizing PantryTrak for intake and reporting purposes<br><br> \n\u00b7\tIn the event paper forms are used, the current TEFAP \/ ODJFS form must be used and kept on file for five (5) years<br><br> \n\u00b7\tIn case of cancellation, the organization must provide a 48 hour notice by phone or e-mail prior to scheduled distribution. If this notice is not given, the organization will incur a $75 fee<br><br> \n\u00b7\tIn the case that the organization rejects any product which is deemed servable by the Food Bank, the organization will be charged a $25 restocking fee per item<br><br> \n\u00b7\tThe organization is responsible for any excess product at the end of the distribution and required to follow the redistribution process <br><br> \n\u00b7\tThe organization must report statistics from each month on The Portal within 48 hours of the distribution <br><br> \n\u00b7\tThe Greater Cleveland Food Bank has the right to discontinue this program at its discretion due to funding, delinquent statistics, excessive account balances, or improper treatment of clients or product<br><br> \n\u00b7\tFood Discrimination guidelines must be adhered to at all times<br><br> \n\n<br><br> \n<\/ul>\n<hr><\/li><li id=\"field_99_89\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_89\"><h3 id=\"general-requirements-for-produce-distribution-programs-fy25\" >General Requirements for Produce Distribution Programs FY25<\/h3>\n<br>\n<b><i>Please read the following requirements and agree to the terms at the bottom of this page.<\/i><\/b><br>\n<br>\nThe Greater Cleveland Food Bank works with over 200 Produce Distribution partners. Each partner is different in size and function, but they are all held to a set of requirements and responsibilities. \n<br><br>\n<strong>Physical Requirements<\/strong>\n<br>\n<br>\n\u00b7\tPaved parking lot or indoor space for distribution<br><br>\n\u00b7\tSpace for up to a 32 foot box-truck to maneuver<br><br>\n\u00b7\tFlat space for 4 to 12 pallets <br><br>\n\u00b7\tClear path to pallet area: no steps, curbs, steep inclines, grass, gravel, snow, ice or soft surfaces<br><br>\n\u00b7\tSpace to discard recyclables, trash, and unusable produce<br><br>\n\u00b7\tSpace to store empty pallets until next distribution or a plan to discard pallets<br><br>\n\u00b7\tThe organization must pass a site evaluation prior to programming and be subject to annual site visits during distributions<br><br>\n\u00b7\tTables for distribution and bags to pack produce <br><br>\n\u00b7\tStorage area for required paperwork (invoices, training documents, and stats receipts) for five years <br><br>\n\n<\/ul>\n<br>\n<strong>Organizational Requirements<\/strong>\n<ul>\n<li> The organization must :<br><br>\n\n\u00b7\tThe organization must submit the appropriate distribution online application: https:\/\/portal.clevelandfoodbank.org\/programs\/mobilepantry\/produce-distribution-app\/<br>  <br> \n\u00b7\tThe organization must complete an online Food Safety Training Course<br><br> \n\u00b7\tThe organization cannot require, accept fees, or solicit donations for produce.  All produce must be distributed at no charge<br><br> \n\u00b7\tThe organization cannot require or imply participation or attendance in religious service, ministry, or political event in order to receive produce<br><br> \n\u00b7\tThe organization must commit to at least three (3) months of monthly distributions scheduled and agreed upon by the Food Bank<br><br> \n\u00b7\tFood Bank product must only be distributed\/used for the approved program\u2019s clients.  It must not be distributed to another agency, group, or organization, or used for any other purpose (ex: fundraisers, block parties, funeral meals)<br><br> \n\u00b7\tThe organization must publish, promote, and adhere to regular hours and dates of distributions to the public<br><br> \n\u00b7\tThe organization must recruit volunteers for the distribution (10-20 is recommended for most distributions)<br><br> \n\n<\/ul>\n<br>\n<strong>Distribution Requirements<\/strong>\n<ul>\n<li> The organization must :<br><br>\n\n\u00b7\tThe organization must attend an annual School Market training with at least one (1) representative<br><br> \n\u00b7\tThe organization must administer USDA Civil Rights Training to all volunteers and volunteers must sign the training sheet on an annual basis<br><br> \n\u00b7\t\u201cAnd Justice For All\u201d and \u201cApply for SNAP\u201d posters must all be displayed during all distributions<br><br> \n\u00b7\tThe organization must comply with the client intake process of utilizing sign in sheets for intake and reporting purposes<br><br> \n\u00b7\tIn case of cancellation, the organization must provide a 48 hour notice by phone or e-mail prior to scheduled distribution. If this notice is not given, the organization will incur a $75 fee. Cancellations due to weather are not included in this rule.<br><br> \n\u00b7\tIn the case that the organization rejects any product which is deemed servable by the Food Bank, the organization will be charged a $25 restocking fee per item<br><br> \n\u00b7\tThe organization is responsible for any excess product at the end of the distribution and required to follow the redistribution process <br><br> \n\u00b7\tThe organization must report statistics from each month on The Portal within 48 hours of the distribution <br><br> \n\u00b7\tThe Greater Cleveland Food Bank has the right to discontinue this program at its discretion due to funding, delinquent statistics, excessive account balances, or improper treatment of clients or product<br><br> \n\u00b7\tFood Discrimination guidelines must be adhered to at all times<br><br> \n\n<br><br> \n<\/ul>\n<hr><\/li><li id=\"field_99_85\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_85\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h2 class=\"gsection_title\" id=\"mobile-pantry-senior-market-or-food-as-medicine\" >Mobile Pantry, Senior Market, or Food as Medicine<\/h2><\/li><li id=\"field_99_86\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_99_86\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><h2 class=\"gsection_title\" id=\"school-market\" >School Market<\/h2><\/li><li id=\"field_99_87\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_87\"><h2 class=\"gsection_title\" id=\"sign\" >Sign<\/h2><\/li><li id=\"field_99_43\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_43\"><label class='gfield_label gform-field-label'  >I have read and agree to the above requirements.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_99_43'>\n\t\t\t<li class='gchoice gchoice_99_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='Yes'  id='choice_99_43_0'    \/>\n\t\t\t\t<label for='choice_99_43_0' id='label_99_43_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_99_44\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_99_44\"><label class='gfield_label gform-field-label' for='input_99_44' >Director\/Administrator\/Pastor Initials<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_99_44' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_99_92\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_99_92\"><label class='gfield_label gform-field-label' for='input_99_92' >Email<\/label><div class='gfield_description' id='gfield_description_99_92'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_92' id='input_99_92' type='text' value='' \/><\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_99' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_99\"]){return false;}  window[\"gf_submitting_99\"]=true; 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