{"id":19,"date":"2016-12-02T19:13:04","date_gmt":"2016-12-02T19:13:04","guid":{"rendered":"http:\/\/mealsonwheels.dev\/?page_id=19"},"modified":"2026-01-22T11:41:21","modified_gmt":"2026-01-22T17:41:21","slug":"daim-ntawv-thov","status":"publish","type":"page","link":"https:\/\/meals-on-wheels.com\/hmn\/care-professionals\/request-form\/","title":{"rendered":"Thov Kev Nthuav Qhia, Cov Ntawv Qhia lossis Cov Ntaub Ntawv Ntxiv"},"content":{"rendered":"<p>We serve the greater Twin Cities area in Minnesota. If you&#8217;re interested in Meals on Wheels for your clients, we\u2019re happy to provide brochures or join you at a meeting or event to share how our nutritious, ready-to-eat meals support both nourishment and social connection.<\/p>\n<p>Simply fill out this form. If you have questions, please give us a call at <a href=\"tel:6126233363\">(612) 623-3363<\/a>. Enrollment specialists are available during work hours.<\/p>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Care Professionals Request Form<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/hmn\/wp-json\/wp\/v2\/pages\/19' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields left_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_1_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"bde1cbdf\" data-field-span=\"12\"><label id='gfield_label_1_1' class='gfield_label gform-field-label' for='input_1_1'><span class='gform-field-label__text'>Full Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_1_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b0c7803e\" data-field-span=\"12\"><label id='gfield_label_1_2' class='gfield_label gform-field-label' for='input_1_2'><span class='gform-field-label__text'>Company\/Organization<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_1_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"895868f2\" data-field-span=\"12\"><label id='gfield_label_1_3' class='gfield_label gform-field-label' for='input_1_3'><span class='gform-field-label__text'>Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='medium'    placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\"\/><\/div><\/li><li id=\"field_1_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"132e581e\" data-field-span=\"12\"><label id='gfield_label_1_4' class='gfield_label gform-field-label' for='input_1_4'><span class='gform-field-label__text'>Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_1_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"f1fa7ee1\" data-field-span=\"12\"><label id='gfield_label_1_5' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>I would like to (select all that apply):<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_5'><li class='gchoice gchoice_1_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Request a Presentation at a Meeting or Event'  id='choice_1_5_1'    aria-labelledby=\"label_1_5_1 gfield_label_1_5\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_1' id='label_1_5_1' class='gform-field-label gform-field-label--type-inline'>Request a Presentation at a Meeting or Event<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Order Client Brochures (English)'  id='choice_1_5_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_2' id='label_1_5_2' class='gform-field-label gform-field-label--type-inline'>Order Client Brochures (English)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Order Client Brochures (Spanish)'  id='choice_1_5_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_3' id='label_1_5_3' class='gform-field-label gform-field-label--type-inline'>Order Client Brochures (Spanish)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='Order Client Brochures (Somali)'  id='choice_1_5_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_4' id='label_1_5_4' class='gform-field-label gform-field-label--type-inline'>Order Client Brochures (Somali)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='Order Client Brochures (Hmong)'  id='choice_1_5_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_5' id='label_1_5_5' class='gform-field-label gform-field-label--type-inline'>Order Client Brochures (Hmong)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_5_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.6' type='checkbox'  value='Other...'  id='choice_1_5_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_5_6' id='label_1_5_6' class='gform-field-label gform-field-label--type-inline'>Other...<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a2bddd55\" data-field-span=\"12\"><label id='gfield_label_1_6' class='gfield_label gform-field-label' for='input_1_6'><span class='gform-field-label__text'>Other Option<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_1_6' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_16\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"d6376c6f\" data-field-span=\"12\"><h2 class=\"gsection_title\">Presentation Details<\/h2><\/li><li id=\"field_1_18\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"656b3dce\" data-field-span=\"12\"><label id='gfield_label_1_18' class='gfield_label gform-field-label' for='input_1_18'><span class='gform-field-label__text'>Provide a brief description of your meeting or event, including location and how many people you expect to attend.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_18' id='input_1_18' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f875ccaa\" data-field-span=\"12\"><h2 class=\"gsection_title\">Brochure Order Details<\/h2><\/li><li id=\"field_1_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4d033073\" data-field-span=\"12\"><label id='gfield_label_1_8' class='gfield_label gform-field-label' for='input_1_8'><span class='gform-field-label__text'>Please tell us how many brochures you would like in the languages you selected.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"42e160b9\" data-field-span=\"12\"><label id='gfield_label_1_9' class='gfield_label gform-field-label' for='input_1_9'><span class='gform-field-label__text'>Street Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a396f7f2\" data-field-span=\"12\"><label id='gfield_label_1_10' class='gfield_label gform-field-label' for='input_1_10'><span class='gform-field-label__text'>City<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_1_10' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_11\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"e86cb798\" data-field-span=\"12\"><label id='gfield_label_1_11' class='gfield_label gform-field-label' for='input_1_11'><span class='gform-field-label__text'>State<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_1_11' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Minnesota' >Minnesota<\/option><option value='Wisconsin' >Wisconsin<\/option><\/select><\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"fa3b4b42\" data-field-span=\"12\"><label id='gfield_label_1_12' class='gfield_label gform-field-label' for='input_1_12'><span class='gform-field-label__text'>Zip Code<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='medium'    placeholder='99999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999\"\/><\/div><\/li><li id=\"field_1_17\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4f66f57d\" data-field-span=\"12\"><label id='gfield_label_1_17' class='gfield_label gform-field-label' for='input_1_17'><span class='gform-field-label__text'>Additional mailing instructions or information<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_17' id='input_1_17' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_19\" class=\"gfield gfield--type-turnstile gfield--input-type-turnstile gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><div class='ginput_container ginput_container_turnstile'><div class=\"cf-turnstile\" id=\"cf-turnstile_1\" data-js-turnstile data-response-field-name=\"cf-turnstile-response_1\" data-theme=\"auto\" data-size=\"\" data-sitekey=\"0x4AAAAAABnThMGycSrvTg20\"><\/div><\/div><\/li><li id=\"field_1_278870\" class=\"gfield gfield--type-text sup-ref-tracking-source field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278870' class='gfield_label gform-field-label' for='input_1_278870'><span class='gform-field-label__text'>Source<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278870' id='input_1_278870' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278871\" class=\"gfield gfield--type-text sup-ref-tracking-ref-params field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278871' class='gfield_label gform-field-label' for='input_1_278871'><span class='gform-field-label__text'>Referral Parameters<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278871' id='input_1_278871' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278872\" class=\"gfield gfield--type-text sup-ref-tracking-referrer field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278872' class='gfield_label gform-field-label' for='input_1_278872'><span class='gform-field-label__text'>Referrer<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278872' id='input_1_278872' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278873\" class=\"gfield gfield--type-text sup-ref-tracking-utm_id field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278873' class='gfield_label gform-field-label' for='input_1_278873'><span class='gform-field-label__text'>utm_id<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278873' id='input_1_278873' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278874\" class=\"gfield gfield--type-text sup-ref-tracking-utm_source field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278874' class='gfield_label gform-field-label' for='input_1_278874'><span class='gform-field-label__text'>utm_source<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278874' id='input_1_278874' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278875\" class=\"gfield gfield--type-text sup-ref-tracking-utm_medium field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278875' class='gfield_label gform-field-label' for='input_1_278875'><span class='gform-field-label__text'>utm_medium<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278875' id='input_1_278875' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278876\" class=\"gfield gfield--type-text sup-ref-tracking-utm_campaign field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278876' class='gfield_label gform-field-label' for='input_1_278876'><span class='gform-field-label__text'>utm_campaign<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278876' id='input_1_278876' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278877\" class=\"gfield gfield--type-text sup-ref-tracking-utm_term field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278877' class='gfield_label gform-field-label' for='input_1_278877'><span class='gform-field-label__text'>utm_term<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_278877' id='input_1_278877' type='text' value='' class=''      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_278878\" class=\"gfield gfield--type-text sup-ref-tracking-utm_content field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"><label id='gfield_label__278878' class='gfield_label gform-field-label' for='input_1_278878'><span 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