{"1":{"name":"Your Name","value":"Elaine Hoffmann","id":1,"type":"name","first":"Elaine","middle":"","last":"Hoffmann"},"3":{"name":"Email Address","value":"el@elhoffmann.com","id":3,"type":"email"},"2":{"name":"Phone","value":"+18598169724","id":2,"type":"phone"},"5":{"name":"I am a:","value":"Other","value_raw":"Other","id":5,"type":"checkbox"},"6":{"name":"School division:","value":"Support","id":6,"type":"text"},"4":{"name":"Message","value":"I am trying to enroll in Gateway Community and Technical College. I took a medical leave from Virginia Intermont College back in 2004. Since then they have closed. The school I am trying to enroll in is requiring that I have either a document sent stating I took a medical release or that the school closed and it is no longer possible to receive that document. I am trying to find out how to get this accomplished as soon as possible. Thank you!\r\nElaine Hoffmann","id":4,"type":"textarea"}}