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If you’re concerned your internet usage might be monitored, call us at 800.799.SAFE (7233). <strong><a href="https://www.thehotline.org/plan-for-safety/internet-safety/">Learn more about digital security</a></strong> and remember to clear your browser history after visiting this website.</p> <p><strong>Click the red “X” in the upper-right corner or “Escape” button on your keyboard twice at any time to leave TheHotline.org immediately.</strong></p> <p class="safety1-action"><a href="#" class="button1 -small" toggle="^.modal1//-" x-data="quickookie()" x-init="cookie_name='modal'" @click="set()"><span>OK</span></a></p> </div> </div> </div> </div> <section role="main" class="content1" id="content" data-warning="Your browser is outdated, it will not render this page properly, please upgrade."> <div class="wrap1"> <div class="wrap1-inner -contain"> <div class="header4"> <div class="header4-main"> <h1 class="title1" reveal="1+/0"> Create Your Personal Safety Plan </h1> </div> <figure class="header4-image" reveal="1+/1"> <span class="img1 " style="--r: 0.8" > <img class="lazyload" data-src="https://www.thehotline.org/wp-content/uploads/media/2020/09/1214306912-hotline-700x560-1.png" alt="create your personal safety plan using our interactive tool" data-srcset="https://www.thehotline.org/wp-content/uploads/media/2020/09/1214306912-hotline-700x560-1.png 700w, https://www.thehotline.org/wp-content/uploads/media/2020/09/1214306912-hotline-700x560-1-500x400.png 500w" data-sizes="auto" /> <i class="loader1 "></i> <noscript><img src="https://www.thehotline.org/wp-content/uploads/media/2020/09/1214306912-hotline-700x560-1.png" alt="create your personal safety plan using our interactive tool"></noscript> </span> <figcaption class="sr-only">create your personal safety plan using our interactive tool</figcaption> </figure> </div> </div> </div> <div class="-xw:4 -contain -mx:a -wysiwyg"><p><b>A <a href="https://www.thehotline.org/create-a-domestic-violence-safety-plan/">safety plan</a> is a personalized, practical plan to improve your safety while experiencing abuse, preparing to <a href="https://www.loveisrespect.org/resources/how-to-make-a-go-bag-when-leaving-an-abusive-relationship/">leave an abusive situation</a>, or after you leave.</b> Follow the steps below to create your personal safety plan.</p> </div><div class="-mt:3"></div><div class="form1 -xw:2 -mx:a -pb:3 -contain"><script type="text/javascript"></script> <div class='gf_browser_chrome gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework gravity-forms-safety-guide_wrapper' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'></div> <div class='gform_heading'> <h3 class="gform_title">Interactive guide to safety planning</h3> <p class='gform_description'></p> </div><form method='post' enctype='multipart/form-data' id='gform_1' class='gravity-forms-safety-guide' action='/plan-for-safety/create-your-personal-safety-plan/#gf_1' data-formid='1' novalidate><div id='gf_page_steps_1' class='gf_page_steps'><div id='gf_step_1_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1</span><span class='gf_step_label'>Introduction</span></div><div id='gf_step_1_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2</span><span class='gf_step_label'>Basics</span></div><div id='gf_step_1_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3</span><span class='gf_step_label'>Home</span></div><div id='gf_step_1_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4</span><span class='gf_step_label'>School</span></div><div id='gf_step_1_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5</span><span class='gf_step_label'>Job</span></div><div id='gf_step_1_6' class='gf_step gf_step_pending'><span class='gf_step_number'>6</span><span class='gf_step_label'>Technology</span></div><div id='gf_step_1_7' class='gf_step gf_step_pending'><span class='gf_step_number'>7</span><span class='gf_step_label'>Partner</span></div><div id='gf_step_1_8' class='gf_step gf_step_pending'><span class='gf_step_number'>8</span><span class='gf_step_label'>Children</span></div><div id='gf_step_1_9' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>9</span><span class='gf_step_label'>Emotional</span></div></div> <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page introduction' data-js='page-field-id-1' > <div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_11" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_11" ><div class="-xw:4"> <br /><strong>SAFETY ALERT:</strong> The interactive guide to safety planning requires you to enter information into an online form. Before you begin, be sure that the computer you are using is in a safe location and is not being monitored by your partner. <a href="https://www.loveisrespect.org/wp-content/uploads/2019/11/LIR-Who_Spying-1.pdf">Click here</a> to learn more about how an abusive partner can monitor your computer. <br> </br> <p> If you are using a school or work computer, remember that the information you enter may be monitored by your school or employer. </p> <p> If it is not safe for you to enter information into the computer, you can still read through the safety plan and think about your answers to the questions. </p> <p> When you exit the safety plan, your information will not be stored on the website. If you need to exit the safety plan quickly, click on the "Escape" button at the top right of the page. If you are in danger, call 911 immediately. </p> <br /><strong>WHAT IS A SAFETY PLAN?</strong> <p>A safety plan is a set of actions that can help lower your risk of being hurt by your partner. It includes information specific to you and your life that will increase your safety at school, home, and other places that you go on a daily basis.</p> <br /><p> <strong>HOW DO I MAKE A SAFETY PLAN?</strong> </p> <p> Take some time to go through each section of this safety planning tool. You will be asked a series of questions to help you identify your safety options. You can use this tool on your own, or you can use it with a friend or an adult you trust. </p> <p> Click on the <i class="gftip gftip-info-circle"></i> to see additional safety tips and other helpful information. </p> <p> At the end of the process, you will have a printable version of your personalized safety plan that you can reference whenever you need it. You can read it online, print it immediately, or have a link sent to your email. The link will be active for 24 hours; after that, your information will be deleted from the website. </p> <p> You will also be given a pocket-sized emergency contact card that you can fill out with phone numbers and keep with you at all times so you always know how to contact the most important people. </p> <br /><p> <strong>KEEP IN MIND:</strong> </p> <ul> <li>For this safety plan to work for you, the information you fill in must be honest and accurate.</li> <li>Once you complete your safety plan, be sure to keep it in an accessible but secure location. You should also consider giving a copy of your safety plan to someone that you trust.</li> <li>If you don't feel safe keeping the printed safety plan or emergency contact card with you, then you can still use the safety tips. Try to memorize at least one phone number of someone you can call any time.</li> <li>You know your situation better than anyone else; trust your judgment and weigh your options before taking any steps.</li> </ul> </div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_next_button_1_8' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-8' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_18" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_18" ></li><li id="field_1_5" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_5" ><label class='gfield_label gform-field-label' >Whom do you live with?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_5'> <li class='gchoice gchoice_1_5_0'> <input name='input_5' type='radio' value='Family' id='choice_1_5_0' /> <label for='choice_1_5_0' id='label_1_5_0' class='gform-field-label gform-field-label--type-inline'>Family</label> </li> <li class='gchoice gchoice_1_5_1'> <input name='input_5' type='radio' value='Roommates' id='choice_1_5_1' /> <label for='choice_1_5_1' id='label_1_5_1' class='gform-field-label gform-field-label--type-inline'>Roommates</label> </li> <li class='gchoice gchoice_1_5_2'> <input name='input_5' type='radio' value='Alone' id='choice_1_5_2' /> <label for='choice_1_5_2' id='label_1_5_2' class='gform-field-label gform-field-label--type-inline'>Alone</label> </li> <li class='gchoice gchoice_1_5_3'> <input name='input_5' type='radio' value='My partner' id='choice_1_5_3' /> <label for='choice_1_5_3' id='label_1_5_3' class='gform-field-label gform-field-label--type-inline'>My partner</label> </li></ul></div></li><li id="field_1_1" class="gfield gfield--type-address gfield--input-type-address field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_1" ><label class='gfield_label gform-field-label gfield_label_before_complex' >What’s your zip code?</label><div class='gfield_description' id='gfield_description_1_1'>This will help us find resources in your community.</div> <div class='ginput_complex ginput_container has_zip ginput_container_address gform-grid-row' id='input_1_1' > <input type='hidden' class='gform_hidden' name='input_1.4' id='input_1_1_4' value=''/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_1_5_container' > <input type='text' name='input_1.5' id='input_1_1_5' value='' placeholder='12345' aria-required='false' /> <label for='input_1_1_5' id='input_1_1_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code</label> </span><input type='hidden' class='gform_hidden' name='input_1.6' id='input_1_1_6' value='United States' /> <div class='gf_clear gf_clear_complex'></div> </div></li><li id="field_1_6" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_6" ><label class='gfield_label gform-field-label' >What school do you attend?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_6'> <li class='gchoice gchoice_1_6_0'> <input name='input_6' type='radio' value='Middle school' id='choice_1_6_0' /> <label for='choice_1_6_0' id='label_1_6_0' class='gform-field-label gform-field-label--type-inline'>Middle school</label> </li> <li class='gchoice gchoice_1_6_1'> <input name='input_6' type='radio' value='High school' id='choice_1_6_1' /> <label for='choice_1_6_1' id='label_1_6_1' class='gform-field-label gform-field-label--type-inline'>High school</label> </li> <li class='gchoice gchoice_1_6_2'> <input name='input_6' type='radio' value='College/University' id='choice_1_6_2' /> <label for='choice_1_6_2' id='label_1_6_2' class='gform-field-label gform-field-label--type-inline'>College/University</label> </li> <li class='gchoice gchoice_1_6_3'> <input name='input_6' type='radio' value='I'm not in school' id='choice_1_6_3' /> <label for='choice_1_6_3' id='label_1_6_3' class='gform-field-label gform-field-label--type-inline'>I'm not in school</label> </li></ul></div></li><li id="field_1_7" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_7" ><label class='gfield_label gform-field-label' >Do you have a job?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_7'> <li class='gchoice gchoice_1_7_0'> <input name='input_7' type='radio' value='Yes' id='choice_1_7_0' /> <label for='choice_1_7_0' id='label_1_7_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_7_1'> <input name='input_7' type='radio' value='No' id='choice_1_7_1' /> <label for='choice_1_7_1' id='label_1_7_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_12" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_12" ><label class='gfield_label gform-field-label' >Do you have children (or are you currently pregnant)?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_12'> <li class='gchoice gchoice_1_12_0'> <input name='input_12' type='radio' value='Yes' id='choice_1_12_0' /> <label for='choice_1_12_0' id='label_1_12_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_12_1'> <input name='input_12' type='radio' value='No' id='choice_1_12_1' /> <label for='choice_1_12_1' id='label_1_12_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_31" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_31" ><label class='gfield_label gform-field-label' >If Yes: How old are your children</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_31'> <li class='gchoice gchoice_1_31_0'> <input name='input_31' type='radio' value='All are younger than 5' id='choice_1_31_0' /> <label for='choice_1_31_0' id='label_1_31_0' class='gform-field-label gform-field-label--type-inline'>All are younger than 5</label> </li> <li class='gchoice gchoice_1_31_1'> <input name='input_31' type='radio' value='Some are younger than 5 and some older' id='choice_1_31_1' /> <label for='choice_1_31_1' id='label_1_31_1' class='gform-field-label gform-field-label--type-inline'>Some are younger than 5 and some older</label> </li> <li class='gchoice gchoice_1_31_2'> <input name='input_31' type='radio' value='All are older than 5' id='choice_1_31_2' /> <label for='choice_1_31_2' id='label_1_31_2' class='gform-field-label gform-field-label--type-inline'>All are older than 5</label> </li></ul></div></li><li id="field_1_13" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible" data-js-reload="field_1_13" ><label class='gfield_label gform-field-label' >Do you identify as:</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_13'> <li class='gchoice gchoice_1_13_0'> <input name='input_13' type='radio' value='Straight' id='choice_1_13_0' /> <label for='choice_1_13_0' id='label_1_13_0' class='gform-field-label gform-field-label--type-inline'>Straight</label> </li> <li class='gchoice gchoice_1_13_1'> <input name='input_13' type='radio' value='Lesbian, gay, bisexual, or queer' id='choice_1_13_1' /> <label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>Lesbian, gay, bisexual, or queer</label> </li> <li class='gchoice gchoice_1_13_2'> <input name='input_13' type='radio' value='Other' id='choice_1_13_2' /> <label for='choice_1_13_2' id='label_1_13_2' class='gform-field-label gform-field-label--type-inline'>Other</label> </li></ul></div></li><li id="field_1_74" class="gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_74" ><label class='gfield_label gform-field-label' for='input_1_74'>Gender:</label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_1_74' type='text' value='' class='medium' aria-invalid="false" /> </div></li><li id="field_1_15" class="gfield gfield--type-email gfield--input-type-email field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_15" ><label class='gfield_label gform-field-label' for='input_1_15'>Email address</label><div class='gfield_description' id='gfield_description_1_15'>We’ll email a private link to your safety plan to the following email address. This link will expire after 24 hours and your private data will be deleted from our site. We never store your information.</div><div class='ginput_container ginput_container_email'> <input name='input_15' id='input_1_15' type='email' value='' class='medium' placeholder='Email address' aria-invalid="false" aria-describedby="gfield_description_1_15" /> </div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_1_19' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("1"); jQuery("#gform_1").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_1_19' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-19' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_17" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_17" > </li><li id="field_1_32" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_32" ><label class='gfield_label gform-field-label' >Have you told someone in your family about your relationship?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_32'> <li class='gchoice gchoice_1_32_0'> <input name='input_32' type='radio' value='Yes' id='choice_1_32_0' /> <label for='choice_1_32_0' id='label_1_32_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_32_1'> <input name='input_32' type='radio' value='No' id='choice_1_32_1' /> <label for='choice_1_32_1' id='label_1_32_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_33" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_33" ><label class='gfield_label gform-field-label' for='input_1_33'>What word or phrase can you use as a code in a phone call, text, or instant message to ask your family, friends, or neighbors to call for help without your partner knowing?</label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_1_33' type='text' value='' class='medium' aria-invalid="false" /> </div></li><li id="field_1_34" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_34" ><label class='gfield_label gform-field-label' for='input_1_34'>During times when you are home alone, who can stay with you if you don't want to be alone?</label><div class='gfield_description' id='gfield_description_1_34'>Write this person's phone number on your emergency card and keep it in your wallet or another safe place. This way you can reach your friends and family even when you do not have your cell phone. This is especially important if your partner has ever threatened or tried to take or break your cell phone.</div><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='medium' aria-describedby="gfield_description_1_34" aria-invalid="false" /> </div></li><li id="field_1_35" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_35" ><label class='gfield_label gform-field-label' for='input_1_35'>If you're not comfortable being at home, where else could you go to stay safe?</label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='medium' aria-invalid="false" /> </div></li><li id="field_1_36" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_36" ><label class='gfield_label gform-field-label' for='input_1_36'>If you need to leave your home in an emergency, what is a safe public place where you could go?</label><div class='gfield_description' id='gfield_description_1_36'>This can be a nearby police station, a store, a McDonald's, or any other place that's open and has people around.</div><div class='ginput_container ginput_container_text'><input name='input_36' id='input_1_36' type='text' value='' class='medium' aria-describedby="gfield_description_1_36" aria-invalid="false" /> </div></li><li id="field_1_40" class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_40" ><label class='gfield_label gform-field-label gfield_label_before_complex' >If you need to leave your house quickly, which items would you need to take with you?</label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_40'><li class='gchoice gchoice_1_40_1'> <input class='gfield-choice-input' name='input_40.1' type='checkbox' value='Identification (e.g., driver's license, school ID, military ID, immigration documents)' id='choice_1_40_1' /> <label for='choice_1_40_1' id='label_1_40_1' class='gform-field-label gform-field-label--type-inline'>Identification (e.g., driver's license, school ID, military ID, immigration documents)</label> </li><li class='gchoice gchoice_1_40_2'> <input class='gfield-choice-input' name='input_40.2' type='checkbox' value='Cell Phone' id='choice_1_40_2' /> <label for='choice_1_40_2' id='label_1_40_2' class='gform-field-label gform-field-label--type-inline'>Cell Phone</label> </li><li class='gchoice gchoice_1_40_3'> <input class='gfield-choice-input' name='input_40.3' type='checkbox' value='Cell phone charger' id='choice_1_40_3' /> <label for='choice_1_40_3' id='label_1_40_3' class='gform-field-label gform-field-label--type-inline'>Cell phone charger</label> </li><li class='gchoice gchoice_1_40_4'> <input class='gfield-choice-input' name='input_40.4' type='checkbox' value='Medication (e.g., asthma inhaler, insulin, Epi-Pen)' id='choice_1_40_4' /> <label for='choice_1_40_4' id='label_1_40_4' class='gform-field-label gform-field-label--type-inline'>Medication (e.g., asthma inhaler, insulin, Epi-Pen)</label> </li><li class='gchoice gchoice_1_40_5'> <input class='gfield-choice-input' name='input_40.5' type='checkbox' value='Cash' id='choice_1_40_5' /> <label for='choice_1_40_5' id='label_1_40_5' class='gform-field-label gform-field-label--type-inline'>Cash</label> </li><li class='gchoice gchoice_1_40_6'> <input class='gfield-choice-input' name='input_40.6' type='checkbox' value='ATM card' id='choice_1_40_6' /> <label for='choice_1_40_6' id='label_1_40_6' class='gform-field-label gform-field-label--type-inline'>ATM card</label> </li><li class='gchoice gchoice_1_40_7'> <input class='gfield-choice-input' name='input_40.7' type='checkbox' value='House key' id='choice_1_40_7' /> <label for='choice_1_40_7' id='label_1_40_7' class='gform-field-label gform-field-label--type-inline'>House key</label> </li><li class='gchoice gchoice_1_40_8'> <input class='gfield-choice-input' name='input_40.8' type='checkbox' value='Car key' id='choice_1_40_8' /> <label for='choice_1_40_8' id='label_1_40_8' class='gform-field-label gform-field-label--type-inline'>Car key</label> </li><li class='gchoice gchoice_1_40_9'> <input class='gfield-choice-input' name='input_40.9' type='checkbox' value='A change of clothes' id='choice_1_40_9' /> <label for='choice_1_40_9' id='label_1_40_9' class='gform-field-label gform-field-label--type-inline'>A change of clothes</label> </li><li class='gchoice gchoice_1_40_11'> <input class='gfield-choice-input' name='input_40.11' type='checkbox' value='Comfort items (e.g., favorite stuffed animal or photograph)' id='choice_1_40_11' /> <label for='choice_1_40_11' id='label_1_40_11' class='gform-field-label gform-field-label--type-inline'>Comfort items (e.g., favorite stuffed animal or photograph)</label> </li><li class='gchoice gchoice_1_40_12'> <input class='gfield-choice-input' name='input_40.12' type='checkbox' value='Baby supplies (formula, diaper, wipes, change of clothes)' id='choice_1_40_12' /> <label for='choice_1_40_12' id='label_1_40_12' class='gform-field-label gform-field-label--type-inline'>Baby supplies (formula, diaper, wipes, change of clothes)</label> </li><li class='gchoice gchoice_1_40_13'> <input class='gfield-choice-input' name='input_40.13' type='checkbox' value='Copy of Protection/Restraining Order' id='choice_1_40_13' /> <label for='choice_1_40_13' id='label_1_40_13' class='gform-field-label gform-field-label--type-inline'>Copy of Protection/Restraining Order</label> </li><li class='gchoice gchoice_1_40_14'> <input class='gfield-choice-input' name='input_40.14' type='checkbox' value='Child's birth certificate' id='choice_1_40_14' /> <label for='choice_1_40_14' id='label_1_40_14' class='gform-field-label gform-field-label--type-inline'>Child's birth certificate</label> </li><li class='gchoice gchoice_1_40_15'> <input class='gfield-choice-input' name='input_40.15' type='checkbox' value='Health insurance card' id='choice_1_40_15' /> <label for='choice_1_40_15' id='label_1_40_15' class='gform-field-label gform-field-label--type-inline'>Health insurance card</label> </li><li class='gchoice gchoice_1_40_16'> <input class='gfield-choice-input' name='input_40.16' type='checkbox' value='Other' id='choice_1_40_16' /> <label for='choice_1_40_16' id='label_1_40_16' class='gform-field-label gform-field-label--type-inline'>Other</label> </li></ul></div></li><li id="field_1_41" class="gfield gfield--type-text gfield--input-type-text field-other field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_41" ><label class='gfield_label gform-field-label' for='input_1_41'>Other:</label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_1_41' type='text' value='' class='medium' aria-invalid="false" /> </div></li><li id="field_1_42" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_42" ><label class='gfield_label gform-field-label' >Do you have a protection order against your partner?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_42'> <li class='gchoice gchoice_1_42_0'> <input name='input_42' type='radio' value='Yes' id='choice_1_42_0' /> <label for='choice_1_42_0' id='label_1_42_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_42_1'> <input name='input_42' type='radio' value='No' id='choice_1_42_1' /> <label for='choice_1_42_1' id='label_1_42_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_1_20' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("2"); jQuery("#gform_1").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_1_20' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("4"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("4"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-20' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_16" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_16" ></li><li id="field_1_69" class="gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_69" ><label class='gfield_label gform-field-label' for='input_1_69'>If you need to avoid seeing your partner on your way to or from class, what route can you take to get you there safely?</label><div class='gfield_description' id='gfield_description_1_69'>This should be a different route than you usually take.</div><div class='ginput_container ginput_container_textarea'><textarea name='input_69' id='input_1_69' class='textarea small' aria-describedby="gfield_description_1_69" aria-invalid="false" rows='10' cols='50'></textarea></div></li><li id="field_1_70" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_70" ><label class='gfield_label gform-field-label' >Have you told someone on campus about your relationship?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_70'> <li class='gchoice gchoice_1_70_0'> <input name='input_70' type='radio' value='Yes' id='choice_1_70_0' /> <label for='choice_1_70_0' id='label_1_70_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_70_1'> <input name='input_70' type='radio' value='No' id='choice_1_70_1' /> <label for='choice_1_70_1' id='label_1_70_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_71" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_71" ><label class='gfield_label gform-field-label' for='input_1_71'>Whom can you spend time with between classes, so that you are not alone?</label><div class='gfield_description' id='gfield_description_1_71'>You can list more than one person.</div><div class='ginput_container ginput_container_text'><input name='input_71' id='input_1_71' type='text' value='' class='medium' aria-describedby="gfield_description_1_71" aria-invalid="false" /> </div></li><li id="field_1_73" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_73" ><label class='gfield_label gform-field-label' for='input_1_73'>If you need to leave school immediately, whom can you call to pick you up or meet you?</label><div class='gfield_description' id='gfield_description_1_73'>Write this person's phone number on your emergency card and keep it in your wallet or another safe place.</div><div class='ginput_container ginput_container_text'><input name='input_73' id='input_1_73' type='text' value='' class='medium' aria-describedby="gfield_description_1_73" aria-invalid="false" /> </div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_1_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("3"); jQuery("#gform_1").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_1_21' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("5"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("5"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-21' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_22" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_22" > </li><li id="field_1_43" class="gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_43" ><label class='gfield_label gform-field-label' for='input_1_43'>If you want to avoid seeing your partner on your way to or from work, what route can you take to get there safely?</label><div class='gfield_description' id='gfield_description_1_43'>This should be a different route than you usually take.</div><div class='ginput_container ginput_container_textarea'><textarea name='input_43' id='input_1_43' class='textarea small' aria-describedby="gfield_description_1_43" aria-invalid="false" rows='10' cols='50'></textarea></div></li><li id="field_1_44" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_44" ><label class='gfield_label gform-field-label' >Have you told someone at work about your relationship?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_44'> <li class='gchoice gchoice_1_44_0'> <input name='input_44' type='radio' value='Yes' id='choice_1_44_0' /> <label for='choice_1_44_0' id='label_1_44_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_44_1'> <input name='input_44' type='radio' value='No' id='choice_1_44_1' /> <label for='choice_1_44_1' id='label_1_44_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_45" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_45" ><label class='gfield_label gform-field-label' >Does your partner work at the same place?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_45'> <li class='gchoice gchoice_1_45_0'> <input name='input_45' type='radio' value='Yes' id='choice_1_45_0' /> <label for='choice_1_45_0' id='label_1_45_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_45_1'> <input name='input_45' type='radio' value='No' id='choice_1_45_1' /> <label for='choice_1_45_1' id='label_1_45_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_47" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_47" ><label class='gfield_label gform-field-label' for='input_1_47'>If you need to leave work immediately, whom can you call to pick you up or meet you?</label><div class='gfield_description' id='gfield_description_1_47'>Write this person's phone number on your emergency card and keep it in your wallet or another safe place.</div><div class='ginput_container ginput_container_text'><input name='input_47' id='input_1_47' type='text' value='' class='medium' aria-describedby="gfield_description_1_47" aria-invalid="false" /> </div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_1_23' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='jQuery("#gform_target_page_number_1").val("4"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("4"); jQuery("#gform_1").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_1_23' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("6"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("6"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-23' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_24" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_24" > </li><li id="field_1_48" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_48" ><label class='gfield_label gform-field-label' >Do you have and use a cell phone?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_48'> <li class='gchoice gchoice_1_48_0'> <input name='input_48' type='radio' value='Yes' id='choice_1_48_0' /> <label for='choice_1_48_0' id='label_1_48_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_48_1'> <input name='input_48' type='radio' value='No' id='choice_1_48_1' /> <label for='choice_1_48_1' id='label_1_48_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_49" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_49" ><label class='gfield_label gform-field-label' >Has your partner ever checked your outgoing calls, text messages, or browsing history on your cell phone or computer?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_49'> <li class='gchoice gchoice_1_49_0'> <input name='input_49' type='radio' value='Yes' id='choice_1_49_0' /> <label for='choice_1_49_0' id='label_1_49_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_49_1'> <input name='input_49' type='radio' value='No' id='choice_1_49_1' /> <label for='choice_1_49_1' id='label_1_49_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_50" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_50" ><label class='gfield_label gform-field-label' >Do you use social networking sites?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_50'> <li class='gchoice gchoice_1_50_0'> <input name='input_50' type='radio' value='Yes' id='choice_1_50_0' /> <label for='choice_1_50_0' id='label_1_50_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_50_1'> <input name='input_50' type='radio' value='No' id='choice_1_50_1' /> <label for='choice_1_50_1' id='label_1_50_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_51" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_51" ><label class='gfield_label gform-field-label' >Has your partner ever sent you an abusive email, text message, or voicemail?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_51'> <li class='gchoice gchoice_1_51_0'> <input name='input_51' type='radio' value='Yes' id='choice_1_51_0' /> <label for='choice_1_51_0' id='label_1_51_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_51_1'> <input name='input_51' type='radio' value='No' id='choice_1_51_1' /> <label for='choice_1_51_1' id='label_1_51_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_52" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_52" ><label class='gfield_label gform-field-label' >Have you shared passwords to your online accounts with your partner?</label><div class='gfield_description' id='gfield_description_1_52'>Be sure to think about all your online accounts, such as Facebook, email, blog, instant messaging, and online banking.</div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_52'> <li class='gchoice gchoice_1_52_0'> <input name='input_52' type='radio' value='Yes' id='choice_1_52_0' /> <label for='choice_1_52_0' id='label_1_52_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_52_1'> <input name='input_52' type='radio' value='No' id='choice_1_52_1' /> <label for='choice_1_52_1' id='label_1_52_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_53" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_53" ><label class='gfield_label gform-field-label' >Does a trusted friend or family member have access to your online accounts?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_53'> <li class='gchoice gchoice_1_53_0'> <input name='input_53' type='radio' value='Yes' id='choice_1_53_0' /> <label for='choice_1_53_0' id='label_1_53_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_53_1'> <input name='input_53' type='radio' value='No' id='choice_1_53_1' /> <label for='choice_1_53_1' id='label_1_53_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_54" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_54" ><label class='gfield_label gform-field-label' >Has your partner ever pretended to be you online?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_54'> <li class='gchoice gchoice_1_54_0'> <input name='input_54' type='radio' value='Yes' id='choice_1_54_0' /> <label for='choice_1_54_0' id='label_1_54_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_54_1'> <input name='input_54' type='radio' value='No' id='choice_1_54_1' /> <label for='choice_1_54_1' id='label_1_54_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_55" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_55" ><label class='gfield_label gform-field-label' >Have you ever sent your partner private photos of yourself?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_55'> <li class='gchoice gchoice_1_55_0'> <input name='input_55' type='radio' value='Yes' id='choice_1_55_0' /> <label for='choice_1_55_0' id='label_1_55_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_55_1'> <input name='input_55' type='radio' value='No' id='choice_1_55_1' /> <label for='choice_1_55_1' id='label_1_55_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_1_25' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='jQuery("#gform_target_page_number_1").val("5"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("5"); jQuery("#gform_1").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_1_25' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("7"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("7"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_7' class='gform_page' data-js='page-field-id-25' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_26" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_26" > </li><li id="field_1_56" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_56" ><label class='gfield_label gform-field-label' for='input_1_56'>Who could you call or text to let them know where you are going with your partner?</label><div class='gfield_description' id='gfield_description_1_56'>Write this person's phone number on your emergency card and keep it in your wallet or another safe place.</div><div class='ginput_container ginput_container_text'><input name='input_56' id='input_1_56' type='text' value='' class='medium' aria-describedby="gfield_description_1_56" aria-invalid="false" /> </div></li><li id="field_1_57" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_57" ><label class='gfield_label gform-field-label' for='input_1_57'>If you were stranded and needed a ride home, whom can you call to pick you up or meet you?</label><div class='gfield_description' id='gfield_description_1_57'>Write this person's phone number on your emergency card and keep it in your wallet or another safe place.</div><div class='ginput_container ginput_container_text'><input name='input_57' id='input_1_57' type='text' value='' class='medium' aria-describedby="gfield_description_1_57" aria-invalid="false" /> </div></li><li id="field_1_58" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_58" ><label class='gfield_label gform-field-label' for='input_1_58'>What word or phrase can you use as a code in a phone call, text, or instant message to ask your family or friends to call for help without your partner knowing?</label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_1_58' type='text' value='' class='medium' aria-invalid="false" /> </div></li><li id="field_1_59" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_59" ><label class='gfield_label gform-field-label' for='input_1_59'>If you decide to end your relationship, where can you do it safely?</label><div class='gfield_description' id='gfield_description_1_59'>This should be a populated public space where can talk with your partner.</div><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='medium' aria-describedby="gfield_description_1_59" aria-invalid="false" /> </div></li><li id="field_1_60" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_60" ><label class='gfield_label gform-field-label' for='input_1_60'>Whom can you call to talk with afterward?</label><div class='gfield_description' id='gfield_description_1_60'>Write this person's phone number on your emergency card and keep it in your wallet or another safe place.</div><div class='ginput_container ginput_container_text'><input name='input_60' id='input_1_60' type='text' value='' class='medium' aria-describedby="gfield_description_1_60" aria-invalid="false" /> </div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_1_27' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='jQuery("#gform_target_page_number_1").val("6"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("6"); jQuery("#gform_1").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_1_27' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("8"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("8"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_8' class='gform_page' data-js='page-field-id-27' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_8' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_28" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_28" > </li><li id="field_1_61" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_61" ><label class='gfield_label gform-field-label' for='input_1_61'>Who could watch your children if you need childcare in an emergency?</label><div class='gfield_description' id='gfield_description_1_61'>Write this person's phone number on your emergency card and keep it in your wallet or another safe place.</div><div class='ginput_container ginput_container_text'><input name='input_61' id='input_1_61' type='text' value='' class='medium' aria-describedby="gfield_description_1_61" aria-invalid="false" /> </div></li><li id="field_1_62" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_62" ><label class='gfield_label gform-field-label' >Do your children know how to call 911?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_62'> <li class='gchoice gchoice_1_62_0'> <input name='input_62' type='radio' value='Yes' id='choice_1_62_0' /> <label for='choice_1_62_0' id='label_1_62_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_62_1'> <input name='input_62' type='radio' value='No' id='choice_1_62_1' /> <label for='choice_1_62_1' id='label_1_62_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_63" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_63" ><label class='gfield_label gform-field-label' for='input_1_63'>What word or phrase can you use as a code between you and your children to let them know that they need to call for help?</label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_1_63' type='text' value='' class='medium' aria-invalid="false" /> </div></li><li id="field_1_64" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_64" ><label class='gfield_label gform-field-label' for='input_1_64'>Where is a safe place that your children could go if in danger?</label><div class='gfield_description' id='gfield_description_1_64'>This can be a room in your home, a neighbor's home, or the local police station. It should be somewhere that your children can safely go by themselves.</div><div class='ginput_container ginput_container_text'><input name='input_64' id='input_1_64' type='text' value='' class='medium' aria-describedby="gfield_description_1_64" aria-invalid="false" /> </div></li></ul> </div> <div class='gform_page_footer top_label'> <input type='button' id='gform_previous_button_1_29' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='jQuery("#gform_target_page_number_1").val("7"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("7"); jQuery("#gform_1").trigger("submit",[true]); } ' /> <input type='button' id='gform_next_button_1_29' class='gform_next_button gform-theme-button button' value='Next Step' onclick='jQuery("#gform_target_page_number_1").val("9"); jQuery("#gform_1").trigger("submit",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery("#gform_target_page_number_1").val("9"); jQuery("#gform_1").trigger("submit",[true]); } ' /> </div> </div> <div id='gform_page_1_9' class='gform_page' data-js='page-field-id-29' style='display:none;'> <div class='gform_page_fields'> <ul id='gform_fields_1_9' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id="field_1_30" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_30" ></li><li id="field_1_65" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_65" ><label class='gfield_label gform-field-label' >Does your partner say or do things to make you feel down on yourself?</label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_65'> <li class='gchoice gchoice_1_65_0'> <input name='input_65' type='radio' value='Yes' id='choice_1_65_0' /> <label for='choice_1_65_0' id='label_1_65_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_65_1'> <input name='input_65' type='radio' value='No' id='choice_1_65_1' /> <label for='choice_1_65_1' id='label_1_65_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li><li id="field_1_66" class="gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_66" ><label class='gfield_label gform-field-label' for='input_1_66'>What are some activities that you enjoy doing?</label><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_1_66' class='textarea small' aria-invalid="false" rows='10' cols='50'></textarea></div></li><li id="field_1_67" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_67" ><label class='gfield_label gform-field-label' for='input_1_67'>When you are feeling down whom can you call to cheer you up?</label><div class='gfield_description' id='gfield_description_1_67'>This should be someone other than your partner. Write this person's phone number on your emergency card and keep it in your wallet or another safe place.</div><div class='ginput_container ginput_container_text'><input name='input_67' id='input_1_67' type='text' value='' class='medium' aria-describedby="gfield_description_1_67" aria-invalid="false" /> </div></li><li id="field_1_68" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_1_68" ><label class='gfield_label gform-field-label' >Does your partner threaten to reveal information about you in a hurtful or embarrassing way?</label><div class='gfield_description' id='gfield_description_1_68'>For example, your gender identity, your HIV status, or a disability.</div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_68'> <li class='gchoice gchoice_1_68_0'> <input name='input_68' type='radio' value='Yes' id='choice_1_68_0' /> <label for='choice_1_68_0' id='label_1_68_0' class='gform-field-label gform-field-label--type-inline'>Yes</label> </li> <li class='gchoice gchoice_1_68_1'> <input name='input_68' type='radio' value='No' id='choice_1_68_1' /> <label for='choice_1_68_1' id='label_1_68_1' class='gform-field-label gform-field-label--type-inline'>No</label> </li></ul></div></li></ul></div> <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous Step' onclick='if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }' /> <input type='submit' id='gform_submit_button_1' class='gform_button button' value='Submit' onclick='if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} ' onkeypress='if( event.keyCode == 13 ){ if(window["gf_submitting_1"]){return false;} if( !jQuery("#gform_1")[0].checkValidity || jQuery("#gform_1")[0].checkValidity()){window["gf_submitting_1"]=true;} jQuery("#gform_1").trigger("submit",[true]); }' /> <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' /> <input type='hidden' class='gform_hidden' name='gform_submit' value='1' /> <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsIjBjNGU5NzAyMGRjOTkxZjkzZjY3OTU4MGM2NzE3YjMwIl0=' /> <input type='hidden' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='2' /> <input type='hidden' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' /> <input type='hidden' name='gform_field_values' value='' /> </div> </div></div> </form> </div><script> gform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https://www.thehotline.org/wp-content/plugins/gravityforms/images/spinner.svg', true );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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