{"id":401,"date":"2024-08-23T12:59:50","date_gmt":"2024-08-23T12:59:50","guid":{"rendered":"https:\/\/barakadf.org\/?page_id=401"},"modified":"2024-08-23T13:09:45","modified_gmt":"2024-08-23T13:09:45","slug":"help-request-form","status":"publish","type":"page","link":"https:\/\/barakadf.or.tz\/?page_id=401","title":{"rendered":"Help Request Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"401\" class=\"elementor elementor-401\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-531410f elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"531410f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-616d6f5\" data-id=\"616d6f5\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2de1812 elementor-widget elementor-widget-shortcode\" data-id=\"2de1812\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-395\"><form id=\"wpforms-form-395\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"395\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F401\" data-token=\"2916f5a5b41b582882c7fa28abfad712\" data-token-time=\"1784618351\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-395-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-395-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-395-field_1-error\" required><label for=\"wpforms-395-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-395-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-395-field_1-last-error\" required><label for=\"wpforms-395-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-395-field_4-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-395-field_4\">Phone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-395-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-395-field_4-error\" required><\/div><div id=\"wpforms-395-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-395-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-395-field_2\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-395-field_2-error\" required><\/div><div id=\"wpforms-395-field_7-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-two-thirds wpforms-first\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Type of Assistance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-395-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"checkbox\" id=\"wpforms-395-field_7_1\" name=\"wpforms[fields][7][]\" value=\"Financial\" aria-errormessage=\"wpforms-395-field_7_1-error\" aria-describedby=\"wpforms-395-field_7-description\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_7_1\">Financial<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-395-field_7_2\" name=\"wpforms[fields][7][]\" value=\"Psychological\" aria-errormessage=\"wpforms-395-field_7_2-error\" aria-describedby=\"wpforms-395-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_7_2\">Psychological<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-395-field_7_3\" name=\"wpforms[fields][7][]\" value=\"Social\" aria-errormessage=\"wpforms-395-field_7_3-error\" aria-describedby=\"wpforms-395-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_7_3\">Social<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-395-field_7_4\" name=\"wpforms[fields][7][]\" value=\"Professional\" aria-errormessage=\"wpforms-395-field_7_4-error\" aria-describedby=\"wpforms-395-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_7_4\">Professional<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-395-field_7_6\" name=\"wpforms[fields][7][]\" value=\"Legal\" aria-errormessage=\"wpforms-395-field_7_6-error\" aria-describedby=\"wpforms-395-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_7_6\">Legal<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-395-field_7_7\" name=\"wpforms[fields][7][]\" value=\"Other ...\" aria-errormessage=\"wpforms-395-field_7_7-error\" aria-describedby=\"wpforms-395-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_7_7\">Other ...<\/label><\/li><\/ul><div id=\"wpforms-395-field_7-description\" class=\"wpforms-field-description\">Select Just One.<\/div><\/fieldset><\/div><div id=\"wpforms-395-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-395-field_8\">Please briefly explain the assistance you require:<\/label><input type=\"text\" id=\"wpforms-395-field_8\" class=\"wpforms-field-large\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-395-field_8-error\" ><\/div><div id=\"wpforms-395-field_3-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-395-field_3\">Please explain the reasons for requesting assistance: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-395-field_3\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-395-field_3-error\" required><\/textarea><\/div><div id=\"wpforms-395-field_9-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Have you ever received assistance from other organizations? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-395-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-395-field_9_1\" name=\"wpforms[fields][9]\" value=\"Yes\" aria-errormessage=\"wpforms-395-field_9_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_9_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-395-field_9_2\" name=\"wpforms[fields][9]\" value=\"No\" aria-errormessage=\"wpforms-395-field_9_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_9_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-395-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-395-field_10\">If yes, please provide their name and contact information:<\/label><input type=\"text\" id=\"wpforms-395-field_10\" class=\"wpforms-field-large\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-395-field_10-error\" ><\/div><div id=\"wpforms-395-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Is there another person who can verify your situation? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-395-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-395-field_11_1\" name=\"wpforms[fields][11]\" value=\"Yes\" aria-errormessage=\"wpforms-395-field_11_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_11_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-395-field_11_2\" name=\"wpforms[fields][11]\" value=\"No\" aria-errormessage=\"wpforms-395-field_11_2-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-395-field_11_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-395-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-395-field_12\">If yes, please provide their name and contact information:<\/label><input type=\"text\" id=\"wpforms-395-field_12\" class=\"wpforms-field-large\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-395-field_12-error\" ><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"395\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/barakadf.or.tz\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F401\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-395\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/barakadf.or.tz\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-401","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=\/wp\/v2\/pages\/401","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=401"}],"version-history":[{"count":8,"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=\/wp\/v2\/pages\/401\/revisions"}],"predecessor-version":[{"id":410,"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=\/wp\/v2\/pages\/401\/revisions\/410"}],"wp:attachment":[{"href":"https:\/\/barakadf.or.tz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=401"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}