{"id":801,"date":"2022-07-18T14:21:05","date_gmt":"2022-07-18T14:21:05","guid":{"rendered":"https:\/\/www1.hendrickscountysso.com\/?page_id=801"},"modified":"2026-04-14T17:51:59","modified_gmt":"2026-04-14T17:51:59","slug":"online-victim-impact-panel","status":"publish","type":"page","link":"https:\/\/www.hendrickscountysso.com\/index.php\/online-victim-impact-panel\/","title":{"rendered":"Virtual Online Live Victim Impact Panel Registration"},"content":{"rendered":"<p><span style=\"font-size: 18pt;\">Virtual, Live Online Survivor Speakout Victim Impact Panel &#8211; Accepted Nationwide*<br \/>\n<span style=\"font-size: 14pt;\"><em><span style=\"color: #ff0000;\">You cannot attend online with your cell phone!<br \/>\n<\/span><\/em><\/span><\/span><\/p>\n<p><em><a href=\"#form\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-68\" src=\"https:\/\/www.hendrickscountysso.com\/wp-content\/uploads\/2021\/09\/register_online_zoom.png\" alt=\"\" width=\"225\" height=\"44\" \/><\/a><\/em><\/p>\n<p><em>Register by <a href=\"#form\">completing form below<\/a>. <strong>*Oklahoma and Arkansas do NOT accept virtual, online panels.\u00a0<\/strong><br \/>\n<\/em><br \/>\nTimes are EDT (Eastern Daylight Time) <em>Space is limited. <\/em>You must provide true and accurate information when you register.<\/p>\n<table style=\"width: 57.0986%; height: 744px;\" border=\"0\" width=\"400\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"width: 111.052%; height: 24px; text-align: center;\" colspan=\"2\"><span style=\"font-size: 14pt;\"><strong>AVAILABLE DATES<\/strong><\/span><br \/>\n<strong><span style=\"color: #000080;\"><span style=\"font-size: 14pt; color: #000000;\"><span style=\"font-size: 10pt;\">Dates subject to change<\/span><\/span><\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\"><del>Friday, April 17, 2026<\/del> <span style=\"font-size: 10pt;\"><strong><span style=\"color: #ff0000;\">CANCELLED<\/span><\/strong><\/span><\/td>\n<td style=\"width: 50.3375%; height: 24px;\"><del>9:45 A.M. to NOON<\/del><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Thursday, April 30, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">5:45 P.M. to 8 P.M.<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Thursday, May 14, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">5:45 P.M. to 8 P.M.<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Tuesday, May 26, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">9:45 A.M. to NOON<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Wednesday, June 10, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">9:45 A.M. to NOON<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Wednesday, June 24, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">5:45 P.M. to 8 P.M.<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Thursday, July 9, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">5:45 P.M. to 8 P.M.<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Tuesday, July 21, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">9:45 A.M. to NOON<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Thursday, August 13, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">5:45 P.M. to 8 P.M.<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Friday, August 28, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">9:45 A.M. to NOON<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Wednesday, September 9, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">5:45 P.M. to 8 P.M.<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Thursday, September 24, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">9:45 A.M. to NOON<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Thursday, October 15, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">5:45 P.M. to 8 P.M.<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Tuesday, October 27, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">9:45 A.M. to NOON<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"width: 60.7142%; height: 24px;\">Tuesday, November 17, 2026<\/td>\n<td style=\"width: 50.3375%; height: 24px;\">9:45 A.M. to NOON<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><a href=\"https:\/\/www.hendrickscountysso.com\/index.php\/read-the-live-zoom-presentation-guidelines\/\">Read the full guidelines to attend ONLINE<\/a><\/p>\n<p>Survivor Speakout Victim Impact Panels are accepted by court systems nationwide. Survivor Speakout online is a 2-hour live online presentation, not a recorded class, and there is no test.<\/p>\n<p><span style=\"color: #ff0000;\">NOTE: <strong>You cannot attend online using your cell phone. <\/strong><\/span>You must have a reliable internet connection and an<em> iPad, Android tablet, laptop or personal computer to attend a Survivor Speakout victim impact panel online.\u00a0<\/em><\/p>\n<p>The form below is to request to attend Survivor Speakout Victim Impact Panel ONLINE. Once the form has been submitted you will be directed to a page to pay your $50.00 fee. You will receive a confirmation email after submitting this form. If you do not receive the confirmation email, check your spam\/junk folder.<\/p>\n<p>You will be considered a \u201cNo Show\u201d if you are late or fail to attend the date you chose to attend. You must reschedule and pay an additional fee if you are a no show for any reason. There are NO REFUNDS.<\/p>\n<p id=\"form\">Your IP address will be recorded with this submission. Complete this form to register. <div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-1068\"><form id=\"wpforms-form-1068\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1068\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/801\" data-token=\"0ab3b37ae57cfdbbad8010c4dcf045b3\" data-token-time=\"1776311015\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1068-field_39-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"39\"><h3 id=\"wpforms-1068-field_39\">Request the date you would like to attend a virtual Survivor Speakout Victim Impact Panel<\/h3><div class=\"wpforms-field-description\">*Oklahoma and Arkansas do NOT accept virtual, online panels.<\/div><\/div><div id=\"wpforms-1068-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_6\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1068-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose a date to attend a virtual online panel<\/option><option value=\"Friday, April 17, 9:45 A.M. to NOON\"  class=\"choice-83 depth-1\"  >Friday, April 17, 9:45 A.M. to NOON<\/option><option value=\"Thursday, April 30, 5:45 P.M. to 8 P.M.\"  class=\"choice-82 depth-1\"  >Thursday, April 30, 5:45 P.M. to 8 P.M.<\/option><option value=\"Thursday, May 14, 5:45 P.M. to 8 P.M.\"  class=\"choice-81 depth-1\"  >Thursday, May 14, 5:45 P.M. to 8 P.M.<\/option><option value=\"Tuesday, May 26, \t9:45 A.M. to NOON\"  class=\"choice-80 depth-1\"  >Tuesday, May 26, \t9:45 A.M. to NOON<\/option><option value=\"Wednesday, June 10, \t9:45 A.M. to NOON\"  class=\"choice-79 depth-1\"  >Wednesday, June 10, \t9:45 A.M. to NOON<\/option><option value=\"Wednesday, June 24, 5:45 P.M. to 8 P.M.\"  class=\"choice-78 depth-1\"  >Wednesday, June 24, 5:45 P.M. to 8 P.M.<\/option><option value=\"Thursday, July 9,  5:45 P.M. to 8 P.M.\"  class=\"choice-89 depth-1\"  >Thursday, July 9,  5:45 P.M. to 8 P.M.<\/option><option value=\"Tuesday, July 21, 9:45 A.M. to NOON\"  class=\"choice-88 depth-1\"  >Tuesday, July 21, 9:45 A.M. to NOON<\/option><option value=\"Thursday, August 13, 5:45 P.M. to 8 P.M.\"  class=\"choice-87 depth-1\"  >Thursday, August 13, 5:45 P.M. to 8 P.M.<\/option><option value=\"Friday, August 28, 9:45 A.M. to NOON\"  class=\"choice-86 depth-1\"  >Friday, August 28, 9:45 A.M. to NOON<\/option><option value=\"Wednesday, September 9,\t5:45 P.M. to 8 P.M.\"  class=\"choice-85 depth-1\"  >Wednesday, September 9,\t5:45 P.M. to 8 P.M.<\/option><option value=\"Thursday, September 24, 9:45 A.M. to NOON\"  class=\"choice-93 depth-1\"  >Thursday, September 24, 9:45 A.M. to NOON<\/option><option value=\"Thursday, October 15,\t5:45 P.M. to 8 P.M.\"  class=\"choice-92 depth-1\"  >Thursday, October 15,\t5:45 P.M. to 8 P.M.<\/option><option value=\"Tuesday, October 27, 9:45 A.M. to NOON\"  class=\"choice-91 depth-1\"  >Tuesday, October 27, 9:45 A.M. to NOON<\/option><option value=\"Tuesday, November 17, 9:45 A.M. to NOON\"  class=\"choice-90 depth-1\"  >Tuesday, November 17, 9:45 A.M. to NOON<\/option><\/select><\/div><div id=\"wpforms-1068-field_51-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"51\"><label class=\"wpforms-field-label\">Technology required <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1068-field_51\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1068-field_51_1\" name=\"wpforms[fields][51][]\" value=\"I understand that I CANNOT use a cell phone to attend Survivor Speakout online and that I must use an iPad, tablet, laptop or personal computer (PC).\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_51_1\">I understand that I CANNOT use a cell phone to attend Survivor Speakout online and that I must use an iPad, tablet, laptop or personal computer (PC).<\/label><\/li><\/ul><\/div>\t\t<div id=\"wpforms-1068-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1068-field_2\" >county Victim were<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1068-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1068-field_3-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Guidelines <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1068-field_3\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1068-field_3_1\" name=\"wpforms[fields][3][]\" value=\"I have read and understand all of the Survivor Speakout Guidelines to attend ONLINE USING ZOOM\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_3_1\">I have read and understand all of the Survivor Speakout Guidelines to attend ONLINE USING ZOOM<\/label><\/li><\/ul><\/div><div id=\"wpforms-1068-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_0\">First Name \/ Last 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-1068-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" placeholder=\"FIRST NAME\" required><label for=\"wpforms-1068-field_0\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1068-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" placeholder=\"LAST NAME\" required><label for=\"wpforms-1068-field_0-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1068-field_67-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"67\"><label class=\"wpforms-field-label\">Your Home Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1068-field_67\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][67][address1]\" required><label for=\"wpforms-1068-field_67\" 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-1068-field_67-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][67][address2]\" ><label for=\"wpforms-1068-field_67-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-1068-field_67-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][67][city]\" required><label for=\"wpforms-1068-field_67-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1068-field_67-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][67][state]\" required><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\"  selected='selected'>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-1068-field_67-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-1068-field_67-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][67][postal]\" required><label for=\"wpforms-1068-field_67-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-1068-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-1068-field_1\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][1][primary]\" spellcheck=\"false\" required><label for=\"wpforms-1068-field_1\" class=\"wpforms-field-sublabel after\">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-1068-field_1-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-1068-field_1\" name=\"wpforms[fields][1][secondary]\" spellcheck=\"false\" required><label for=\"wpforms-1068-field_1-secondary\" class=\"wpforms-field-sublabel after\">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-1068-field_36-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_36\">Telephone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1068-field_36\" class=\"wpforms-field-small wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][36]\" aria-label=\"Telephone\" required><\/div><div id=\"wpforms-1068-field_33-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"33\"><h3 id=\"wpforms-1068-field_33\">On what charges were you arrested?<\/h3><\/div><div id=\"wpforms-1068-field_7-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_7\">Charge <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1068-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose one<\/option><option value=\"DWI\"  class=\"choice-1 depth-1\"  >DWI<\/option><option value=\"DUI\"  class=\"choice-2 depth-1\"  >DUI<\/option><option value=\"OWI\"  class=\"choice-3 depth-1\"  >OWI<\/option><option value=\"OUI\"  class=\"choice-7 depth-1\"  >OUI<\/option><option value=\"PI\"  class=\"choice-6 depth-1\"  >PI<\/option><option value=\"Minor in Consumption\"  class=\"choice-5 depth-1\"  >Minor in Consumption<\/option><option value=\"Open Container\"  class=\"choice-4 depth-1\"  >Open Container<\/option><option value=\"Illegal possession of alcohol\"  class=\"choice-9 depth-1\"  >Illegal possession of alcohol<\/option><option value=\"Drug Related\"  class=\"choice-8 depth-1\"  >Drug Related<\/option><option value=\"Other\"  class=\"choice-10 depth-1\"  >Other<\/option><\/select><\/div><div id=\"wpforms-1068-field_37-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_37\">If you chose &#039;Other&#039; above, please tell us what you were charged with<\/label><input type=\"text\" id=\"wpforms-1068-field_37\" class=\"wpforms-field-large\" name=\"wpforms[fields][37]\" ><div class=\"wpforms-field-description\">If you chose 'Other' above, please tell us what you were charged with<\/div><\/div><div id=\"wpforms-1068-field_34-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"34\"><h3 id=\"wpforms-1068-field_34\">Your probation officer<\/h3><\/div><div id=\"wpforms-1068-field_9-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_9\">Probation officer <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1068-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose one<\/option><option value=\"My probation officer is not listed below\"  class=\"choice-3 depth-1\"  >My probation officer is not listed below<\/option><option value=\"I do not know my probation officer&#039;s name\"  class=\"choice-1 depth-1\"  >I do not know my probation officer's name<\/option><option value=\"I have not been assigned a probation officer because I have a diversion agreement\"  class=\"choice-2 depth-1\"  >I have not been assigned a probation officer because I have a diversion agreement<\/option><option value=\"My attorney recommended that I attend a victim impact panel before my court date\"  class=\"choice-68 depth-1\"  >My attorney recommended that I attend a victim impact panel before my court date<\/option><option value=\"Abigail O\u2019Brien\"  class=\"choice-54 depth-1\"  >Abigail O\u2019Brien<\/option><option value=\"Alex Redman\"  class=\"choice-53 depth-1\"  >Alex Redman<\/option><option value=\"Amber Hoffert\"  class=\"choice-59 depth-1\"  >Amber Hoffert<\/option><option value=\"Amie Hibbeln\"  class=\"choice-70 depth-1\"  >Amie Hibbeln<\/option><option value=\"Andrew Lillpop\"  class=\"choice-15 depth-1\"  >Andrew Lillpop<\/option><option value=\"Ashley Starling\"  class=\"choice-14 depth-1\"  >Ashley Starling<\/option><option value=\"Betsy Schuler\"  class=\"choice-13 depth-1\"  >Betsy Schuler<\/option><option value=\"Ben Neureiter\"  class=\"choice-12 depth-1\"  >Ben Neureiter<\/option><option value=\"Brandon Fowler\"  class=\"choice-63 depth-1\"  >Brandon Fowler<\/option><option value=\"Brian Day\"  class=\"choice-57 depth-1\"  >Brian Day<\/option><option value=\"Brittany Stodghill\"  class=\"choice-11 depth-1\"  >Brittany Stodghill<\/option><option value=\"Caleb Lazano\"  class=\"choice-55 depth-1\"  >Caleb Lazano<\/option><option value=\"Caleb Nanzer\"  class=\"choice-10 depth-1\"  >Caleb Nanzer<\/option><option value=\"Carmen Sims\"  class=\"choice-9 depth-1\"  >Carmen Sims<\/option><option value=\"Carol Nienaber\"  class=\"choice-8 depth-1\"  >Carol Nienaber<\/option><option value=\"Caroline Cathcart\"  class=\"choice-58 depth-1\"  >Caroline Cathcart<\/option><option value=\"Chad Boruff\"  class=\"choice-56 depth-1\"  >Chad Boruff<\/option><option value=\"Cheryl Koch\"  class=\"choice-6 depth-1\"  >Cheryl Koch<\/option><option value=\"Chad Koebcke\"  class=\"choice-5 depth-1\"  >Chad Koebcke<\/option><option value=\"Chad Ulmer\"  class=\"choice-4 depth-1\"  >Chad Ulmer<\/option><option value=\"Chantel Cloud\"  class=\"choice-49 depth-1\"  >Chantel Cloud<\/option><option value=\"Christina Candia\"  class=\"choice-23 depth-1\"  >Christina Candia<\/option><option value=\"Corey Walker\"  class=\"choice-22 depth-1\"  >Corey Walker<\/option><option value=\"Courtney Sacchini\"  class=\"choice-21 depth-1\"  >Courtney Sacchini<\/option><option value=\"Dwight Stevenson\"  class=\"choice-20 depth-1\"  >Dwight Stevenson<\/option><option value=\"Elizabeth Krieg\"  class=\"choice-19 depth-1\"  >Elizabeth Krieg<\/option><option value=\"Erinn McCluney\"  class=\"choice-52 depth-1\"  >Erinn McCluney<\/option><option value=\"Faith Edwards\"  class=\"choice-18 depth-1\"  >Faith Edwards<\/option><option value=\"Faith Oliver\"  class=\"choice-17 depth-1\"  >Faith Oliver<\/option><option value=\"Jamie Wodtke\"  class=\"choice-65 depth-1\"  >Jamie Wodtke<\/option><option value=\"Jana Schwindt\"  class=\"choice-62 depth-1\"  >Jana Schwindt<\/option><option value=\"Jesse Tucker\"  class=\"choice-16 depth-1\"  >Jesse Tucker<\/option><option value=\"Johni Taylor\"  class=\"choice-64 depth-1\"  >Johni Taylor<\/option><option value=\"Justin Culp\"  class=\"choice-31 depth-1\"  >Justin Culp<\/option><option value=\"Katrina Skelton\"  class=\"choice-67 depth-1\"  >Katrina Skelton<\/option><option value=\"Kevin McCleese\"  class=\"choice-30 depth-1\"  >Kevin McCleese<\/option><option value=\"Kristin Ushman\"  class=\"choice-29 depth-1\"  >Kristin Ushman<\/option><option value=\"Leah Baker\"  class=\"choice-28 depth-1\"  >Leah Baker<\/option><option value=\"Makayla Huse\"  class=\"choice-60 depth-1\"  >Makayla Huse<\/option><option value=\"Malachi Taylor\"  class=\"choice-27 depth-1\"  >Malachi Taylor<\/option><option value=\"Mariah Pearson\"  class=\"choice-69 depth-1\"  >Mariah Pearson<\/option><option value=\"Mariah Myers\"  class=\"choice-46 depth-1\"  >Mariah Myers<\/option><option value=\"McKinzee Terry\"  class=\"choice-50 depth-1\"  >McKinzee Terry<\/option><option value=\"Megan Caruso\"  class=\"choice-26 depth-1\"  >Megan Caruso<\/option><option value=\"Megan Morguson\"  class=\"choice-25 depth-1\"  >Megan Morguson<\/option><option value=\"Melody Sears\"  class=\"choice-24 depth-1\"  >Melody Sears<\/option><option value=\"Patrick Gillian\"  class=\"choice-51 depth-1\"  >Patrick Gillian<\/option><option value=\"Rebecca Shrock\"  class=\"choice-37 depth-1\"  >Rebecca Shrock<\/option><option value=\"Reid Roethe\"  class=\"choice-36 depth-1\"  >Reid Roethe<\/option><option value=\"Richard Porter\"  class=\"choice-35 depth-1\"  >Richard Porter<\/option><option value=\"Richard Martinez\"  class=\"choice-34 depth-1\"  >Richard Martinez<\/option><option value=\"Ronda Gibson\"  class=\"choice-48 depth-1\"  >Ronda Gibson<\/option><option value=\"Shelby Wiser\"  class=\"choice-33 depth-1\"  >Shelby Wiser<\/option><option value=\"Stephen Owens\"  class=\"choice-32 depth-1\"  >Stephen Owens<\/option><option value=\"Steve Roberts\"  class=\"choice-44 depth-1\"  >Steve Roberts<\/option><option value=\"Suzan Shrock-Gideon\"  class=\"choice-42 depth-1\"  >Suzan Shrock-Gideon<\/option><option value=\"Thomas Purkhiser\"  class=\"choice-41 depth-1\"  >Thomas Purkhiser<\/option><option value=\"Tim Miller\"  class=\"choice-40 depth-1\"  >Tim Miller<\/option><option value=\"Zach Minardo\"  class=\"choice-47 depth-1\"  >Zach Minardo<\/option><\/select><\/div><div id=\"wpforms-1068-field_75-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"75\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_75\">Enter your attorney&#039;s name and email address<\/label><input type=\"text\" id=\"wpforms-1068-field_75\" class=\"wpforms-field-large\" name=\"wpforms[fields][75]\" ><div class=\"wpforms-field-description\">Enter your attorney's name and email address<\/div><\/div><div id=\"wpforms-1068-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-1068-field_10\">If your probation officer&#039;s name is not listed, enter their name here<\/label><input type=\"text\" id=\"wpforms-1068-field_10\" class=\"wpforms-field-large\" name=\"wpforms[fields][10]\" ><div class=\"wpforms-field-description\">If your probation officer's name is not listed, enter their name here<\/div><\/div><div id=\"wpforms-1068-field_32-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"32\"><h3 id=\"wpforms-1068-field_32\">Who is the judge presiding over your case?<\/h3><\/div><div id=\"wpforms-1068-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_12\">Judge <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1068-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose one<\/option><option value=\"I do not know my judge&#039;s name\"  class=\"choice-16 depth-1\"  >I do not know my judge's name<\/option><option value=\"The judge presiding over my case is not listed below\"  class=\"choice-17 depth-1\"  >The judge presiding over my case is not listed below<\/option><option value=\"The Honorable Rhett Stuard\"  class=\"choice-3 depth-1\"  >The Honorable Rhett Stuard<\/option><option value=\"The Honorable Dan Zielinski\"  class=\"choice-5 depth-1\"  >The Honorable Dan Zielinski<\/option><option value=\"The Honorable Mark Smith\"  class=\"choice-1 depth-1\"  >The Honorable Mark Smith<\/option><option value=\"The Honorable Stephanie Lemay-Luken\"  class=\"choice-6 depth-1\"  >The Honorable Stephanie Lemay-Luken<\/option><option value=\"The Honorable Charles E. Hostetter\"  class=\"choice-14 depth-1\"  >The Honorable Charles E. Hostetter<\/option><option value=\"The Honorable David Coleman\"  class=\"choice-7 depth-1\"  >The Honorable David Coleman<\/option><option value=\"The Honorable Travis Crane\"  class=\"choice-21 depth-1\"  >The Honorable Travis Crane<\/option><option value=\"The Honorable Lindsay R. Walker\"  class=\"choice-15 depth-1\"  >The Honorable Lindsay R. Walker<\/option><option value=\"The Honorable James D. Spencer\"  class=\"choice-13 depth-1\"  >The Honorable James D. Spencer<\/option><option value=\"The Honorable Kathryn Khuen\"  class=\"choice-22 depth-1\"  >The Honorable Kathryn Khuen<\/option><option value=\"The Honorable Maureen T. Owen\"  class=\"choice-12 depth-1\"  >The Honorable Maureen T. Owen<\/option><option value=\"The Honorable Bruce E. Petit\"  class=\"choice-11 depth-1\"  >The Honorable Bruce E. Petit<\/option><option value=\"The Honorable J. Jeffrey Edens\"  class=\"choice-10 depth-1\"  >The Honorable J. Jeffrey Edens<\/option><option value=\"The Honorable Matt Headley\"  class=\"choice-9 depth-1\"  >The Honorable Matt Headley<\/option><option value=\"The Honorable Tammy Somers\"  class=\"choice-8 depth-1\"  >The Honorable Tammy Somers<\/option><option value=\"The Honorable Clayton A. Graham\"  class=\"choice-19 depth-1\"  >The Honorable Clayton A. Graham<\/option><option value=\"The Honorable Amy Jones\"  class=\"choice-18 depth-1\"  >The Honorable Amy Jones<\/option><option value=\"The Honorable Ryan Tansel\"  class=\"choice-20 depth-1\"  >The Honorable Ryan Tansel<\/option><\/select><\/div><div id=\"wpforms-1068-field_13-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"13\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_13\">If you know the name of your judge, but they are not on the list, enter it here<\/label><input type=\"text\" id=\"wpforms-1068-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-1068-field_20-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_20\">Your age <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1068-field_20\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][20]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose one<\/option><option value=\"15-18\"  class=\"choice-1 depth-1\"  >15-18<\/option><option value=\"19-25\"  class=\"choice-2 depth-1\"  >19-25<\/option><option value=\"26-30\"  class=\"choice-3 depth-1\"  >26-30<\/option><option value=\"31-35\"  class=\"choice-13 depth-1\"  >31-35<\/option><option value=\"36-40\"  class=\"choice-12 depth-1\"  >36-40<\/option><option value=\"41-45\"  class=\"choice-11 depth-1\"  >41-45<\/option><option value=\"46-50\"  class=\"choice-10 depth-1\"  >46-50<\/option><option value=\"51-55\"  class=\"choice-9 depth-1\"  >51-55<\/option><option value=\"56-60\"  class=\"choice-8 depth-1\"  >56-60<\/option><option value=\"61-65\"  class=\"choice-7 depth-1\"  >61-65<\/option><option value=\"66-70\"  class=\"choice-6 depth-1\"  >66-70<\/option><option value=\"71-75\"  class=\"choice-5 depth-1\"  >71-75<\/option><option value=\"76-80\"  class=\"choice-4 depth-1\"  >76-80<\/option><option value=\"81-85\"  class=\"choice-17 depth-1\"  >81-85<\/option><option value=\"86-90\"  class=\"choice-16 depth-1\"  >86-90<\/option><option value=\"91-95\"  class=\"choice-15 depth-1\"  >91-95<\/option><option value=\"96-100\"  class=\"choice-14 depth-1\"  >96-100<\/option><\/select><\/div><div id=\"wpforms-1068-field_38-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"38\"><h3 id=\"wpforms-1068-field_38\">County information<\/h3><\/div><div id=\"wpforms-1068-field_21-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_21\">In which county were you arrested, charged or convicted? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1068-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose one<\/option><option value=\"I live outside of Indiana\"  class=\"choice-93 depth-1\"  >I live outside of Indiana<\/option><option value=\"Adams \"  class=\"choice-1 depth-1\"  >Adams<\/option><option value=\"Allen \"  class=\"choice-2 depth-1\"  >Allen<\/option><option value=\"Benton \"  class=\"choice-3 depth-1\"  >Benton<\/option><option value=\"Blackford \"  class=\"choice-13 depth-1\"  >Blackford<\/option><option value=\"Boone \"  class=\"choice-12 depth-1\"  >Boone<\/option><option value=\"Brown \"  class=\"choice-11 depth-1\"  >Brown<\/option><option value=\"Carroll \"  class=\"choice-10 depth-1\"  >Carroll<\/option><option value=\"Cass \"  class=\"choice-9 depth-1\"  >Cass<\/option><option value=\"Clark \"  class=\"choice-8 depth-1\"  >Clark<\/option><option value=\"Clay \"  class=\"choice-7 depth-1\"  >Clay<\/option><option value=\"Clinton \"  class=\"choice-6 depth-1\"  >Clinton<\/option><option value=\"Crawford \"  class=\"choice-5 depth-1\"  >Crawford<\/option><option value=\"Daviess \"  class=\"choice-4 depth-1\"  >Daviess<\/option><option value=\"Dearborn \"  class=\"choice-23 depth-1\"  >Dearborn<\/option><option value=\"Decatur \"  class=\"choice-22 depth-1\"  >Decatur<\/option><option value=\"DeKalb \"  class=\"choice-21 depth-1\"  >DeKalb<\/option><option value=\"Delaware \"  class=\"choice-20 depth-1\"  >Delaware<\/option><option value=\"Dubois \"  class=\"choice-19 depth-1\"  >Dubois<\/option><option value=\"Elkhart \"  class=\"choice-18 depth-1\"  >Elkhart<\/option><option value=\"Fayette \"  class=\"choice-17 depth-1\"  >Fayette<\/option><option value=\"Floyd \"  class=\"choice-16 depth-1\"  >Floyd<\/option><option value=\"Fountain \"  class=\"choice-15 depth-1\"  >Fountain<\/option><option value=\"Franklin \"  class=\"choice-14 depth-1\"  >Franklin<\/option><option value=\"Fulton \"  class=\"choice-48 depth-1\"  >Fulton<\/option><option value=\"Gibson \"  class=\"choice-47 depth-1\"  >Gibson<\/option><option value=\"Grant \"  class=\"choice-46 depth-1\"  >Grant<\/option><option value=\"Greene \"  class=\"choice-45 depth-1\"  >Greene<\/option><option value=\"Hamilton \"  class=\"choice-44 depth-1\"  >Hamilton<\/option><option value=\"Hancock \"  class=\"choice-43 depth-1\"  >Hancock<\/option><option value=\"Harrison \"  class=\"choice-42 depth-1\"  >Harrison<\/option><option value=\"Hendricks \"  class=\"choice-41 depth-1\"  >Hendricks<\/option><option value=\"Henry \"  class=\"choice-40 depth-1\"  >Henry<\/option><option value=\"Howard \"  class=\"choice-39 depth-1\"  >Howard<\/option><option value=\"Huntington \"  class=\"choice-38 depth-1\"  >Huntington<\/option><option value=\"Jackson \"  class=\"choice-37 depth-1\"  >Jackson<\/option><option value=\"Jasper \"  class=\"choice-36 depth-1\"  >Jasper<\/option><option value=\"Jay \"  class=\"choice-35 depth-1\"  >Jay<\/option><option value=\"Jefferson \"  class=\"choice-34 depth-1\"  >Jefferson<\/option><option value=\"Jennings \"  class=\"choice-33 depth-1\"  >Jennings<\/option><option value=\"Johnson \"  class=\"choice-32 depth-1\"  >Johnson<\/option><option value=\"Knox \"  class=\"choice-31 depth-1\"  >Knox<\/option><option value=\"Kosciusko \"  class=\"choice-30 depth-1\"  >Kosciusko<\/option><option value=\"LaGrange \"  class=\"choice-29 depth-1\"  >LaGrange<\/option><option value=\"Lake \"  class=\"choice-28 depth-1\"  >Lake<\/option><option value=\"LaPorte \"  class=\"choice-27 depth-1\"  >LaPorte<\/option><option value=\"Lawrence \"  class=\"choice-26 depth-1\"  >Lawrence<\/option><option value=\"Madison \"  class=\"choice-25 depth-1\"  >Madison<\/option><option value=\"Marion \"  class=\"choice-24 depth-1\"  >Marion<\/option><option value=\"Marshall \"  class=\"choice-68 depth-1\"  >Marshall<\/option><option value=\"Martin \"  class=\"choice-67 depth-1\"  >Martin<\/option><option value=\"Miami \"  class=\"choice-66 depth-1\"  >Miami<\/option><option value=\"Monroe \"  class=\"choice-65 depth-1\"  >Monroe<\/option><option value=\"Montgomery \"  class=\"choice-64 depth-1\"  >Montgomery<\/option><option value=\"Morgan \"  class=\"choice-63 depth-1\"  >Morgan<\/option><option value=\"Newton \"  class=\"choice-62 depth-1\"  >Newton<\/option><option value=\"Noble \"  class=\"choice-61 depth-1\"  >Noble<\/option><option value=\"Ohio \"  class=\"choice-60 depth-1\"  >Ohio<\/option><option value=\"Orange \"  class=\"choice-59 depth-1\"  >Orange<\/option><option value=\"Owen \"  class=\"choice-58 depth-1\"  >Owen<\/option><option value=\"Parke \"  class=\"choice-57 depth-1\"  >Parke<\/option><option value=\"Perry \"  class=\"choice-56 depth-1\"  >Perry<\/option><option value=\"Pike \"  class=\"choice-55 depth-1\"  >Pike<\/option><option value=\"Porter \"  class=\"choice-54 depth-1\"  >Porter<\/option><option value=\"Posey \"  class=\"choice-53 depth-1\"  >Posey<\/option><option value=\"Pulaski \"  class=\"choice-52 depth-1\"  >Pulaski<\/option><option value=\"Putnam \"  class=\"choice-51 depth-1\"  >Putnam<\/option><option value=\"Randolph \"  class=\"choice-50 depth-1\"  >Randolph<\/option><option value=\"Ripley \"  class=\"choice-49 depth-1\"  >Ripley<\/option><option value=\"Rush \"  class=\"choice-78 depth-1\"  >Rush<\/option><option value=\"St. Joseph\"  class=\"choice-77 depth-1\"  >St. Joseph<\/option><option value=\"Scott \"  class=\"choice-76 depth-1\"  >Scott<\/option><option value=\"Shelby \"  class=\"choice-75 depth-1\"  >Shelby<\/option><option value=\"Spencer \"  class=\"choice-74 depth-1\"  >Spencer<\/option><option value=\"Starke \"  class=\"choice-73 depth-1\"  >Starke<\/option><option value=\"Steuben \"  class=\"choice-72 depth-1\"  >Steuben<\/option><option value=\"Sullivan \"  class=\"choice-71 depth-1\"  >Sullivan<\/option><option value=\"Switzerland \"  class=\"choice-70 depth-1\"  >Switzerland<\/option><option value=\"Tippecanoe \"  class=\"choice-69 depth-1\"  >Tippecanoe<\/option><option value=\"Tipton \"  class=\"choice-83 depth-1\"  >Tipton<\/option><option value=\"Union \"  class=\"choice-82 depth-1\"  >Union<\/option><option value=\"Vanderburgh \"  class=\"choice-81 depth-1\"  >Vanderburgh<\/option><option value=\"Vermillion \"  class=\"choice-80 depth-1\"  >Vermillion<\/option><option value=\"Vigo \"  class=\"choice-79 depth-1\"  >Vigo<\/option><option value=\"Wabash \"  class=\"choice-91 depth-1\"  >Wabash<\/option><option value=\"Warren \"  class=\"choice-90 depth-1\"  >Warren<\/option><option value=\"Warrick \"  class=\"choice-89 depth-1\"  >Warrick<\/option><option value=\"Washington \"  class=\"choice-88 depth-1\"  >Washington<\/option><option value=\"Wayne \"  class=\"choice-87 depth-1\"  >Wayne<\/option><option value=\"Wells \"  class=\"choice-86 depth-1\"  >Wells<\/option><option value=\"White \"  class=\"choice-85 depth-1\"  >White<\/option><option value=\"Whitley \"  class=\"choice-84 depth-1\"  >Whitley<\/option><\/select><\/div><div id=\"wpforms-1068-field_58-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"58\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_58\">If outside of Indiana, list the city, county and state where you were arrested, charged or convicted<\/label><input type=\"text\" id=\"wpforms-1068-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" ><\/div><div id=\"wpforms-1068-field_22-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_22\">In which county do you live? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1068-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose one<\/option><option value=\"My county is outside of Indiana\"  class=\"choice-94 depth-1\"  >My county is outside of Indiana<\/option><option value=\"Adams \"  class=\"choice-1 depth-1\"  >Adams<\/option><option value=\"Allen \"  class=\"choice-2 depth-1\"  >Allen<\/option><option value=\"Benton \"  class=\"choice-3 depth-1\"  >Benton<\/option><option value=\"Blackford \"  class=\"choice-13 depth-1\"  >Blackford<\/option><option value=\"Boone \"  class=\"choice-12 depth-1\"  >Boone<\/option><option value=\"Brown \"  class=\"choice-11 depth-1\"  >Brown<\/option><option value=\"Carroll \"  class=\"choice-10 depth-1\"  >Carroll<\/option><option value=\"Cass \"  class=\"choice-9 depth-1\"  >Cass<\/option><option value=\"Clark \"  class=\"choice-8 depth-1\"  >Clark<\/option><option value=\"Clay \"  class=\"choice-7 depth-1\"  >Clay<\/option><option value=\"Clinton \"  class=\"choice-6 depth-1\"  >Clinton<\/option><option value=\"Crawford \"  class=\"choice-5 depth-1\"  >Crawford<\/option><option value=\"Daviess \"  class=\"choice-4 depth-1\"  >Daviess<\/option><option value=\"Dearborn \"  class=\"choice-23 depth-1\"  >Dearborn<\/option><option value=\"Decatur \"  class=\"choice-22 depth-1\"  >Decatur<\/option><option value=\"DeKalb \"  class=\"choice-21 depth-1\"  >DeKalb<\/option><option value=\"Delaware \"  class=\"choice-20 depth-1\"  >Delaware<\/option><option value=\"Dubois \"  class=\"choice-19 depth-1\"  >Dubois<\/option><option value=\"Elkhart \"  class=\"choice-18 depth-1\"  >Elkhart<\/option><option value=\"Fayette \"  class=\"choice-17 depth-1\"  >Fayette<\/option><option value=\"Floyd \"  class=\"choice-16 depth-1\"  >Floyd<\/option><option value=\"Fountain \"  class=\"choice-15 depth-1\"  >Fountain<\/option><option value=\"Franklin \"  class=\"choice-14 depth-1\"  >Franklin<\/option><option value=\"Fulton \"  class=\"choice-48 depth-1\"  >Fulton<\/option><option value=\"Gibson \"  class=\"choice-47 depth-1\"  >Gibson<\/option><option value=\"Grant \"  class=\"choice-46 depth-1\"  >Grant<\/option><option value=\"Greene \"  class=\"choice-45 depth-1\"  >Greene<\/option><option value=\"Hamilton \"  class=\"choice-44 depth-1\"  >Hamilton<\/option><option value=\"Hancock \"  class=\"choice-43 depth-1\"  >Hancock<\/option><option value=\"Harrison \"  class=\"choice-42 depth-1\"  >Harrison<\/option><option value=\"Hendricks \"  class=\"choice-41 depth-1\"  >Hendricks<\/option><option value=\"Henry \"  class=\"choice-40 depth-1\"  >Henry<\/option><option value=\"Howard \"  class=\"choice-39 depth-1\"  >Howard<\/option><option value=\"Huntington \"  class=\"choice-38 depth-1\"  >Huntington<\/option><option value=\"Jackson \"  class=\"choice-37 depth-1\"  >Jackson<\/option><option value=\"Jasper \"  class=\"choice-36 depth-1\"  >Jasper<\/option><option value=\"Jay \"  class=\"choice-35 depth-1\"  >Jay<\/option><option value=\"Jefferson \"  class=\"choice-34 depth-1\"  >Jefferson<\/option><option value=\"Jennings \"  class=\"choice-33 depth-1\"  >Jennings<\/option><option value=\"Johnson \"  class=\"choice-32 depth-1\"  >Johnson<\/option><option value=\"Knox \"  class=\"choice-31 depth-1\"  >Knox<\/option><option value=\"Kosciusko \"  class=\"choice-30 depth-1\"  >Kosciusko<\/option><option value=\"LaGrange \"  class=\"choice-29 depth-1\"  >LaGrange<\/option><option value=\"Lake \"  class=\"choice-28 depth-1\"  >Lake<\/option><option value=\"LaPorte \"  class=\"choice-27 depth-1\"  >LaPorte<\/option><option value=\"Lawrence \"  class=\"choice-26 depth-1\"  >Lawrence<\/option><option value=\"Madison \"  class=\"choice-25 depth-1\"  >Madison<\/option><option value=\"Marion \"  class=\"choice-24 depth-1\"  >Marion<\/option><option value=\"Marshall \"  class=\"choice-68 depth-1\"  >Marshall<\/option><option value=\"Martin \"  class=\"choice-67 depth-1\"  >Martin<\/option><option value=\"Miami \"  class=\"choice-66 depth-1\"  >Miami<\/option><option value=\"Monroe \"  class=\"choice-65 depth-1\"  >Monroe<\/option><option value=\"Montgomery \"  class=\"choice-64 depth-1\"  >Montgomery<\/option><option value=\"Morgan \"  class=\"choice-63 depth-1\"  >Morgan<\/option><option value=\"Newton \"  class=\"choice-62 depth-1\"  >Newton<\/option><option value=\"Noble \"  class=\"choice-61 depth-1\"  >Noble<\/option><option value=\"Ohio \"  class=\"choice-60 depth-1\"  >Ohio<\/option><option value=\"Orange \"  class=\"choice-59 depth-1\"  >Orange<\/option><option value=\"Owen \"  class=\"choice-58 depth-1\"  >Owen<\/option><option value=\"Parke \"  class=\"choice-57 depth-1\"  >Parke<\/option><option value=\"Perry \"  class=\"choice-56 depth-1\"  >Perry<\/option><option value=\"Pike \"  class=\"choice-55 depth-1\"  >Pike<\/option><option value=\"Porter \"  class=\"choice-54 depth-1\"  >Porter<\/option><option value=\"Posey \"  class=\"choice-53 depth-1\"  >Posey<\/option><option value=\"Pulaski \"  class=\"choice-52 depth-1\"  >Pulaski<\/option><option value=\"Putnam \"  class=\"choice-51 depth-1\"  >Putnam<\/option><option value=\"Randolph \"  class=\"choice-50 depth-1\"  >Randolph<\/option><option value=\"Ripley \"  class=\"choice-49 depth-1\"  >Ripley<\/option><option value=\"Rush \"  class=\"choice-78 depth-1\"  >Rush<\/option><option value=\"St. Joseph\"  class=\"choice-77 depth-1\"  >St. Joseph<\/option><option value=\"Scott \"  class=\"choice-76 depth-1\"  >Scott<\/option><option value=\"Shelby \"  class=\"choice-75 depth-1\"  >Shelby<\/option><option value=\"Spencer \"  class=\"choice-74 depth-1\"  >Spencer<\/option><option value=\"Starke \"  class=\"choice-73 depth-1\"  >Starke<\/option><option value=\"Steuben \"  class=\"choice-72 depth-1\"  >Steuben<\/option><option value=\"Sullivan \"  class=\"choice-71 depth-1\"  >Sullivan<\/option><option value=\"Switzerland \"  class=\"choice-70 depth-1\"  >Switzerland<\/option><option value=\"Tippecanoe \"  class=\"choice-69 depth-1\"  >Tippecanoe<\/option><option value=\"Tipton \"  class=\"choice-83 depth-1\"  >Tipton<\/option><option value=\"Union \"  class=\"choice-82 depth-1\"  >Union<\/option><option value=\"Vanderburgh \"  class=\"choice-81 depth-1\"  >Vanderburgh<\/option><option value=\"Vermillion \"  class=\"choice-80 depth-1\"  >Vermillion<\/option><option value=\"Vigo \"  class=\"choice-79 depth-1\"  >Vigo<\/option><option value=\"Wabash \"  class=\"choice-91 depth-1\"  >Wabash<\/option><option value=\"Warren \"  class=\"choice-90 depth-1\"  >Warren<\/option><option value=\"Warrick \"  class=\"choice-89 depth-1\"  >Warrick<\/option><option value=\"Washington \"  class=\"choice-88 depth-1\"  >Washington<\/option><option value=\"Wayne \"  class=\"choice-87 depth-1\"  >Wayne<\/option><option value=\"Wells \"  class=\"choice-86 depth-1\"  >Wells<\/option><option value=\"White \"  class=\"choice-85 depth-1\"  >White<\/option><option value=\"Whitley \"  class=\"choice-84 depth-1\"  >Whitley<\/option><\/select><\/div><div id=\"wpforms-1068-field_55-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"55\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_55\">If you live outside of Indiana, list the city, county and state where you live<\/label><input type=\"text\" id=\"wpforms-1068-field_55\" class=\"wpforms-field-medium\" name=\"wpforms[fields][55]\" ><\/div><div id=\"wpforms-1068-field_71-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"71\"><label class=\"wpforms-field-label\">How did you hear about Survivor Speakout<\/label><ul id=\"wpforms-1068-field_71\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1068-field_71_1\" name=\"wpforms[fields][71]\" value=\"My probation officer\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_71_1\">My probation officer<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1068-field_71_2\" name=\"wpforms[fields][71]\" value=\"My attorney\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_71_2\">My attorney<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1068-field_71_3\" name=\"wpforms[fields][71]\" value=\"Online search\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_71_3\">Online search<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1068-field_71_4\" name=\"wpforms[fields][71]\" value=\"Other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_71_4\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-1068-field_57-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"57\" style=\"display:none;\"><input type=\"text\" id=\"wpforms-1068-field_57\" class=\"wpforms-field-medium\" name=\"wpforms[fields][57]\" ><div class=\"wpforms-field-description\">If you chose \"Other\" above, tell us how you heard about Survivor Speakout?<\/div><\/div><div id=\"wpforms-1068-field_60-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"60\"><label class=\"wpforms-field-label\">This is a graphic presentation <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1068-field_60\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1068-field_60_1\" name=\"wpforms[fields][60][]\" value=\"I understand that the Survivor Speakout Victim Impact Panel is graphic in nature dealing with death\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_60_1\">I understand that the Survivor Speakout Victim Impact Panel is graphic in nature dealing with death<\/label><\/li><\/ul><\/div><div id=\"wpforms-1068-field_53-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"53\"><label class=\"wpforms-field-label\">PHOTO ID <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1068-field_53\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1068-field_53_1\" name=\"wpforms[fields][53][]\" value=\"I understand that I will be asked to present my photo ID\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_53_1\">I understand that I will be asked to present my photo ID<\/label><\/li><\/ul><\/div><div id=\"wpforms-1068-field_46-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-1068-field_46\">Comments\/Questions<\/label><textarea id=\"wpforms-1068-field_46\" class=\"wpforms-field-medium\" name=\"wpforms[fields][46]\" ><\/textarea><\/div><div id=\"wpforms-1068-field_73-container\" class=\"wpforms-field wpforms-field-captcha\" data-field-id=\"73\"><p id=\"wpforms-1068-field_73-question\" class=\"wpforms-captcha-question\">What number comes after 3?<\/p>\n\t\t<input type=\"text\" id=\"wpforms-1068-field_73\" class=\"wpforms-field-small wpforms-field-required a\" data-rule-wpf-captcha=\"qa\" data-is-wrapped-field=\"1\" data-a=\"4\" name=\"wpforms[fields][73][a]\" aria-describedby=\"wpforms-1068-field_73-question\" required>\n\t\t<input type=\"hidden\" name=\"wpforms[fields][73][q]\" value=\"1\">\n\n\t\t<\/div><div id=\"wpforms-1068-field_68-container\" class=\"wpforms-field wpforms-field-hidden\" data-field-id=\"68\"><input type=\"hidden\" id=\"wpforms-1068-field_68\" name=\"wpforms[fields][68]\" value=\"216.73.216.14\"><\/div><div id=\"wpforms-1068-field_66-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"66\"><label class=\"wpforms-field-label\">Subt\u00edtulos de traducci\u00f3n al espa\u00f1ol<\/label><ul id=\"wpforms-1068-field_66\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1068-field_66_1\" name=\"wpforms[fields][66][]\" value=\"Me gustar\u00eda solicitar subt\u00edtulos de traducci\u00f3n del ingl\u00e9s al espa\u00f1ol cuando asista.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1068-field_66_1\">Me gustar\u00eda solicitar subt\u00edtulos de traducci\u00f3n del ingl\u00e9s al espa\u00f1ol cuando asista.<\/label><\/li><\/ul><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1068-field_2-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-1068-field_2-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-1068-field_2-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" ><div class=\"g-recaptcha\" data-sitekey=\"6Ldiyd0eAAAAALqH8eNzS9fkWudYdd-Snd57LKB-\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-recaptcha=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1068\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/pages\/801\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1068\" class=\"wpforms-submit\" data-alt-text=\"Form is submitting\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.hendrickscountysso.com\/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 --><em>\u00a0<\/em><\/p>\n<p>Contact Survivor Speakout directly with questions. <a href=\"tel:3172893242\">317.289.3242\u00a0<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Virtual, Live Online Survivor Speakout Victim Impact Panel &#8211; Accepted Nationwide* You cannot attend online with your cell phone! Register by completing form below. *Oklahoma and Arkansas do NOT accept &hellip; <\/p>\n","protected":false},"author":3,"featured_media":134,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-801","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/pages\/801","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/comments?post=801"}],"version-history":[{"count":44,"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/pages\/801\/revisions"}],"predecessor-version":[{"id":2960,"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/pages\/801\/revisions\/2960"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/media\/134"}],"wp:attachment":[{"href":"https:\/\/www.hendrickscountysso.com\/index.php\/wp-json\/wp\/v2\/media?parent=801"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}