DisclaimerYesNo (type: esriFieldTypeString, alias: I am requesting that OHA keep my name and address confidential to the extent permitted by law. OHA will use this information as necessary for voucher tracking and distribution., SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes, I am requesting that OHA keep my name and address confidential to the extent permitted by law.], [no: No, I am not requesting that OHA keep my name and address confidential.])
domestic_water_use (type: esriFieldTypeString, alias: Does your household use water from a private (domestic) well for things like drinking, cooking, and washing dishes?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes, the well is private. I own or rent the property and use the well.], [no: No, I get water from a public water system. I pay a water bill.])
LearnAbout (type: esriFieldTypeString, alias: How did you learn about OHA's free well testing?, SQL Type: sqlTypeOther, length: 150, nullable: true, editable: true, Coded Values: [New Media: I saw an online notice (web advertising, online newspaper, Facebook or other social media)], [Online Search: I did a search online], [Traditional Media: I heard a radio ad, saw a newspaper ad or saw a news article], ... 3 more ...)
Confidential_Info (type: esriFieldTypeString, alias: Does the applicant want to keep their information confidential?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
YouthCount (type: esriFieldTypeInteger, alias: How many people in your household are age 15 and younger?, SQL Type: sqlTypeOther, nullable: true, editable: true)
AdultCount (type: esriFieldTypeInteger, alias: How many people in your household are age 16 and older?, SQL Type: sqlTypeOther, nullable: true, editable: true)
Pregnancy_status (type: esriFieldTypeString, alias: Is anyone in your household pregnant or may become pregnant?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
Infant_Toddlers (type: esriFieldTypeString, alias: Are there any babies or small children in your household age 2 or younger?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
RealDYesNo (type: esriFieldTypeString, alias: Would you like to tell us your race, ethnicity, language and ability levels?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
RaceEthnicity (type: esriFieldTypeString, alias: How do you identify your race, ethnicity, tribal affiliation, country of origin, or ancestry?, SQL Type: sqlTypeOther, length: 500, nullable: true, editable: true)
RaceEthnicityPrimary (type: esriFieldTypeString, alias: If you checked more than one category in the previous question, is there one you think of as your primary racial or ethnic identity? Please select the category or your response below., SQL Type: sqlTypeOther, length: 500, nullable: true, editable: true)
Language (type: esriFieldTypeString, alias: What language or languages do you use at home?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [English Only: English Only], [Other: Other])
LanguageOther (type: esriFieldTypeString, alias: Enter the other langauge spoken in the home, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
LanguageCommunication (type: esriFieldTypeString, alias: In what language do you want us to communicate in person, on the phone, or virtually with you?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
LanguageWritten (type: esriFieldTypeString, alias: In what language do you want us to write to you?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
InterpreterNeeded (type: esriFieldTypeString, alias: Do you need or want an interpreter for us to communicate with you?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [don't know: Don't know], ... 1 more ...)
InterpreterType (type: esriFieldTypeString, alias: If you need or want an interpreter, what type of interpreter is preferred?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [Spoken language interpreter: Spoken language interpreter], [American Sign Language interpreter: American Sign Language interpreter], [Deaf interpreter for Deaf/Blind, additional barriers, or both: Deaf interpreter for Deaf/Blind, additional barriers, or both], ... 2 more ...)
EnglishProficiency (type: esriFieldTypeString, alias: How well do you speak English?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [Very well: Very well], [Well: Well], [Not well: Not well], ... 6 more ...)
Hearing (type: esriFieldTypeString, alias: Are you deaf or do you have serious difficulty hearing?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [don't know: Don't know], ... 1 more ...)
Blind (type: esriFieldTypeString, alias: Are you blind or do you have serious difficulty seeing, even when wearing glasses?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [don't know: Don't know], ... 1 more ...)
MentalDifficulties (type: esriFieldTypeString, alias: Because of a physical, mental or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [don't know: Don't know], ... 1 more ...)
LearningDifficulties (type: esriFieldTypeString, alias: Do you have serious difficulty learning how to do things most people your age can learn?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [don't know: Don't know], ... 1 more ...)
CommDifficulties (type: esriFieldTypeString, alias: Using your usual (customary language), do you have serious difficulty communicating (for example understanding or being understood by others)?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [don't know: Don't know], ... 1 more ...)
ErrandDifficulties (type: esriFieldTypeString, alias: Because of a physical, mental or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [don't know: Don't know], ... 1 more ...)
SharedWell (type: esriFieldTypeString, alias: Does your household share a well with another property?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No], [unsure: Unsure])
AgeUnder15 (type: esriFieldTypeInteger, alias: How many people in your household are age 15 and younger?, SQL Type: sqlTypeOther, nullable: true, editable: true)
Age16andUp (type: esriFieldTypeInteger, alias: How many people in your household are age 16 and older?, SQL Type: sqlTypeOther, nullable: true, editable: true)
Pregnant (type: esriFieldTypeString, alias: Is anyone in your household pregnant or may become pregnant?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
InfantsBelow2 (type: esriFieldTypeString, alias: Are there any babies or small children in your household age 2 or younger?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
WellStreetLatitude (type: esriFieldTypeDouble, alias: Well X Coordination, SQL Type: sqlTypeOther, nullable: true, editable: true)
WellStreetLongitude (type: esriFieldTypeDouble, alias: Well Y Coordination, SQL Type: sqlTypeOther, nullable: true, editable: true)
WellTypeChoice (type: esriFieldTypeString, alias: Does your household use water from a private (domestic) well for things like drinking, cooking, and washing dishes?, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true, Coded Values: [private: Yes, the well is private. I own or rent the property and use the well.], [public: No, I get water from a public water system. I pay a water bill.], [yes: Yes], ... 1 more ...)
HouseholdStreetMailingUnit (type: esriFieldTypeString, alias: Apartment, unit or suite number, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true)
HouseholdStreetAddressUnit (type: esriFieldTypeString, alias: Apartment, unit or suite number, SQL Type: sqlTypeOther, length: 25, nullable: true, editable: true)
HouseWellSame (type: esriFieldTypeString, alias: Are the home and well address the same?, SQL Type: sqlTypeOther, length: 5, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
Templates:
Name: New Feature
Description:
Drawing Tool: esriFeatureEditToolNone
Prototype: