First Name
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Middle Name (Optional)
Last Name
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Email
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Please confirm your email. it is the only way we con contact right now.
Phone (if in U.S.)
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Enter 10 digit phone number with area code. Numbers only.
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Country of Residence
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Country
State of Residence
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Zip/Postal Code (5-digit only)
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Community Hub
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Funding Source for Services
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Emergency Contact First Name
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Emergency Contact Last Name
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Relationship to Participant
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Emergency Contact Email
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Enter 10-digit phone number (numbers only). Format will be applied automatically.
Emergency Contact Phone
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Enter 10 digit phone number with area code. Numbers only.
Authorization to Share Results With Emergency Contact or Care Partner
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jfu-TF-Readiness_Result_Text_Label_Choice
Ready for Placement or Pending Placement or Not Ready At This Time
jfu-TF-CRST Readiness Score
jf-TF-CRST Submit Date
jfu-TF-jotform-CRST-unique-id
KEY--- Jotform Value Auto Generated, /connects GH to JF Data
JFU-crst Internal ID
GH value autogenerated (not working all the time)
jfu-TF-Zero Guardrail Counter
jfu-gh-community-name
AA, MA, SA or YA- confirm
jfu-interview date for community info
jfu-gh-communiy-last name-initial
Value would be R if Last name is Rollins
jfu-CRST email result sent
Email Auto Sent W CRST Results? Yes or No
jfu-CRST Result Email Sent Date
jfu-admin-pi-enrollment-eligible
jfu-admin-non-enrollment-reason
D= Decline; W = Withdraw or
jfu-Hub Activation Status-A or W
jfu-mem-date-joined community
jfu-mem-interview -status
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