{"id":1539,"date":"2021-09-02T20:45:31","date_gmt":"2021-09-02T20:45:31","guid":{"rendered":"https:\/\/www.deltastate.edu\/cced\/?page_id=1539"},"modified":"2025-02-13T15:18:29","modified_gmt":"2025-02-13T15:18:29","slug":"tbs-intake","status":"publish","type":"page","link":"https:\/\/www.deltastate.edu\/cced\/bridge\/tbs-intake\/","title":{"rendered":"BRIDGE TBS Intake Form"},"content":{"rendered":"[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; 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#nectar-slider-instance-1, #nectar-slider-instance-1 .swiper-container { height: calc( 420 * 100vw \/ 1600 ); } <\/style><div data-midnight=\"nectar-slider\" class=\"parallax_slider_outer \"><div  data-transition=\"slide\" data-overall_style=\"classic\" data-flexible-height=\"true\" data-animate-in-effect=\"none\" data-fullscreen=\"false\" data-button-sizing=\"regular\" data-button-styling=\"btn_with_count\" data-autorotate=\"\" data-parallax=\"true\" data-parallax-disable-mobile=\"\" data-caption-trans=\"fade_in_from_bottom\" data-parallax-style=\"bg_only\" data-bg-animation=\"none\" data-full-width=\"true\" class=\"nectar-slider-wrap \" id=\"nectar-slider-instance-1\"><div class=\"swiper-container\"  data-tho=\"auto\" data-tco=\"auto\" data-pho=\"auto\" data-pco=\"auto\" data-loop=\"false\" data-height=\"420\" data-min-height=\"250\" data-arrows=\"false\" data-bullets=\"false\" data-bullet_style=\"see_through\" data-bullet_position=\"bottom\" data-desktop-swipe=\"false\" data-settings=\"\"> <div class=\"swiper-wrapper\"><div class=\"swiper-slide\" data-desktop-content-width=\"auto\" data-tablet-content-width=\"auto\" data-bg-alignment=\"center\" data-color-scheme=\"light\" data-x-pos=\"left\" data-y-pos=\"bottom\" ><div class=\"slide-bg-wrap\"><div class=\"image-bg\" style=\"background-image: url(https:\/\/www.deltastate.edu\/cced\/wp-content\/uploads\/sites\/50\/2025\/02\/2.1.17-campus-beauty-11.jpg);\"> &nbsp; <\/div><div class=\"slide-bg-overlay\" style=\"background-color: #0a0a0a;\"> &nbsp; <\/div><\/div><div class=\"container\">\r\n\t\t\t\t\t\t<div class=\"content\"><h1>BRIDGE Technical Business Support (TBS) &amp; Business Assessment Intake<\/h1><\/div>\r\n\t\t\t\t\t\t\t\t<\/div><!--\/container--><div class=\"video-texture \"> <span class=\"ie-fix\"><\/span> <\/div><\/div> <!--\/swiper-slide--><\/div><div class=\"nectar-slider-loading \"> <span class=\"loading-icon none\">   <\/span> <\/div> <\/div> 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' ><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/cced\/wp-json\/wp\/v2\/pages\/1539#gf_3' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_3_94\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_94'>Company<\/label><div class='ginput_container'><input name='input_94' id='input_3_94' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_3_94'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_3_80\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Date of Enrollment<\/legend><div id='input_3_80' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_3_80_1_container'><label for='input_3_80_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_80[]' id='input_3_80_1'   aria-required='false'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_3_80_2_container'><label for='input_3_80_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_80[]' id='input_3_80_2'   aria-required='false'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option 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gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_80[]' id='input_3_80_3'   aria-required='false'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_3_75\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Part I: Client Request for Professional Technical Business Support (Please Complete entire form)<\/h3><\/div><fieldset id=\"field_3_23\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Client Name (Representative of the business)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_3_23'>\n                            \n                            <span id='input_3_23_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.3' id='input_3_23_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_23_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_3_23_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.4' id='input_3_23_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_3_23_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_3_23_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_23.6' id='input_3_23_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_23_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_3_35\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_3_35_container'>\n                                <span id='input_3_35_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_35' id='input_3_35' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_3_35' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_3_35_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_35_2' id='input_3_35_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_3_35_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_3_34\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_34'>Mobile phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_34' id='input_3_34' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_81\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_81'>Work phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_81' id='input_3_81' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_76\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_76'>Fax<\/label><div class='ginput_container ginput_container_phone'><input name='input_76' id='input_3_76' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_82'>Legal Name of Business<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_3_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_83\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you the Owner or Co-owner?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_83'>\n\t\t\t<div class='gchoice gchoice_3_83_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='Owner'  id='choice_3_83_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_83_0' id='label_3_83_0' class='gform-field-label gform-field-label--type-inline'>Owner<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_83_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_83' type='radio' value='Co-owner'  id='choice_3_83_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_83_1' id='label_3_83_1' class='gform-field-label gform-field-label--type-inline'>Co-owner<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_84\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Date of Start of Business<\/legend><div id='input_3_84' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_3_84_1_container'><label for='input_3_84_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_84[]' id='input_3_84_1'   aria-required='false'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_3_84_2_container'><label for='input_3_84_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_84[]' id='input_3_84_2'   aria-required='false'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_3_84_3_container'><label for='input_3_84_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_84[]' id='input_3_84_3'   aria-required='false'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_3_89\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you 18 years old and under?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_89'>\n\t\t\t<div class='gchoice gchoice_3_89_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Yes'  id='choice_3_89_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_89_0' id='label_3_89_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_89_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='No'  id='choice_3_89_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_89_1' id='label_3_89_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_77\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Street Address\/PO Box (give business address if currently in business)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_77' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_77_1_container' >\n                                        <input type='text' name='input_77.1' id='input_3_77_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_77_1' id='input_3_77_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_3_77_2_container' >\n                                        <input type='text' name='input_77.2' id='input_3_77_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_77_2' id='input_3_77_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_3_77_3_container' >\n                                    <input type='text' name='input_77.3' id='input_3_77_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_77_3' id='input_3_77_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_77_4_container' >\n                                        <select name='input_77.4' id='input_3_77_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_3_77_4' id='input_3_77_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_77_5_container' >\n                                    <input type='text' name='input_77.5' id='input_3_77_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_77_5' id='input_3_77_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_77.6' id='input_3_77_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_78\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_78'>County<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_3_78' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_32\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I am requesting professional technical business support from Delta State University&#039;s BRIDGE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_32'>\n\t\t\t<div class='gchoice gchoice_3_32_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='Yes'  id='choice_3_32_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_32_0' id='label_3_32_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_32_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_32' type='radio' value='No'  id='choice_3_32_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_32_1' id='label_3_32_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_47'>Electronic Signature (Consent to Enroll in BRIDGE program):<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_3_47' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_85\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_85'>Your business website<\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_3_85' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Part II: Client Intake Section   (Client must complete entirely prior to services)<\/h3><\/div><fieldset id=\"field_3_50\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Race (mark only one)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_50'>\n\t\t\t<div class='gchoice gchoice_3_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='American Indian or Alaskan Native'  id='choice_3_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_50_0' id='label_3_50_0' class='gform-field-label gform-field-label--type-inline'>American Indian or Alaskan Native<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Asian'  id='choice_3_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_50_1' id='label_3_50_1' class='gform-field-label gform-field-label--type-inline'>Asian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_50_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Black or African American'  id='choice_3_50_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_50_2' id='label_3_50_2' class='gform-field-label gform-field-label--type-inline'>Black or African American<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_50_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Native Hawaiian or Other Pacific Islander'  id='choice_3_50_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_50_3' id='label_3_50_3' class='gform-field-label gform-field-label--type-inline'>Native Hawaiian or Other Pacific Islander<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_50_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='White'  id='choice_3_50_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_50_4' id='label_3_50_4' class='gform-field-label gform-field-label--type-inline'>White<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_50_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='gf_other_choice'  id='choice_3_50_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_50_5' id='label_3_50_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_3_50_other' class='gchoice_other_control' name='input_50_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_51\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Ethnicity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_51'>\n\t\t\t<div class='gchoice gchoice_3_51_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='Hispanic or Latino'  id='choice_3_51_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_51_0' id='label_3_51_0' class='gform-field-label gform-field-label--type-inline'>Hispanic or Latino<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_51_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_51' type='radio' value='Not Hispanic or Latino'  id='choice_3_51_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_51_1' id='label_3_51_1' class='gform-field-label gform-field-label--type-inline'>Not Hispanic or Latino<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_52'>\n\t\t\t<div class='gchoice gchoice_3_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Male'  id='choice_3_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_0' id='label_3_52_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Female'  id='choice_3_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_1' id='label_3_52_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_86\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Disability<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_86'>\n\t\t\t<div class='gchoice gchoice_3_86_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='Yes'  id='choice_3_86_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_86_0' id='label_3_86_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_86_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_86' type='radio' value='No'  id='choice_3_86_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_86_1' id='label_3_86_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_87\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Veteran<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_87'>\n\t\t\t<div class='gchoice gchoice_3_87_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='Yes'  id='choice_3_87_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_87_0' id='label_3_87_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_87_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_87' type='radio' value='No'  id='choice_3_87_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_87_1' id='label_3_87_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_53\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Registered with the Secretary of State of Mississippi<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_53'>\n\t\t\t<div class='gchoice gchoice_3_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='Yes'  id='choice_3_53_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_53_0' id='label_3_53_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='No'  id='choice_3_53_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_53_1' id='label_3_53_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_left_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Legal entity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_54'>\n\t\t\t<div class='gchoice gchoice_3_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='LLC'  id='choice_3_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_0' id='label_3_54_0' class='gform-field-label gform-field-label--type-inline'>LLC<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Corporation'  id='choice_3_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_1' id='label_3_54_1' class='gform-field-label gform-field-label--type-inline'>Corporation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_54_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Sole Proprietorship'  id='choice_3_54_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_2' id='label_3_54_2' class='gform-field-label gform-field-label--type-inline'>Sole Proprietorship<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_54_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='S-Corporation'  id='choice_3_54_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_3' id='label_3_54_3' class='gform-field-label gform-field-label--type-inline'>S-Corporation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_54_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Partnership'  id='choice_3_54_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_4' id='label_3_54_4' class='gform-field-label gform-field-label--type-inline'>Partnership<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_54_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Not formed yet'  id='choice_3_54_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_5' id='label_3_54_5' class='gform-field-label gform-field-label--type-inline'>Not formed yet<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_54_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='gf_other_choice'  id='choice_3_54_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_54_6' id='label_3_54_6' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_3_54_other' class='gchoice_other_control' name='input_54_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_88'>Referred by (please specify)<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_3_88' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_middle_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you currently in business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_55'>\n\t\t\t<div class='gchoice gchoice_3_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_3_55_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_55_0' id='label_3_55_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_3_55_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_55_1' id='label_3_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_61\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_3col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Type of Business (Choose your industry category)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_61'>\n\t\t\t<div class='gchoice gchoice_3_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Manufacturing'  id='choice_3_61_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_0' id='label_3_61_0' class='gform-field-label gform-field-label--type-inline'>Manufacturing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Restaurant'  id='choice_3_61_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_1' id='label_3_61_1' class='gform-field-label gform-field-label--type-inline'>Restaurant<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Construction'  id='choice_3_61_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_2' id='label_3_61_2' class='gform-field-label gform-field-label--type-inline'>Construction<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Retail Trade'  id='choice_3_61_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_3' id='label_3_61_3' class='gform-field-label gform-field-label--type-inline'>Retail Trade<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Real Estate\/Rental\/Leasing'  id='choice_3_61_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_4' id='label_3_61_4' class='gform-field-label gform-field-label--type-inline'>Real Estate\/Rental\/Leasing<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Finance &amp; Insurance'  id='choice_3_61_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_5' id='label_3_61_5' class='gform-field-label gform-field-label--type-inline'>Finance &amp; Insurance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Technology'  id='choice_3_61_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_6' id='label_3_61_6' class='gform-field-label gform-field-label--type-inline'>Technology<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Educational Services'  id='choice_3_61_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_7' id='label_3_61_7' class='gform-field-label gform-field-label--type-inline'>Educational Services<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Professional, Technical Services'  id='choice_3_61_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_8' id='label_3_61_8' class='gform-field-label gform-field-label--type-inline'>Professional, Technical Services<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Health Care'  id='choice_3_61_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_9' id='label_3_61_9' class='gform-field-label gform-field-label--type-inline'>Health Care<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Administrative &amp; Support'  id='choice_3_61_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_10' id='label_3_61_10' class='gform-field-label gform-field-label--type-inline'>Administrative &amp; Support<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_61_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='gf_other_choice'  id='choice_3_61_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_61_11' id='label_3_61_11' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_3_61_other' class='gchoice_other_control' name='input_61_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_64'>Total No. of Employees (Full Time), not including self<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_3_64' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_65'>Total No. of Employees (Part Time), not including self<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_3_65' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >MDA Women &amp; Minority Certified<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_58'>\n\t\t\t<div class='gchoice gchoice_3_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Yes'  id='choice_3_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_58_0' id='label_3_58_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='No'  id='choice_3_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_58_1' id='label_3_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_67\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_middle_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >SBA HubZone Certified<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_67'>\n\t\t\t<div class='gchoice gchoice_3_67_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Yes'  id='choice_3_67_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_67_0' id='label_3_67_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_67_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='No'  id='choice_3_67_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_67_1' id='label_3_67_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gf_left_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Registered with MS APEX Procurement Accelerator<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_66'>\n\t\t\t<div class='gchoice gchoice_3_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Yes'  id='choice_3_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_66_0' id='label_3_66_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='No'  id='choice_3_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_66_1' id='label_3_66_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_68\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you use Social Media for your business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_68'>\n\t\t\t<div class='gchoice gchoice_3_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Yes'  id='choice_3_68_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_68_0' id='label_3_68_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='No'  id='choice_3_68_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_68_1' id='label_3_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gf_middle_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do you conduct business online?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_70'>\n\t\t\t<div class='gchoice gchoice_3_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes'  id='choice_3_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_70_0' id='label_3_70_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No'  id='choice_3_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_70_1' id='label_3_70_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_90\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Would you like to participate in the BRIDGE Family Entrepreneurship\/Youth &amp; Family Financial Literacy Program?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_90'>\n\t\t\t<div class='gchoice gchoice_3_90_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Yes'  id='choice_3_90_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_90_0' id='label_3_90_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_90_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='No'  id='choice_3_90_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_90_1' id='label_3_90_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_91\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you interested in applying for a loan for your business?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_91'>\n\t\t\t<div class='gchoice gchoice_3_91_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='Yes'  id='choice_3_91_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_91_0' id='label_3_91_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_91_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_91' type='radio' value='No'  id='choice_3_91_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_91_1' id='label_3_91_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_92\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you interested in a credit repair program?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_92'>\n\t\t\t<div class='gchoice gchoice_3_92_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_92' type='radio' value='Yes'  id='choice_3_92_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_92_0' id='label_3_92_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_92_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_92' type='radio' value='No'  id='choice_3_92_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_92_1' id='label_3_92_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_93\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you interested in participating in the Sunflower County Small Business Marketplace?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_93'>\n\t\t\t<div class='gchoice gchoice_3_93_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='Yes'  id='choice_3_93_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_93_0' id='label_3_93_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_93_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_93' type='radio' value='No'  id='choice_3_93_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_93_1' id='label_3_93_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_74\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_2col gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What is the nature of professional technical business support you are seeking? (Choose primary category)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_74'>\n\t\t\t<div class='gchoice gchoice_3_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Start-up Assistance'  id='choice_3_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_0' id='label_3_74_0' class='gform-field-label gform-field-label--type-inline'>Start-up Assistance<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Business Plan'  id='choice_3_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_1' id='label_3_74_1' class='gform-field-label gform-field-label--type-inline'>Business Plan<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Financing\/Capital (ex. applying for loan, building equity capital)'  id='choice_3_74_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_2' id='label_3_74_2' class='gform-field-label gform-field-label--type-inline'>Financing\/Capital (ex. applying for loan, building equity capital)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Managing a Business'  id='choice_3_74_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_3' id='label_3_74_3' class='gform-field-label gform-field-label--type-inline'>Managing a Business<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Human Resources\/Managing Employees'  id='choice_3_74_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_4' id='label_3_74_4' class='gform-field-label gform-field-label--type-inline'>Human Resources\/Managing Employees<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Customer Relations'  id='choice_3_74_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_5' id='label_3_74_5' class='gform-field-label gform-field-label--type-inline'>Customer Relations<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Business Accounting\/Budget'  id='choice_3_74_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_6' id='label_3_74_6' class='gform-field-label gform-field-label--type-inline'>Business Accounting\/Budget<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Cash Flow Management'  id='choice_3_74_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_7' id='label_3_74_7' class='gform-field-label gform-field-label--type-inline'>Cash Flow Management<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Tax Planning'  id='choice_3_74_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_8' id='label_3_74_8' class='gform-field-label gform-field-label--type-inline'>Tax Planning<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Marketing\/Sales (promotion, research, pricing, etc.)'  id='choice_3_74_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_9' id='label_3_74_9' class='gform-field-label gform-field-label--type-inline'>Marketing\/Sales (promotion, research, pricing, etc.)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Government Contracting (including certifications)'  id='choice_3_74_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_10' id='label_3_74_10' class='gform-field-label gform-field-label--type-inline'>Government Contracting (including certifications)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Franchising'  id='choice_3_74_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_11' id='label_3_74_11' class='gform-field-label gform-field-label--type-inline'>Franchising<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Buy\/Sell Business'  id='choice_3_74_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_12' id='label_3_74_12' class='gform-field-label gform-field-label--type-inline'>Buy\/Sell Business<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Technology\/Computers'  id='choice_3_74_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_13' id='label_3_74_13' class='gform-field-label gform-field-label--type-inline'>Technology\/Computers<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='eCommerce (using the Internet to do business)'  id='choice_3_74_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_14' id='label_3_74_14' class='gform-field-label gform-field-label--type-inline'>eCommerce (using the Internet to do business)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Legal Issues (ex. Should I incorporate?)'  id='choice_3_74_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_15' id='label_3_74_15' class='gform-field-label gform-field-label--type-inline'>Legal Issues (ex. Should I incorporate?)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='COVID-19 Relief Options'  id='choice_3_74_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_16' id='label_3_74_16' class='gform-field-label gform-field-label--type-inline'>COVID-19 Relief Options<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_74_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='gf_other_choice'  id='choice_3_74_17' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_74_17' id='label_3_74_17' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_3_74_other' class='gchoice_other_control' name='input_74_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' 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