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<nav class="navbar navbar-default">
<div class="container-fluid">
<!-- Brand and toggle get grouped for better mobile display -->
<div class="navbar-header">
<button type="button" class="navbar-toggle collapsed" data-toggle="collapse" data-target="#defaultNavbar1"><span class="sr-only">Toggle navigation</span><span class="icon-bar"></span><span class="icon-bar"></span><span class="icon-bar"></span></button>
<img src="http://www.my-sisters-house.org/wp-content/uploads/2015/02/calvcp-logo-color@2000-300x90.png" alt="CalVCP logo" width="200" class="img-responsive header-logo"></div>
<!-- Collect the nav links, forms, and other content for toggling -->
<div class="collapse navbar-collapse" id="defaultNavbar1">
<ul class="nav navbar-nav navbar-right">
<li><a href="vcp.html">Home</a></li>
<li><a href="vcp-profile.html">Profile</a></li>
<li class="active"><a href="#" data-toggle="modal" data-target="#newApplication">New Application</a></li>
<li><a href="vcp-contact-us.html">Contact Us</a></li>
<li><a href="vcp-help.html">Help/FAQ</a></li>
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false">Language <span class="caret"></span></a>
<ul class="dropdown-menu">
<li><a href="vcp.html">English</a></li>
<li><a href="vcp-sp.html">Spanish</a></li>
<li><a href="vcp-ru.html">Russian</a></li>
</ul>
</li>
</ul>
</div>
<!-- /.navbar-collapse -->
</div>
<!-- /.container-fluid -->
</nav>
<!-- Start New Application Modal -->
<div class="modal fade" id="newApplication" tabindex="-1" role="dialog" aria-labelledby="newApplication">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
<h4 class="modal-title" id="myModalLabel">Start new Application</h4>
</div>
<div class="modal-body">
<div class="form-group">
<label for="exampleInputEmail1">Application Name</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Brother's death">
</div>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-default" data-dismiss="modal">Cancel</button>
<a href="vcp-application.html" role="button" class="btn btn-success btn-large">Continue</a>
</div>
</div>
</div>
</div>
<div class="container">
<div class="col-lg-12 col-md-12">
<div class="page-header">
<h1>Brother's Death <button type="button" class="btn btn-default btn-sm" data-toggle="modal" data-target="#editAppName"><span class="glyphicon glyphicon-pencil"> </span> Edit</button></h1>
<!-- Edit Application Name Modal -->
<div class="modal fade" id="editAppName" tabindex="-1" role="dialog" aria-labelledby="editAppName">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
<h4 class="modal-title" id="myModalLabel">Edit Application Name</h4>
</div>
<div class="modal-body">
<div class="form-group">
<label for="exampleInputEmail1">Application Name</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Brother's death">
</div>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-default" data-dismiss="modal">Cancel</button>
<a href="vcp-application.html" role="button" class="btn btn-success btn-large">Edit</a>
</div>
</div>
</div>
</div> <!-- / Edit Application Name Modal -->
</div> <!-- / Page Header -->
</div>
<div class="row">
<!-- Sidebar -->
<div class="text-justify col-lg-3 col-sm-3 col-md-3">
<h4 class="hidden-xs">Progress</h4>
<div class="visible-xs-block">
<a id="progress-button" class="btn btn-default" role="button">
<span class="glyphicon glyphicon-menu-hamburger"></span> Progress
</a>
<br /><br />
</div>
<ul id="progress-menu" class="nav nav-pills nav-stacked hidden-xs">
<li role="presentation" class="active"><a href="vcp-application.html" class="disabled"><span class="glyphicon glyphicon-check pull-right"></span>Section 1</a></li>
<li role="presentation"><a href="vcp-application-2.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 2</a></li>
<li role="presentation"><a href="vcp-application-3.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 3</a></li>
<li role="presentation"><a href="vcp-application-4.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 4</a></li>
<li role="presentation"><a href="vcp-application-5.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 5</a></li>
<li role="presentation"><a href="vcp-application-6.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 6</a></li>
<li role="presentation"><a href="vcp-application-7.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 7</a></li>
<li role="presentation"><a href="vcp-application-8.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 8</a></li>
<li role="presentation"><a href="vcp-application-9.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 9</a></li>
<li role="presentation"><a href="vcp-application-10.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 10</a></li>
<li role="presentation"><a href="vcp-application-11.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 11</a></li>
<li role="presentation"><a href="vcp-application-12.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 12</a></li>
<li role="presentation"><a href="vcp-application-13.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Section 13</a></li>
<li role="presentation"><a href="vcp-application-Summary.html"><span class="glyphicon glyphicon-unchecked pull-right"></span>Summary</a></li>
</ul>
</div><!-- /Sidebar -->
<!-- Main Content -->
<div class="col-xs-12 col-lg-9 col-sm-9 col-md-9">
<h4>Section 1 - Claimant</h4>
<div class="alert alert-info" role="alert">
<h4>A Separate application must be filed for each person seeking assistance.</h4>
<p>Section 1 must be completed for all applications. The claimant is the person who has expenses or is seeking assistance as a result of a crime. If you are filing this application on behalf of someone else, put their information in Section 1 and your information in Section 3.</p>
</div>
<form>
<div class="row">
<div class="col-lg-6 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">First Name</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="First Name">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Middle Name</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Middle Name">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Last Name</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Last Name">
</div>
</div>
<div class="col-lg-offset-0 col-lg-3 col-xs-12 col-sm-6">
<div class="form-group">
<label for="Gender" class="select">Gender</label>
<select class="form-control">
<option>Male</option>
<option>Female</option>
</select>
</div>
</div>
<div class="col-lg-offset-0 col-lg-3 col-xs-12 col-sm-12">
<div class="form-group">
<label for="Gender" class="select">Relationship to victim</label>
<select class="form-control">
<option>Self</option>
<option>Family Member that Witnessed the Crime</option>
<option>Other</option>
</select>
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-12">
<div class="form-group">
<label for="Gender" class="select">Does the claimant have a Social Security Number?</label>
<select class="form-control">
<option>Yes</option>
<option>No</option>
</select>
</div>
</div>
<div class="col-lg-offset-0 col-lg-3 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Social Security #</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="SS#">
</div>
</div>
<div class="col-lg-offset-0 col-lg-3 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Date of Birth</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Date of Birth">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12">
<div class="form-group">
<label for="exampleInputEmail1">Mailing Address</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Street Number and Name or P.O. Box">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-12">
<div class="form-group">
<label for="exampleInputEmail1">Address 2</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Apartment or Unit #">
</div>
</div>
<div class="col-lg-offset-0 col-lg-4 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">City</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="Sacramento">
</div>
</div>
<div class="col-lg-offset-0 col-lg-2 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">State</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="CA">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Zip</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="95822">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Home Telephone</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="(916) 345-6783">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Work Telephone</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="(916) 345-0000 x123">
</div>
</div>
<div class="col-lg-offset-0 col-lg-6 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">Cell Phone</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="(916) 345-2345">
</div>
</div>
<div class="col-lg-offset-0 col-lg-4 col-xs-12 col-sm-6">
<div class="form-group">
<label for="exampleInputEmail1">E-Mail</label>
<input type="email" class="form-control" id="exampleInputEmail1" placeholder="andrey@mylife.com">
</div>
</div>
<div class="col-lg-offset-0 col-lg-2 col-xs-12 col-sm-6">
<div class="form-group">
<label for="Gender" class="select">E-Mail Type</label>
<select class="form-control">
<option>Personal</option>
<option>Work</option>
</select>
</div>
</div>
<div class="col-lg-offset-0 col-lg-12 col-xs-12">
<div class="checkbox">
<label>
<input type="checkbox" value="">
From the date of the crime to now, has the claimant been in prison, on probation, on parole or post-release community supervision because of a felony? </label>
</div>
</div>
<div class="col-lg-offset-0 col-lg-12 col-xs-12">
<div class="checkbox">
<label>
<input type="checkbox" value="">
Is the claimant required to register as a sex offender?
</label>
</div>
</div>
<div class="bg-warning col-lg-offset-0 col-lg-12 col-xs-12">
<div class="checkbox">
<label>
<input type="checkbox" value="">
Check This Box if You Are a Parent/Guardian Applying on Behalf of a Minor Witness to Violent Crime. Minor witnesses are eligible for mental health treatment only. Claimant is under age 18, a witness in close proximity to a violent crime, but is neither the crime victim nor related to the victim. Provide available victim, crime or other information in remaining sections.
</label>
</div>
</div>
<div class="col-lg-offset-0 col-lg-12 col-xs-12">
<br><br>
<span class="glyphicon glyphicon-info-sign"></span>
If you are an adult victim and the expenses are for you, skip to <a href="vcp-application-4.html">Section 4</a>. If not, Continue to Section 2
</div>
</div><!--/ Row-->
<hr>
<button type="button" class="btn btn-default btn-sm" data-toggle="modal" data-target="#exitApplication"> Exit</button>
<!-- Exit (Are you sure?) Modal -->
<div class="modal fade" id="exitApplication" tabindex="-1" role="dialog" aria-labelledby="exitApplication">
<div class="modal-dialog" role="document">
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button>
<h4 class="modal-title" id="myModalLabel">Before you exit</h4>
</div>
<div class="modal-body">
Do you want to save this application for later?
</div>
<div class="modal-footer">
<a href="vcp.html" role="button" class="btn btn-default btn-large">Don't save</a>
<a href="vcp.html" role="button" class="btn btn-success btn-large">Save</a>
</div>
</div>
</div>
</div><!-- /Exit (Are you sure?) Modal -->
<div class="pull-right">
<a href="vcp-application-2.html" role="button" class="btn btn-primary btn-large">Next</a>
</div>
</form>
</div> <!-- /Main Content -->
<br />
<br />
</div>
<br />
<br />
<br />
<hr>
<div class="row">
<div class="text-center col-md-6 col-md-offset-3">
<h4>California Victims Compensation Program</h4>
<p>Copyright © 2016 · All Rights Reserved · <a href="www.calvcp.ca.gov">calvcp.ca.gov</a></p>
</div>
</div>
<hr>
</div>
.header-logo{
padding: 10px;
width: 100px;
}
$( "#progress-button" ).click(function() {
$("#progress-menu").toggleClass('hidden-xs');
});
Also see: Tab Triggers