{"id":4948,"date":"2023-08-03T13:53:42","date_gmt":"2023-08-03T20:53:42","guid":{"rendered":"https:\/\/seniors.nikkeiplace.org\/?page_id=4948"},"modified":"2025-08-13T10:56:31","modified_gmt":"2025-08-13T17:56:31","slug":"h-u-g-s-application","status":"publish","type":"page","link":"https:\/\/seniors.nikkeiplace.org\/ja\/h-u-g-s-application\/","title":{"rendered":"H.U.G.S. Application"},"content":{"rendered":"<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4947-o1\" lang=\"en-CA\" dir=\"ltr\" data-wpcf7-id=\"4947\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ja\/wp-json\/wp\/v2\/pages\/4948#wpcf7-f4947-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/ja\/wp-json\/wp\/v2\/pages\/4948#wpcf7-f4947-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4947\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_CA\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4947-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<style>\n .radio{\n vertical-align:middle;\n white-space: pre;\n }\n\ninput.wpcf7-form-control.wpcf7-submit {\n display: block;\n margin: 0 auto;\n}\n<\/style>\n<style> \n .container{\n width: 200px;\n height: 200px;\n position: relative;\n margin: auto;\n }\n .box{\n width: 100%;\n height: 100%; \n position: absolute;\n top: 0;\n left: 0;\n opacity: 1; \/* for demo purpose *\/\n }\n .stack-top{\n z-index: 9;\n }\n<\/style>\n<p><script>\ndocument.addEventListener( 'wpcf7mailsent', function( event ) {\n location = 'https:\/\/seniors.nikkeiplace.org\/thank-you\/';\n }, false );\n\n<\/script>\n<\/p>\n<h1 style=\"margin-left:auto; margin-right:auto; text-align:center\">Type of Application\n<\/h1>\n<div style=\"display:flex\">\n\t<p style=\"text-align:center; width:50%\">For Self <input type=\"radio\" name=\"application-type\" class=\"radio\" onchange=\"forSelf()\" \/>\n\t<\/p>\n\t<p style=\"text-align:center; width:50%\">For Someone Else <input type=\"radio\" name=\"application-type\" class=\"radio\" onchange=\"forSomeoneElse()\" \/>\n\t<\/p>\n<\/div>\n<div id=\"box-a\">\n<\/div>\n<div id=\"box-b\">\n<\/div>\n<div id=\"box-c\">\n<\/div>\n<body>\n\t<div class=\"container\">\n\t\t<div class=\"box\"red;\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit Form\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"box stack-top\" style=\"background: white;\" id=\"overlay\">\n\t\t<\/div>\n\t<\/div>\n<\/body><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"ja\"\/><\/form>\n<\/div>\n<\/div>\n\n\n\n<style>\n    .input {\n        text-align:center;\n        margin-bottom:1.5rem;\n    }\n    .question {\n        font-size:25px;    \n    }\n button {\n background:transparent;\n}\n<\/style>\n<script>\n\n    var loadedA = false;\n\n    function forSelf() {\n        console.log(\"For Self\");\n\n        const element = document.getElementById(\"someone-else\");\n        if (element != null) {\n            element.remove();\n        }\n\n        if (!loadedA) {\n            \n            const elem = document.getElementById(\"overlay\");\n            if (elem != null) {            \n                elem.remove();\n            }\n            var boxA = document.getElementById(\"box-a\");\n            \n            boxA.insertAdjacentHTML(\"afterend\", \"<div margin-left='auto' margin-right='auto' style='text-align:center' id='for-self'><h1>Applicant Information<\/h1><label class='question'>Full Name<\/label><\/br><input type='text' style='text-transform:none; text-align:center' name='name' class='input'><\/br><label class='question'>Address<\/label><\/br><input type='text' style='text-transform:none' name='address' class='input'><\/br><label class='question'>City<\/label><\/br><input type='text' style='text-transform:none' name='city' class='input'><\/br><label class='question'>Postal Code<\/label><\/br><input type='text' style='text-transform:none' name='postal-code' class='input'><\/br><label class='question'>Birth Date<\/label><\/br><input type='date' style='text-transform:none' name='birth-date' class='input'><\/br><label class='question'>Birth Place<\/label><\/br><input type='text' style='text-transform:none' name='birth-place' class='input'><\/br><label class='question'>Primary Language<\/label><\/br><label class='radio' style='margin-right:10px'>English<\/label><input class='radio' type='radio' style='text-transform:none' name='primary-language' style='radio' value='English'><\/br><label style='margin-right:10px'>Japanese<\/label><input type='radio' style='text-transform:none;' name='primary-language' class='radio' value='Japanese'><\/br><label class='question' style='margin-top:1.5rem'>Primary Phone Number<\/label><\/br><input type='tel' style='text-transform:none' name='phone-number' class='input'><\/br><label class='question'>Secondary Phone Number<\/label><\/br><input type='tel' style='text-transform:none' name='phone-number-secondary' class='input'><\/br><label class='question'>Email<\/label><\/br><input type='email' style='text-transform:none' name='email' class='input'><\/br><label class='question'>Preferred Method of Contact<\/label><\/br><label style='margin-right:10px'>Phone Number<\/label><input type='radio' style='text-transform:none' name='contact-method' class='radio' value='Phone Number'><\/br><label style='margin-right:10px'>Email<\/label><input type='radio' style='text-transform:none' name='contact-method' class='radio' value='Email' class='input'><\/br><label class='question' style='margin-top:1.5rem'>Internment Years and Location (if applicable)<\/label><\/br><input type='text' style='text-transform:none' name='internment' class='input'><\/br><label class='question'>Reason for Application<\/label><\/br><input type='text' style='text-transform:none' name='application-reason' class='input'><\/br><\/div>\");\n            loadedA = true;\n        }\n\n        const permission = document.getElementById('permission');\n\n        if (permission != null) {\n            permission.remove();\n        }\n\n        const target = document.getElementById('for-self');\n        target.insertAdjacentHTML(\"afterend\", \"<div margin-left='auto' margin-right='auto' style='text-align:center' id='permission'><label class='question'>Do you give H.U.G.S. consent to contact you?<\/label><\/br><label class='radio' style='margin-right:10px'>Yes, I give H.U.G.S. permission to contact me.<\/label><input class='radio' type='radio' style='text-transform:none' name='permission-contact' style='radio' value='This Applicant Gives Consent to Contact'><\/br><\/div>\")\n    }\n<\/script>\n\n<script>\n\n    function forSomeoneElse() {\n        console.log(\"For someone else\");\n        forSelf();\n        var container = document.getElementById(\"box-b\");\nconst elem = document.getElementById(\"overlay\");\n            if (elem != null) {            \n                elem.remove();\n            }\n        container.insertAdjacentHTML(\"afterend\", \"<div id='someone-else' margin-left='auto' margin-right='auto' style='text-align:center'><h1>Primary Contact Information<\/h1><label class='question'>Full Name<\/label><\/br><input type='text' style='text-transform:none; text-align:center' name='name-contact' class='input'><\/br><label class='question'>Relationship to Applicant<\/label><\/br><input type='text' style='text-transform:none; text-align:center' name='relationship' class='input'><\/br><label class='question'>Phone Number<\/label><\/br><input type='text' style='text-transform:none; text-align:center' name='phone-number-contact' class='input'><\/br><label class='question'>Email<\/label><\/br><input type='text' style='text-transform:none; text-align:center' name='email-contact' class='input'><\/br><label class='question'>Best Person to Schedule and Confirm Appointments<\/label><\/br><label style='margin-right:10px'>Applicant<\/label><input type='radio' style='text-transform:none' name='to-contact' class='radio' value='Applicant'><\/br><label style='margin-right:10px'>Primary Contact<\/label><input type='radio' style='text-transform:none' name='to-contact' class='radio' value='Contact' class='input'><\/div>\");   \n        \n        const permission = document.getElementById('permission');\n        \n        if (permission != null) {\n            permission.remove();\n        }\n\n        const target = document.getElementById('someone-else');\n        target.insertAdjacentHTML(\"afterend\", \"<div margin-left='auto' margin-right='auto' style='text-align:center' id='permission'><label class='question'>Have you received consent from the Survivor to apply on their behalf?<\/label><\/br><label class='radio' style='margin-right:10px'>Yes, I have received consent from the Survivor to apply on their behalf.<\/label><input class='radio' type='radio' style='text-transform:none' name='permission-contact' value='Yes, this applicant has received consent from the Survivor to apply on their behalf'><\/br><\/div>\");\n    }\n<\/script>","protected":false},"excerpt":{"rendered":"Type of Application For Self For Someone Else","protected":false},"author":10,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-4948","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>H.U.G.S. Application - Nikkei Place Seniors<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/seniors.nikkeiplace.org\/ja\/h-u-g-s-application\/\" \/>\n<meta property=\"og:locale\" content=\"ja_JP\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H.U.G.S. Application - Nikkei Place Seniors\" \/>\n<meta property=\"og:url\" content=\"https:\/\/seniors.nikkeiplace.org\/ja\/h-u-g-s-application\/\" \/>\n<meta property=\"og:site_name\" content=\"Nikkei Place Seniors\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/nikkeiplacefoundation\" \/>\n<meta property=\"article:modified_time\" content=\"2025-08-13T17:56:31+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@nikkeiplace\" \/>\n<meta name=\"twitter:label1\" content=\"\u63a8\u5b9a\u8aad\u307f\u53d6\u308a\u6642\u9593\" \/>\n\t<meta name=\"twitter:data1\" content=\"1\u5206\" \/>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"H.U.G.S. Application - Nikkei Place Seniors","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/seniors.nikkeiplace.org\/ja\/h-u-g-s-application\/","og_locale":"ja_JP","og_type":"article","og_title":"H.U.G.S. Application - Nikkei Place Seniors","og_url":"https:\/\/seniors.nikkeiplace.org\/ja\/h-u-g-s-application\/","og_site_name":"Nikkei Place Seniors","article_publisher":"https:\/\/www.facebook.com\/nikkeiplacefoundation","article_modified_time":"2025-08-13T17:56:31+00:00","twitter_card":"summary_large_image","twitter_site":"@nikkeiplace","twitter_misc":{"\u63a8\u5b9a\u8aad\u307f\u53d6\u308a\u6642\u9593":"1\u5206"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/seniors.nikkeiplace.org\/h-u-g-s-application\/","url":"https:\/\/seniors.nikkeiplace.org\/h-u-g-s-application\/","name":"H.U.G.S. Application - Nikkei Place Seniors","isPartOf":{"@id":"https:\/\/seniors.nikkeiplace.org\/#website"},"datePublished":"2023-08-03T20:53:42+00:00","dateModified":"2025-08-13T17:56:31+00:00","breadcrumb":{"@id":"https:\/\/seniors.nikkeiplace.org\/h-u-g-s-application\/#breadcrumb"},"inLanguage":"ja","potentialAction":[{"@type":"ReadAction","target":["https:\/\/seniors.nikkeiplace.org\/h-u-g-s-application\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/seniors.nikkeiplace.org\/h-u-g-s-application\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/seniors.nikkeiplace.org\/"},{"@type":"ListItem","position":2,"name":"H.U.G.S. Application"}]},{"@type":"WebSite","@id":"https:\/\/seniors.nikkeiplace.org\/#website","url":"https:\/\/seniors.nikkeiplace.org\/","name":"\u65e5\u7cfb\u30d7\u30ec\u30a4\u30b9\u30b7\u30cb\u30a2","description":"Living, laughing, and aging gracefully","publisher":{"@id":"https:\/\/seniors.nikkeiplace.org\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/seniors.nikkeiplace.org\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"ja"},{"@type":"Organization","@id":"https:\/\/seniors.nikkeiplace.org\/#organization","name":"Nikkei Seniors Health Care & Housing Society","url":"https:\/\/seniors.nikkeiplace.org\/","logo":{"@type":"ImageObject","inLanguage":"ja","@id":"https:\/\/seniors.nikkeiplace.org\/#\/schema\/logo\/image\/","url":"https:\/\/seniors.nikkeiplace.org\/wp-content\/uploads\/2019\/09\/NSHCHS_200x80.png","contentUrl":"https:\/\/seniors.nikkeiplace.org\/wp-content\/uploads\/2019\/09\/NSHCHS_200x80.png","width":200,"height":80,"caption":"Nikkei Seniors Health Care & Housing Society"},"image":{"@id":"https:\/\/seniors.nikkeiplace.org\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/nikkeiplacefoundation","https:\/\/x.com\/nikkeiplace","https:\/\/www.instagram.com\/nikkeiplace\/"]}]}},"_links":{"self":[{"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/pages\/4948","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/comments?post=4948"}],"version-history":[{"count":4,"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/pages\/4948\/revisions"}],"predecessor-version":[{"id":5627,"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/pages\/4948\/revisions\/5627"}],"wp:attachment":[{"href":"https:\/\/seniors.nikkeiplace.org\/ja\/wp-json\/wp\/v2\/media?parent=4948"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}