{"id":560,"date":"2022-09-21T23:10:02","date_gmt":"2022-09-21T23:10:02","guid":{"rendered":"https:\/\/nstarr.arg.org\/?page_id=560"},"modified":"2022-09-22T18:47:44","modified_gmt":"2022-09-22T18:47:44","slug":"residence-form","status":"publish","type":"page","link":"https:\/\/nstarr.arg.org\/index.php\/residence-form\/","title":{"rendered":"Recovery Residence Form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.2.2&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.2.2&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.2.2&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.2.2&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1><strong>Recovery Residence Form<\/strong><\/h1>\n<p><strong><span><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-545\"><form id=\"wpforms-form-545\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"545\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/560\" data-token=\"70c1ff4de911aa63e6f2d5a4c1370c6e\" data-token-time=\"1776509148\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-545-field_31-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_31\">Your Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-545-field_31\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][31][first]\" required><label for=\"wpforms-545-field_31\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-545-field_31-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][31][last]\" required><label for=\"wpforms-545-field_31-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-545-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_19\">Your Title (in relation to the recovery residence) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-545-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required><div class=\"wpforms-field-description\">If you are with an Oxford House, you can state that you are resident if you are not currently an officer.<\/div><\/div><div id=\"wpforms-545-field_30-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_30\">Your email address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-545-field_30\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][30]\" spellcheck=\"false\" required><div class=\"wpforms-field-description\">Provide the email address we should use to email you a survey link, passcode, and information about the study, or to ask you questions about your recovery residence. <\/div><\/div><div id=\"wpforms-545-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_21\">Your phone number<\/label><input type=\"text\" id=\"wpforms-545-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/div><div id=\"wpforms-545-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_2\">Recovery Residence Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-545-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><div class=\"wpforms-field-description\">PLEASE NAME ONE OF YOUR RESIDENCES ONLY. The name of the recovery residence you want to take the NSTARR survey for and\/or add to the NSTARR database. <\/div><\/div><div id=\"wpforms-545-field_34-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_34\">Is this residence an Oxford House?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-545-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_34_1\" name=\"wpforms[fields][34]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_34_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_34_2\" name=\"wpforms[fields][34]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_34_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-545-field_25-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_25\">Recovery Residence Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_25\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][25][address1]\" required><label for=\"wpforms-545-field_25\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_25-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][25][address2]\" ><label for=\"wpforms-545-field_25-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_25-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][25][city]\" required><label for=\"wpforms-545-field_25-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-545-field_25-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][25][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-545-field_25-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_25-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][25][postal]\" required><label for=\"wpforms-545-field_25-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div class=\"wpforms-field-description\">The address of the recovery residence listed above. We will not share this information if you indicate that preference in a following question. <\/div><\/div><div id=\"wpforms-545-field_26-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_26\">Recovery Residence Phone Number<\/label><input type=\"tel\" id=\"wpforms-545-field_26\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][26]\" aria-label=\"Recovery Residence Phone Number\" ><\/div><div id=\"wpforms-545-field_27-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_27\">Recovery Residence Website \/ URL<\/label><input type=\"url\" id=\"wpforms-545-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" ><\/div><div id=\"wpforms-545-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_17\">Do you want to complete a voluntary survey for NSTARR? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-545-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_17_1\" name=\"wpforms[fields][17]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_17_2\" name=\"wpforms[fields][17]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_17_2\">No<\/label><\/li><\/ul><div class=\"wpforms-field-description\">If you select yes, and we don\u2019t already have a completed survey for this residence, we will email you a survey link and passcode to take the survey.\r\n\r\n<\/div><\/div><div id=\"wpforms-545-field_33-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_33\">We will not share your name or contact information with anyone else. Researchers who study recovery residences may be interested in knowing about your residence. Can we share your residence address information with other researchers if they agree not to provide it to anyone else? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-545-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_33_1\" name=\"wpforms[fields][33]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_33_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_33_2\" name=\"wpforms[fields][33]\" value=\"No - Do not share my residence address information\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_33_2\">No - Do not share my residence address information<\/label><\/li><\/ul><\/div><div id=\"wpforms-545-field_10-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_10\">Parent Organization Name<\/label><input type=\"text\" id=\"wpforms-545-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><div class=\"wpforms-field-description\">The name of the organization that operates or manages the recovery residence listed above.<\/div><\/div><div id=\"wpforms-545-field_24-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_24\">Parent Organization Address<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_24\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][24][address1]\" ><label for=\"wpforms-545-field_24\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_24-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][24][address2]\" ><label for=\"wpforms-545-field_24-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_24-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][24][city]\" ><label for=\"wpforms-545-field_24-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-545-field_24-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][24][state]\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-545-field_24-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_24-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][24][postal]\" ><label for=\"wpforms-545-field_24-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div class=\"wpforms-field-description\">*Skip this question if this is an Oxford House<\/div><\/div><div id=\"wpforms-545-field_23-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_23\">Parent Organization Phone Number<\/label><input type=\"tel\" id=\"wpforms-545-field_23\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][23]\" aria-label=\"Parent Organization Phone Number\" ><\/div><div id=\"wpforms-545-field_22-container\" class=\"wpforms-field wpforms-field-url wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"22\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_22\">Parent Organization Website<\/label><input type=\"url\" id=\"wpforms-545-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><\/div><div id=\"wpforms-545-field_53-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"53\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_53\">How many recovery residences does this organization operate?<\/label><input type=\"number\" id=\"wpforms-545-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" ><\/div><div id=\"wpforms-545-field_52-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"52\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_52\">If the parent organization operates other recovery residences, please list the name(s) and the address(es) of those here.<\/label><textarea id=\"wpforms-545-field_52\" class=\"wpforms-field-medium\" name=\"wpforms[fields][52]\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"545\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/pages\/560\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-545\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/nstarr.arg.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/span><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Recovery Residence Form <div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-545\"><form id=\"wpforms-form-545\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"545\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/560\" data-token=\"70c1ff4de911aa63e6f2d5a4c1370c6e\" data-token-time=\"1776509148\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-545-field_31-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_31\">Your Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-545-field_31\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][31][first]\" required><label for=\"wpforms-545-field_31\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-545-field_31-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][31][last]\" required><label for=\"wpforms-545-field_31-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-545-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_19\">Your Title (in relation to the recovery residence) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-545-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required><div class=\"wpforms-field-description\">If you are with an Oxford House, you can state that you are resident if you are not currently an officer.<\/div><\/div><div id=\"wpforms-545-field_30-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_30\">Your email address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-545-field_30\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][30]\" spellcheck=\"false\" required><div class=\"wpforms-field-description\">Provide the email address we should use to email you a survey link, passcode, and information about the study, or to ask you questions about your recovery residence. <\/div><\/div><div id=\"wpforms-545-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_21\">Your phone number<\/label><input type=\"text\" id=\"wpforms-545-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/div><div id=\"wpforms-545-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_2\">Recovery Residence Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-545-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><div class=\"wpforms-field-description\">PLEASE NAME ONE OF YOUR RESIDENCES ONLY. The name of the recovery residence you want to take the NSTARR survey for and\/or add to the NSTARR database. <\/div><\/div><div id=\"wpforms-545-field_34-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_34\">Is this residence an Oxford House?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-545-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_34_1\" name=\"wpforms[fields][34]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_34_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_34_2\" name=\"wpforms[fields][34]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_34_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-545-field_25-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_25\">Recovery Residence Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_25\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][25][address1]\" required><label for=\"wpforms-545-field_25\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_25-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][25][address2]\" ><label for=\"wpforms-545-field_25-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_25-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][25][city]\" required><label for=\"wpforms-545-field_25-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-545-field_25-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][25][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-545-field_25-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_25-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][25][postal]\" required><label for=\"wpforms-545-field_25-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div class=\"wpforms-field-description\">The address of the recovery residence listed above. We will not share this information if you indicate that preference in a following question. <\/div><\/div><div id=\"wpforms-545-field_26-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_26\">Recovery Residence Phone Number<\/label><input type=\"tel\" id=\"wpforms-545-field_26\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][26]\" aria-label=\"Recovery Residence Phone Number\" ><\/div><div id=\"wpforms-545-field_27-container\" class=\"wpforms-field wpforms-field-url\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_27\">Recovery Residence Website \/ URL<\/label><input type=\"url\" id=\"wpforms-545-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" ><\/div><div id=\"wpforms-545-field_17-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_17\">Do you want to complete a voluntary survey for NSTARR? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-545-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_17_1\" name=\"wpforms[fields][17]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_17_2\" name=\"wpforms[fields][17]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_17_2\">No<\/label><\/li><\/ul><div class=\"wpforms-field-description\">If you select yes, and we don\u2019t already have a completed survey for this residence, we will email you a survey link and passcode to take the survey.\r\n\r\n<\/div><\/div><div id=\"wpforms-545-field_33-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_33\">We will not share your name or contact information with anyone else. Researchers who study recovery residences may be interested in knowing about your residence. Can we share your residence address information with other researchers if they agree not to provide it to anyone else? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-545-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_33_1\" name=\"wpforms[fields][33]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_33_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-545-field_33_2\" name=\"wpforms[fields][33]\" value=\"No - Do not share my residence address information\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-545-field_33_2\">No - Do not share my residence address information<\/label><\/li><\/ul><\/div><div id=\"wpforms-545-field_10-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_10\">Parent Organization Name<\/label><input type=\"text\" id=\"wpforms-545-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><div class=\"wpforms-field-description\">The name of the organization that operates or manages the recovery residence listed above.<\/div><\/div><div id=\"wpforms-545-field_24-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_24\">Parent Organization Address<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_24\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][24][address1]\" ><label for=\"wpforms-545-field_24\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-545-field_24-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][24][address2]\" ><label for=\"wpforms-545-field_24-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_24-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][24][city]\" ><label for=\"wpforms-545-field_24-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-545-field_24-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][24][state]\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-545-field_24-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-545-field_24-postal\" class=\"wpforms-field-address-postal wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][24][postal]\" ><label for=\"wpforms-545-field_24-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div class=\"wpforms-field-description\">*Skip this question if this is an Oxford House<\/div><\/div><div id=\"wpforms-545-field_23-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_23\">Parent Organization Phone Number<\/label><input type=\"tel\" id=\"wpforms-545-field_23\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][23]\" aria-label=\"Parent Organization Phone Number\" ><\/div><div id=\"wpforms-545-field_22-container\" class=\"wpforms-field wpforms-field-url wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"22\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_22\">Parent Organization Website<\/label><input type=\"url\" id=\"wpforms-545-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" ><\/div><div id=\"wpforms-545-field_53-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"53\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_53\">How many recovery residences does this organization operate?<\/label><input type=\"number\" id=\"wpforms-545-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" ><\/div><div id=\"wpforms-545-field_52-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"52\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-545-field_52\">If the parent organization operates other recovery residences, please list the name(s) and the address(es) of those here.<\/label><textarea id=\"wpforms-545-field_52\" class=\"wpforms-field-medium\" name=\"wpforms[fields][52]\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"545\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/pages\/560\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-545\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/nstarr.arg.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --> &nbsp;<\/p>\n","protected":false},"author":1000,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<p>[wpforms id=\"545\" title=\"false\" description=\"false\"]<\/p>","_et_gb_content_width":"","footnotes":""},"class_list":["post-560","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/pages\/560","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/users\/1000"}],"replies":[{"embeddable":true,"href":"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/comments?post=560"}],"version-history":[{"count":0,"href":"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/pages\/560\/revisions"}],"wp:attachment":[{"href":"https:\/\/nstarr.arg.org\/index.php\/wp-json\/wp\/v2\/media?parent=560"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}