<?php

/* DorcasTabithaBundle:Referrals:referralslayout.html_1.twig */
class __TwigTemplate_ce152d51379e83860db88faa496a457a extends Twig_Template
{
    public function __construct(Twig_Environment $env)
    {
        parent::__construct($env);

        $this->parent = false;

        $this->blocks = array(
        );
    }

    protected function doDisplay(array $context, array $blocks = array())
    {
        // line 1
        echo "  
<input type=\"submit\" value=\"Next\" style=\"color:#00b5cb; background-color:white;\">
<br>&nbsp;<br>

        <div style=\"color:maroon;\">
        ";
        // line 6
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($_form_);
        echo "
        </div>

        <hr />      
        <p>
        REFERRED FROM:
        </p>
        <hr />

        <div id=\"western_wake\">
            ";
        // line 16
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "western_wake"));
        echo "
            ";
        // line 17
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "western_wake"));
        echo "
            ";
        // line 18
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "western_wake"), array("attr" => array("size" => "3")));
        echo " 
        </div>
        <div id=\"western_wake_date\">
            ";
        // line 21
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "western_wake_date"));
        echo "
            ";
        // line 22
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "western_wake_date"));
        echo "
            ";
        // line 23
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "western_wake_date"), array("attr" => array("size" => "11", "class" => "datepicker", "onchange" => "wwdate(this)")));
        echo "
        </div>
         <div id=\"oxford_house\">
            ";
        // line 26
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "oxford_house"));
        echo "
            ";
        // line 27
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "oxford_house"));
        echo "
            ";
        // line 28
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "oxford_house"), array("attr" => array("size" => "3")));
        echo "
        </div>
        <div id=\"oxford_house_date\">
            ";
        // line 31
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "oxford_house_date"));
        echo "
            ";
        // line 32
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "oxford_house_date"));
        echo "
            ";
        // line 33
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "oxford_house_date"), array("attr" => array("size" => "11", "class" => "datepicker", "onchange" => "ohdate(this)")));
        echo "      </div>
        <div id=\"church\">
            ";
        // line 35
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "church"));
        echo "
            ";
        // line 36
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "church"));
        echo "
            ";
        // line 37
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "church"));
        echo "
        </div>
        <div id=\"church_date\">
            ";
        // line 40
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "church_date"));
        echo "
            ";
        // line 41
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "church_date"));
        echo "
            ";
        // line 42
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "church_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>
   <div id=\"other\">
            ";
        // line 45
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "other"));
        echo "
            ";
        // line 46
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "other"));
        echo "
            ";
        // line 47
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "other"), array("attr" => array("size" => "20")));
        echo "
        </div>
        <div id=\"other_date\">
            ";
        // line 50
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "other_date"));
        echo "
            ";
        // line 51
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "other_date"));
        echo "
            ";
        // line 52
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "other_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>

        <br>&nbsp;<br>
        <hr />      
        <p>
        DORCAS PROGRAMS:
        </p>
        <hr />

        <div id=\"margaret_keller\">
            ";
        // line 63
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "margaret_keller"));
        echo "
            ";
        // line 64
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "margaret_keller"));
        echo "
            ";
        // line 65
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "margaret_keller"), array("attr" => array("size" => "3")));
        echo "
        </div>
        <div id=\"margaret_keller_date\">
            ";
        // line 68
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "margaret_keller_date"));
        echo "
            ";
        // line 69
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "margaret_keller_date"));
        echo "
            ";
        // line 70
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "margaret_keller_date"), array("attr" => array("size" => "11", "class" => "datepicker", "onchange" => "mkdate(this)")));
        echo "
        </div>
         <div id=\"childcare\">
            ";
        // line 73
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "childcare"));
        echo "
            ";
        // line 74
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "childcare"));
        echo "
            ";
        // line 75
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "childcare"), array("attr" => array("size" => "3")));
        echo "
        </div>
        <div id=\"childcare_date\">
            ";
        // line 78
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "childcare_date"));
        echo "
            ";
        // line 79
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "childcare_date"));
        echo "
            ";
        // line 80
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "childcare_date"), array("attr" => array("size" => "11", "class" => "datepicker", "onchange" => "ccdate(this)")));
        echo "
        </div>
        <div id=\"resource_office\">
            ";
        // line 83
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "resource_office"));
        echo "
            ";
        // line 84
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "resource_office"));
        echo "
            ";
        // line 85
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "resource_office"));
        echo "
        </div>
        <div id=\"church_date\">
            ";
        // line 88
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "resource_office_date"));
        echo "
            ";
        // line 89
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "resource_office_date"));
        echo "
            ";
        // line 90
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "resource_office_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>

        <br>&nbsp;<br>
        <hr />      
        <p>
        SHORT-TERM REFERRALS:
        </p>
        <hr />

<div style=\"float: left; padding:3px;\">
        Housing

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

            <div id=\"housing_cornerstone\">
                        ";
        // line 106
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_cornerstone"));
        echo "
                        ";
        // line 107
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_cornerstone"));
        echo "   
                    </div>
            <div id=\"housing_raleighrescuemission\">
                        ";
        // line 110
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_raleighrescuemission"));
        echo "
                        ";
        // line 111
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_raleighrescuemission"));
        echo "          
                    </div>
            <div id=\"housing_salvationarmy\">
                        ";
        // line 114
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_salvationarmy"));
        echo "   
                        ";
        // line 115
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_salvationarmy"));
        echo "
                    </div>
            <div id=\"housing_panlutheranministries\">
                        ";
        // line 118
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_panlutheranministries"));
        echo "   
                        ";
        // line 119
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_panlutheranministries"));
        echo "
                    </div>
            <div id=\"housing_southwilmingtonstreetshelter\">
                        ";
        // line 122
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_southwilmingtonstreetshelter"));
        echo "   
                        ";
        // line 123
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_southwilmingtonstreetshelter"));
        echo "
                    </div>
            <div id=\"housing_thewomansshelter\">
                        ";
        // line 126
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_thewomansshelter"));
        echo "   
                        ";
        // line 127
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_thewomansshelter"));
        echo "
                    </div>
            <div id=\"housing_trianglefamilyservices\">
                        ";
        // line 130
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_trianglefamilyservices"));
        echo "   
                        ";
        // line 131
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_trianglefamilyservices"));
        echo "
                    </div>
            <div id=\"housing_wakecountyhumanservices\">
                        ";
        // line 134
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_wakecountyhumanservices"));
        echo "   
                        ";
        // line 135
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_wakecountyhumanservices"));
        echo "
                    </div>
            <div id=\"housing_wakeinterfaithhospitalitynetwork\">
                        ";
        // line 138
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_wakeinterfaithhospitalitynetwork"));
        echo "   
                        ";
        // line 139
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_wakeinterfaithhospitalitynetwork"));
        echo "
                    </div>
            <div id=\"housing_interact\">
                        ";
        // line 142
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_interact"));
        echo "   
                        ";
        // line 143
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_interact"));
        echo "
                    </div>
            <div id=\"housing_caryingplace\">
                        ";
        // line 146
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_caryingplace"));
        echo "   
                        ";
        // line 147
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_caryingplace"));
        echo "
                    </div>
            <div id=\"housing_other\">
                        ";
        // line 150
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "housing_other"));
        echo "   
                        ";
        // line 151
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "housing_other"));
        echo "
                    </div>        

</div> 
</div>  



<div style=\"float: left; padding:3px;\">
        Financial
<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

            <div id=\"financial_wakecountyhumanservicesenergyprogram\">
                        ";
        // line 164
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financial_wakecountyhumanservicesenergyprogram"));
        echo "   
                        ";
        // line 165
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financial_wakecountyhumanservicesenergyprogram"));
        echo "
                    </div>\t
\t\t\t<div id=\"financial_trianglefamily\">
                        ";
        // line 168
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financial_trianglefamily"));
        echo "   
                        ";
        // line 169
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financial_trianglefamily"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"financial_salvationarmy\">
                        ";
        // line 172
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financial_salvationarmy"));
        echo "   
                        ";
        // line 173
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financial_salvationarmy"));
        echo "
                    </div>\t
\t\t\t<div id=\"financial_northraleighministries\">
                        ";
        // line 176
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financial_northraleighministries"));
        echo "   
                        ";
        // line 177
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financial_northraleighministries"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"financial_firstpresbyterianchurch\">
                        ";
        // line 180
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financial_firstpresbyterianchurch"));
        echo "   
                        ";
        // line 181
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financial_firstpresbyterianchurch"));
        echo "
                    </div>\t
\t\t\t<div id=\"financial_sacredheartchurch\">
                        ";
        // line 184
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financial_sacredheartchurch"));
        echo "   
                        ";
        // line 185
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financial_sacredheartchurch"));
        echo "
                    </div>\t
\t\t\t<div id=\"financial_otherfinancialassistanceprogram\">
                        ";
        // line 188
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financial_otherfinancialassistanceprogram"));
        echo "   
                        ";
        // line 189
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financial_otherfinancialassistanceprogram"));
        echo "
                    </div>\t


</div>
</div>

<div style=\"float: left; padding:3px;\">
        Food and Clothing
<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

<div id=\"foodandclothing_foodstampswakecountyhumanservices\">
                        ";
        // line 201
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_foodstampswakecountyhumanservices"));
        echo "   
                        ";
        // line 202
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_foodstampswakecountyhumanservices"));
        echo "
                    </div>\t
\t\t\t<div id=\"foodandclothing_urbanministriesfoodpantry\">
                        ";
        // line 205
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_urbanministriesfoodpantry"));
        echo "   
                        ";
        // line 206
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_urbanministriesfoodpantry"));
        echo "
                    </div>\t
\t\t\t<div id=\"foodandclothing_catholicparishoutreach\">
                        ";
        // line 209
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_catholicparishoutreach"));
        echo "   
                        ";
        // line 210
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_catholicparishoutreach"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"foodandclothing_northraleighministries\">
                        ";
        // line 213
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_northraleighministries"));
        echo "   
                        ";
        // line 214
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_northraleighministries"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"foodandclothing_salvationarmy\">
                        ";
        // line 217
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_salvationarmy"));
        echo "   
                        ";
        // line 218
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_salvationarmy"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"foodandclothing_shepherdstable\">
                        ";
        // line 221
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_shepherdstable"));
        echo "   
                        ";
        // line 222
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_shepherdstable"));
        echo "
                    </div>\t
\t\t\t<div id=\"foodandclothing_withlovefromjesus\">
                        ";
        // line 225
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_withlovefromjesus"));
        echo "   
                        ";
        // line 226
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_withlovefromjesus"));
        echo "
                    </div>\t
\t\t\t<div id=\"foodandclothing_firstbaptistraleigh\">
                        ";
        // line 229
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_firstbaptistraleigh"));
        echo "   
                        ";
        // line 230
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_firstbaptistraleigh"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"foodandclothing_otherfoodandclothingprogram\">
                        ";
        // line 233
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "foodandclothing_otherfoodandclothingprogram"));
        echo "   
                        ";
        // line 234
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "foodandclothing_otherfoodandclothingprogram"));
        echo "
                    </div>\t
\t\t\t\t\t
</div>
</div>\t

<div style=\" padding:3px;\">
        Healthcare and Recovery
<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >\t

\t\t<div id=\"healthcareandrecovery_wakehealthservices\">
                        ";
        // line 245
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "healthcareandrecovery_wakehealthservices"));
        echo "   
                        ";
        // line 246
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "healthcareandrecovery_wakehealthservices"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"healthcareandrecovery_opendoorclinic\">
                        ";
        // line 249
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "healthcareandrecovery_opendoorclinic"));
        echo "   
                        ";
        // line 250
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "healthcareandrecovery_opendoorclinic"));
        echo "
                    </div>\t
\t\t\t<div id=\"healthcareandrecovery_alliancemedicalministry\">
                        ";
        // line 253
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "healthcareandrecovery_alliancemedicalministry"));
        echo "   
                        ";
        // line 254
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "healthcareandrecovery_alliancemedicalministry"));
        echo "
                    </div>\t
\t\t\t<div id=\"healthcareandrecovery_thehealingplaceofwakecounty\">
                        ";
        // line 257
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "healthcareandrecovery_thehealingplaceofwakecounty"));
        echo "   
                        ";
        // line 258
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "healthcareandrecovery_thehealingplaceofwakecounty"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"healthcareandrecovery_trianglealanoclub\">
                        ";
        // line 261
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "healthcareandrecovery_trianglealanoclub"));
        echo "   
                        ";
        // line 262
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "healthcareandrecovery_trianglealanoclub"));
        echo "
                    </div>\t
\t\t\t
\t\t\t<div id=\"healthcareandrecovery_northcarolinabaptistdentalbus\">
                        ";
        // line 266
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "healthcareandrecovery_northcarolinabaptistdentalbus"));
        echo "   
                        ";
        // line 267
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "healthcareandrecovery_northcarolinabaptistdentalbus"));
        echo "
                    </div>\t
\t\t\t<div id=\"healthcareandrecovery_otherhealthcareandrecoveryprogram\">
                        ";
        // line 270
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "healthcareandrecovery_otherhealthcareandrecoveryprogram"));
        echo "   
                        ";
        // line 271
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "healthcareandrecovery_otherhealthcareandrecoveryprogram"));
        echo "
                    </div>\t\t\t
\t\t\t\t\t
\t\t\t\t\t
</div>
</div>\t


        <br>&nbsp;<br>
        <hr />      
        <p>
        LONG-TERM REFERRALS:
        </p>
        <hr />
\t\t
<div style=\"float: left; padding:3px;\">
        Comprehensive Programs

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >\t

\t\t<div id=\"comprehensiveprograms_cornerstone\">
                        ";
        // line 292
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "comprehensiveprograms_cornerstone"));
        echo "   
                        ";
        // line 293
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "comprehensiveprograms_cornerstone"));
        echo "
                    </div>\t
\t\t\t<div id=\"comprehensiveprograms_stepupministry\">
                        ";
        // line 296
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "comprehensiveprograms_stepupministry"));
        echo "   
                        ";
        // line 297
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "comprehensiveprograms_stepupministry"));
        echo "
                    </div>\t
\t\t\t<div id=\"comprehensiveprograms_thecaryingplace\">
                        ";
        // line 300
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "comprehensiveprograms_thecaryingplace"));
        echo "   
                        ";
        // line 301
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "comprehensiveprograms_thecaryingplace"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"comprehensiveprograms_wakecountyhumanservices\">
                        ";
        // line 304
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "comprehensiveprograms_wakecountyhumanservices"));
        echo "   
                        ";
        // line 305
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "comprehensiveprograms_wakecountyhumanservices"));
        echo "
                    </div>\t
\t\t\t<div id=\"comprehensiveprograms_wakeinterfaithhospitalitynetwork\">
                        ";
        // line 308
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "comprehensiveprograms_wakeinterfaithhospitalitynetwork"));
        echo "   
                        ";
        // line 309
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "comprehensiveprograms_wakeinterfaithhospitalitynetwork"));
        echo "
                    </div>\t
\t\t\t<div id=\"comprehensiveprograms_othercomprehensiveprogram\">
                        ";
        // line 312
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "comprehensiveprograms_othercomprehensiveprogram"));
        echo "   
                        ";
        // line 313
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "comprehensiveprograms_othercomprehensiveprogram"));
        echo "
                    </div>\t\t\t\t
\t\t\t\t\t
</div>
</div>
\t\t

<div style=\"float: left; padding:3px;\">
        Employment

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >\t\t


\t\t<div id=\"employment_centerforhopeandhealing\">
                        ";
        // line 327
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "employment_centerforhopeandhealing"));
        echo "   
                        ";
        // line 328
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "employment_centerforhopeandhealing"));
        echo "
                    </div>\t
\t\t\t<div id=\"employment_dorcasministriesresourceoffice\">
                        ";
        // line 331
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "employment_dorcasministriesresourceoffice"));
        echo "   
                        ";
        // line 332
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "employment_dorcasministriesresourceoffice"));
        echo "
                    </div>\t
\t\t\t<div id=\"employment_joblink\">
                        ";
        // line 335
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "employment_joblink"));
        echo "   
                        ";
        // line 336
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "employment_joblink"));
        echo "
                    </div>\t
\t\t\t<div id=\"employment_jobsforlifeatdorcas\">
                        ";
        // line 339
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "employment_jobsforlifeatdorcas"));
        echo "   
                        ";
        // line 340
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "employment_jobsforlifeatdorcas"));
        echo "
                    </div>\t
\t\t\t<div id=\"employment_waketechcommunitycollegehrdclasses\">
                        ";
        // line 343
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "employment_waketechcommunitycollegehrdclasses"));
        echo "   
                        ";
        // line 344
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "employment_waketechcommunitycollegehrdclasses"));
        echo "
                    </div>\t
\t\t\t<div id=\"employment_otheremploymentprogram\">
                        ";
        // line 347
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "employment_otheremploymentprogram"));
        echo "   
                        ";
        // line 348
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "employment_otheremploymentprogram"));
        echo "
                    </div>\t\t\t
\t\t
\t\t
\t\t
\t\t
</div>
</div>\t\t

<div style=\"float: left; padding:3px;\">
        Education

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >\t\t

\t\t<div id=\"education_margaretkellerscholarship\">
                        ";
        // line 363
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "education_margaretkellerscholarship"));
        echo "   
                        ";
        // line 364
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "education_margaretkellerscholarship"));
        echo "
                    </div>\t
\t\t\t<div id=\"education_waketechcommunitycollegeesl\">
                        ";
        // line 367
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "education_waketechcommunitycollegeesl"));
        echo "   
                        ";
        // line 368
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "education_waketechcommunitycollegeesl"));
        echo "
                    </div>\t
\t\t\t<div id=\"education_waketechcommunitycollegehrdclasses\">
                        ";
        // line 371
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "education_waketechcommunitycollegehrdclasses"));
        echo "   
                        ";
        // line 372
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "education_waketechcommunitycollegehrdclasses"));
        echo "
                    </div>\t
\t\t\t<div id=\"education_othertraining\">
                        ";
        // line 375
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "education_othertraining"));
        echo "   
                        ";
        // line 376
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "education_othertraining"));
        echo "
                    </div>\t\t\t

</div>
</div>


<div style=\" padding:3px;\">
        Financial Counseling

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

\t\t<div id=\"financialcounseling_budgetcounseling\">
                        ";
        // line 389
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financialcounseling_budgetcounseling"));
        echo "   
                        ";
        // line 390
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financialcounseling_budgetcounseling"));
        echo "
                    </div>
\t\t\t<div id=\"financialcounseling_consumereducationcounseling\">
                        ";
        // line 393
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financialcounseling_consumereducationcounseling"));
        echo "   
                        ";
        // line 394
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financialcounseling_consumereducationcounseling"));
        echo "
                    </div>\t
\t\t\t<div id=\"financialcounseling_trianglefamilyservices\">
                        ";
        // line 397
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financialcounseling_trianglefamilyservices"));
        echo "   
                        ";
        // line 398
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financialcounseling_trianglefamilyservices"));
        echo "
                    </div>\t
\t\t\t<div id=\"financialcounseling_otherfinancialcounseling\">
                        ";
        // line 401
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "financialcounseling_otherfinancialcounseling"));
        echo "   
                        ";
        // line 402
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "financialcounseling_otherfinancialcounseling"));
        echo "
                    </div>\t\t

</div>
</div>

<div style=\"float: left; padding:3px;\">
        Legal Services

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

\t\t<div id=\"legalservices_legalaidofnorthcarolina\">
                        ";
        // line 414
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "legalservices_legalaidofnorthcarolina"));
        echo "   
                        ";
        // line 415
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "legalservices_legalaidofnorthcarolina"));
        echo "
                    </div>
\t\t\t<div id=\"legalservices_northcarolinalegalservicesinc\">
                        ";
        // line 418
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "legalservices_northcarolinalegalservicesinc"));
        echo "   
                        ";
        // line 419
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "legalservices_northcarolinalegalservicesinc"));
        echo "
                    </div>\t
\t\t\t<div id=\"legalservices_otherlegalservices\">
                        ";
        // line 422
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "legalservices_otherlegalservices"));
        echo "   
                        ";
        // line 423
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "legalservices_otherlegalservices"));
        echo "
                    </div>\t\t

</div>
</div>


<div style=\"float: left; padding:3px;\">
        Personal Counseling

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

\t\t<div id=\"personalcounseling_centerforhopeandhealing\">
                        ";
        // line 436
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "personalcounseling_centerforhopeandhealing"));
        echo "   
                        ";
        // line 437
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "personalcounseling_centerforhopeandhealing"));
        echo "
                    </div>
\t\t\t<div id=\"personalcounseling_trianglefamilyservices\">
                        ";
        // line 440
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "personalcounseling_trianglefamilyservices"));
        echo "   
                        ";
        // line 441
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "personalcounseling_trianglefamilyservices"));
        echo "
                    </div>\t
\t\t\t<div id=\"personalcounseling_westernwakehumanservicescenter\">
                        ";
        // line 444
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "personalcounseling_westernwakehumanservicescenter"));
        echo "   
                        ";
        // line 445
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "personalcounseling_westernwakehumanservicescenter"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"personalcounseling_othercounselingprogram\">
                        ";
        // line 448
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "personalcounseling_othercounselingprogram"));
        echo "   
                        ";
        // line 449
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "personalcounseling_othercounselingprogram"));
        echo "
                    </div>\t\t\t

</div>
</div>

<div style=\"float: left; padding:3px;\">
        Substance Abuse Programs

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

\t\t<div id=\"substanceabuseprograms_havenhouseinc\">
                        ";
        // line 461
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "substanceabuseprograms_havenhouseinc"));
        echo "   
                        ";
        // line 462
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "substanceabuseprograms_havenhouseinc"));
        echo "
                    </div>
\t\t\t<div id=\"substanceabuseprograms_oxfordhouse\">
                        ";
        // line 465
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "substanceabuseprograms_oxfordhouse"));
        echo "   
                        ";
        // line 466
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "substanceabuseprograms_oxfordhouse"));
        echo "
                    </div>\t
\t\t\t<div id=\"substanceabuseprograms_southlight\">
                        ";
        // line 469
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "substanceabuseprograms_southlight"));
        echo "   
                        ";
        // line 470
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "substanceabuseprograms_southlight"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"substanceabuseprograms_thehealingplace\">
                        ";
        // line 473
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "substanceabuseprograms_thehealingplace"));
        echo "   
                        ";
        // line 474
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "substanceabuseprograms_thehealingplace"));
        echo "
                    </div>\t
\t\t\t<div id=\"substanceabuseprograms_trianglealanoclub\">
                        ";
        // line 477
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "substanceabuseprograms_trianglealanoclub"));
        echo "   
                        ";
        // line 478
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "substanceabuseprograms_trianglealanoclub"));
        echo "
                    </div>\t
\t\t\t<div id=\"substanceabuseprograms_othersubstanceabuseprogram\">
                        ";
        // line 481
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "substanceabuseprograms_othersubstanceabuseprogram"));
        echo "   
                        ";
        // line 482
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "substanceabuseprograms_othersubstanceabuseprogram"));
        echo "
                    </div>\t\t

</div>
</div>

<div style=\"padding:3px;\">
        Medical

<div style=\"border:2px solid #ccc; width:300px; height: 100px; overflow-y: scroll;\" >

\t\t<div id=\"medical_alliancemedicalministry\">
                        ";
        // line 494
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "medical_alliancemedicalministry"));
        echo "   
                        ";
        // line 495
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "medical_alliancemedicalministry"));
        echo "
                    </div>
\t\t\t<div id=\"medical_theopendoorclinic\">
                        ";
        // line 498
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "medical_theopendoorclinic"));
        echo "   
                        ";
        // line 499
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "medical_theopendoorclinic"));
        echo "
                    </div>
\t\t\t<div id=\"medical_uncschoolofdentistry\">
                        ";
        // line 502
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "medical_uncschoolofdentistry"));
        echo "   
                        ";
        // line 503
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "medical_uncschoolofdentistry"));
        echo "
                    </div>\t\t
\t\t\t<div id=\"medical_wakecountyhumanservices\">
                        ";
        // line 506
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "medical_wakecountyhumanservices"));
        echo "   
                        ";
        // line 507
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "medical_wakecountyhumanservices"));
        echo "
                    </div>\t
\t\t\t<div id=\"medical_wakehealthservices\">
                        ";
        // line 510
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "medical_wakehealthservices"));
        echo "   
                        ";
        // line 511
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "medical_wakehealthservices"));
        echo "
                    </div>\t
\t\t\t<div id=\"medical_othermedicalprogram\">
                        ";
        // line 514
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "medical_othermedicalprogram"));
        echo "   
                        ";
        // line 515
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "medical_othermedicalprogram"));
        echo "
                    </div>\t
</div>
</div>



        ";
        // line 522
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderRest($_form_);
        echo "

";
    }

    public function getTemplateName()
    {
        return "DorcasTabithaBundle:Referrals:referralslayout.html_1.twig";
    }

    public function isTraitable()
    {
        return false;
    }

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}
