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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<title>WORTH — Women on the Road to Health</title>
<meta name="viewport" content="width=device-width, initial-scale=1, minimum-scale=1, maximum-scale=1">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.0.0-alpha.6/css/bootstrap.min.css" integrity="sha384-rwoIResjU2yc3z8GV/NPeZWAv56rSmLldC3R/AZzGRnGxQQKnKkoFVhFQhNUwEyJ" crossorigin="anonymous">
<script src="https://code.jquery.com/jquery-3.2.0.slim.min.js" crossorigin="anonymous"></script>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/Swiper/3.4.2/css/swiper.min.css">
<script src="https://cdnjs.cloudflare.com/ajax/libs/Swiper/3.4.2/js/swiper.min.js"></script>
<script src="js/common.js"></script>
<script src="js/myth-fact.js"></script>
<script src="js/feeling.js"></script>
<script src="js/safety.js"></script>
<script src="js/social-support.js"></script>
<link rel="stylesheet" href="css/worth.css">
</head>
<body>
<div class="swiper-container">
<div class="swiper-wrapper">
<div class="swiper-slide">
<div class="container">
<div class="jumbotron">
<h1 class="display-3">
Welcome to WORTH
</h1>
</div>
</div><!-- end .container -->
</div>
<div class="swiper-slide">
<div class="container">
<h2>Table of Contents</h2>
<ol class="toc">
<li>
<a href="#session-1">Session 1</a>
<ol>
<a href="#session-1-1">Introduction to WORTH</a>
</ol>
<ol>
<a href="#session-1-2">HIV Testing, intro and OraQuick info</a>
</ol>
</li>
<li>
<a href="#session-2">Session 2</a>
<ol>
<a href="#session-2-1">Welcome to session 2</a>
</ol>
</li>
<li>
<a href="#session-3">Session 3</a>
<ol>
<a href="#session-3-1">Welcome to session 3</a>
</ol>
</li>
<li>
<a href="#session-4">Session 4</a>
<ol><a href="#session-4-1">Welcome to session 4</a></ol>
<ol><a href="#session-4-2">Review of goals</a></ol>
<ol><a href="#session-4-3">Session 3 review</a></ol>
<ol><a href="#session-4-4">Practicing POP</a></ol>
<ol><a href="#session-4-5">Intro to self-talk</a></ol>
<ol><a href="#session-4-6">Self-talk</a></ol>
<ol><a href="#session-4-7">Intro to asserting relationships and safety</a></ol>
<ol><a href="#session-4-8">IPV screener plus score</a></ol>
<ol><a href="#session-4-9">Intro to safety planning</a></ol>
<ol><a href="#session-4-10">Safety planning</a></ol>
<ol><a href="#session-4-11">Negotiation</a></ol>
<ol><a href="#session-4-12">Barriers to condom use</a></ol>
<ol><a href="#session-4-13">Practicing negotiation</a></ol>
<ol><a href="#session-4-14">Alternatives to negotiation</a></ol>
<ol><a href="#session-4-15">Intro to feelings check-in station</a></ol>
<ol><a href="#session-4-16">Feelings check-in station</a></ol>
<ol><a href="#session-4-17">Social support map intro</a></ol>
<ol><a href="#session-4-18">Social support map</a></ol>
<ol><a href="#session-4-19">Intro to goal setting for social support</a></ol>
<ol><a href="#session-4-20">Goal setting for social support</a></ol>
<ol><a href="#session-4-21">Goal setting for risk reduction</a></ol>
<ol><a href="#session-4-22">Intro service referrals</a></ol>
<ol><a href="#session-4-23">Service referrals</a></ol>
<ol><a href="#session-4-24">Goal setting service referrals (video)</a></ol>
<ol><a href="#session-4-25">Goal setting service referrals</a></ol>
<ol><a href="#session-4-26">I am worth it (video)</a></ol>
<ol><a href="#session-4-27">I am worth it</a></ol>
<ol><a href="#session-4-28">Congrats you're done with it</a></ol>
</li>
<li>
<a href="#session-5">Session 5</a>
<ol>
<a href="#session-5-1">s5.1</a>
</ol>
</li>
</ol>
</div><!-- end .container -->
</div>
<div class="swiper-slide" id="session-1-1">
<div class="container">
<h1>Welcome to your first session!</h1>
<div class="jumbotron">
<h1 class="display-3">
Let's Talk: Sister to Sister
</h1>
<p class="lead">In this session, we're going to…</p>
<ul class="lead">
<li>Learn about what to expect in E-WORTH.</li>
<li>Learn about HIV testing.</li>
<li>Get an HIV test.</li>
<li>Discuss how racism, sexism, and other factors affect our lives and our safety.</li>
</ul>
</div>
</div>
</div>
<div class="swiper-slide" id="session-1-2">
<div class="container">
HIV Testing, intro and OraQuick info
</div>
</div>
<div class="swiper-slide" id="session-2-1">
<div class="container">
<h1>Welcome to your second session!</h1>
<div class="jumbotron">
<h1 class="display-3">
What's the 411?
</h1>
<p class="lead">In this session, we're going to…</p>
<ul class="lead">
<li>Meet the women of E-WORTH.</li>
<li>Discuss the high rates of HIV among African-American women.</li>
<li>Discuss how to protect our health.</li>
<li>Set goals for risk reduction.</li>
</ul>
</div>
</div>
</div>
<div class="swiper-slide" id="session-3-1">
<div class="container">
<h1>Welcome to your third session!</h1>
<div class="jumbotron">
<h1 class="display-3">
Protecting myself, protecting my community
</h1>
<p class="lead">In this session, we're going to…</p>
<ul class="lead">
<li>Discover tools to help us stay safe.</li>
<li>Learn skills to negotiate safer sex.</li>
<li>Discuss how to increase our sexual pleasure while reducing our risk of HIV/STIs.</li>
</ul>
</div>
</div>
</div>
<div class="swiper-slide" id="session-4-1">
<div class="container">
<h1>Welcome to your fourth session!</h1>
<div class="jumbotron">
<h1 class="display-3">
Staying Safe and Strong
</h1>
<p class="lead">In this session, we're going to…</p>
<ul class="lead">
<li>Put what you've learned in E-WORTH into practice.</li>
<li>Learn skills to help you communicate with your sexual partners.</li>
<li>Think about people who can help you along your journey.</li>
</ul>
</div>
</div>
</div>
<div class="swiper-slide" id="session-4-2">
<div class="container">
<h1>Review of goals</h1>
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/-0kZZx-JmM4"
allowfullscreen></iframe>
</div>
</div>
</div>
<div class="swiper-slide" id="session-4-3">
<div class="container">
Session 3 review
</div>
</div>
<div class="swiper-slide" id="session-4-4">
<div class="container">
Practicing POP
</div>
</div>
<div class="swiper-slide" id="session-4-5">
<div class="container">
Intro to self-talk
</div>
</div>
<div class="swiper-slide" id="session-4-6">
<div class="container">
Self-talk
</div>
</div>
<div class="swiper-slide" id="session-4-7">
<div class="container">
Intro to asserting relationships and safety
</div>
</div>
<div class="swiper-slide" id="session-4-8">
<div class="container">
IPV screener plus score
</div>
</div>
<div class="swiper-slide" id="session-4-9">
<div class="container">
Intro to safety planning
</div>
</div>
<div class="swiper-slide" id="session-4-10">
<div class="container safety">
<div class="progress-safety">
<div class="progress-bar" role="progressbar"
aria-valuenow="0" aria-valuemin="0" aria-valuemax="100"></div>
</div>
<h1>Safety planning</h1>
<div class="panel s1">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/9jdzRZa4yIg"
allowfullscreen></iframe>
</div>
<hr>
<button type="button" class="btn btn-primary btn-block s1">
Next
</button>
</div>
<div class="panel hidden s2">
<div class="form-group">
It is a good idea to practice how to
get out of your house or apartment
safely. What doors, windows,
elevators, stairwells, or fire escapes
would you use? Consider which exits
are safest. Write down how you would
get out.
<input class="form-control inp1" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s2">
Next
</button>
</div>
<div class="panel hidden s3">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/9jdzRZa4yIg"
allowfullscreen></iframe>
</div>
<hr>
<button type="button" class="btn btn-primary btn-block s3">
Next
</button>
</div>
<div class="panel hidden s4">
<div class="form-group">
Tell a person whom you trust about the
violence and request they call the
police if they hear suspicious noises
coming from your apartment. Write
down the names of people you can tell.
<input class="form-control inp2" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s4">
Next
</button>
</div>
<div class="panel hidden s5">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/tDjE2fwDuk4"
allowfullscreen></iframe>
</div>
<hr>
<button type="button" class="btn btn-primary btn-block s5">
Next
</button>
</div>
<div class="panel hidden s6">
<div class="form-group">
My code word will be:
<input class="form-control inp3" type="text">
</div>
<div class="form-group">
<button type="button" class="btn btn-primary btn-block s6">
Next
</button>
</div>
</div>
<div class="panel hidden s7">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/v2d0AOfDibg"
allowfullscreen></iframe>
</div>
<hr>
<button type="button" class="btn btn-primary btn-block s7">
Next
</button>
</div>
<div class="panel hidden s8">
<div class="form-group">
Decide where you can go if you have to
leave your apartment. Decide this even
if you don't think you will experience
another violent incident. Try to think
of more than one option. Write down
two places you can go if you need to
leave your home.
<input class="form-control inp4" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s8">
Next
</button>
</div>
<div class="panel hidden s9">
<div class="form-group">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/K6ZjLqzcoj4"
allowfullscreen></iframe>
</div>
</div>
<button type="button" class="btn btn-primary btn-block s9">
Next
</button>
</div>
<div class="panel hidden s10">
<div class="form-group">
When you expect you are going to have
an argument with your partner, move to
a space that is lowest risk. Try to
avoid arguments in the bathroom, and
kitchens, near weapons or in rooms
without access to an outside door.
Write down the spaces in your
apartment that are the lowest risk.
<input class="form-control inp5" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s10">
Next
</button>
</div>
<div class="panel hidden s11">
<div class="form-group">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/dXnNqALxXQ4"
allowfullscreen></iframe>
</div>
</div>
<button type="button" class="btn btn-primary btn-block s11">
Next
</button>
</div>
<div class="panel hidden s12">
<div class="form-group">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/M38AtKJqDkQ"
allowfullscreen></iframe>
</div>
</div>
<button type="button" class="btn btn-primary btn-block s12">
Next
</button>
</div>
<div class="panel hidden s13">
<div class="form-group">
There are things you can do to
keep safe if you are preparing to
leave your partner. To be able to
leave quickly, find someone you
can leave an extra set of keys,
money, and other emergency items
like clothes with. Write down who
you will leave these things with.
<input class="form-control inp6" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s13">
Next
</button>
</div>
<div class="panel hidden s14">
<div class="form-group">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/jP9udIvRqoo"
allowfullscreen></iframe>
</div>
</div>
<button type="button" class="btn btn-primary btn-block s14">
Next
</button>
</div>
<div class="panel hidden s15">
<div class="form-group">
Keep copies of important documents
(social security cards, birth
certificates, immunization records)
somewhere outside your home. Write
down where you can leave important
documents.
<input class="form-control inp7" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s15">
Next
</button>
</div>
<div class="panel hidden s16">
<div class="form-group">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/4yghR7hfgIE"
allowfullscreen></iframe>
</div>
</div>
<button type="button" class="btn btn-primary btn-block s16">
Next
</button>
</div>
<div class="panel hidden s17">
<div class="form-group">
It's important to become financially
independent. Write down the date you
plan to open a savings account.
<input class="form-control inp8" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s17">
Next
</button>
</div>
<div class="panel hidden s18">
<div class="form-group">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/64vpaeDJATU"
allowfullscreen></iframe>
</div>
</div>
<button type="button" class="btn btn-primary btn-block s18">
Next
</button>
</div>
<div class="panel hidden s19">
<div class="form-group">
If there are other things you can
think of that will make you more
independent, write them here.
<input class="form-control inp9" type="text">
</div>
<button type="button" class="btn btn-primary btn-block s19">
Next
</button>
</div>
<div class="panel hidden s20">
<div class="form-group">
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/axgnnMlstak"
allowfullscreen></iframe>
</div>
</div>
<button type="button" class="btn btn-primary btn-block s20">
Next
</button>
</div>
<div class="panel hidden s21">
<ul>
<li>Exits: <div class="summary1"><strong></strong></div></li>
<li>Trusted people: <div class="summary2"><strong></strong></div></li>
<li>Code word: <div class="summary3"><strong></strong></div></li>
<li>Safe places outside home: <div class="summary4"><strong></strong></div></li>
<li>Safe places in your home: <div class="summary5"><strong></strong></div></li>
<li>Who to leave things with: <div class="summary6"><strong></strong></div></li>
<li>Where to keep important documents: <div class="summary7"><strong></strong></div></li>
<li>When to open savings account: <div class="summary8"><strong></strong></div></li>
<li>Ideas for independence: <div class="summary9"><strong></strong></div></li>
</ul>
<button type="button" class="btn btn-primary btn-block s1">
Start over
</button>
</div>
</div>
</div>
<div class="swiper-slide" id="session-4-11">
<div class="container">
<h1>Negotiation</h1>
</div>
</div>
<div class="swiper-slide" id="session-4-12">
<div class="container">
<h1>Barriers to condom use</h1>
</div>
</div>
<div class="swiper-slide" id="session-4-13">
<div class="container">
<h1>Practicing negotiation</h1>
</div>
</div>
<div class="swiper-slide" id="session-4-17">
<div class="container">
<h1>Social support map intro</h1>
<div class="embed-responsive embed-responsive-16by9">
<iframe class="embed-responsive-item" width="560" height="315"
src="https://www.youtube.com/embed/pWZ-XA_OpNY"
allowfullscreen></iframe>
</div>
</div>
</div>
<div class="swiper-slide" id="session-4-18">
<div class="container social-support">
<div class="progress-social-support">
<div class="progress-bar" role="progressbar"
aria-valuenow="0" aria-valuemin="0" aria-valuemax="100"></div>
</div>
<h1>Social Support</h1>
<h3>My Friends & Family Map</h3>
<div class="panel s1">
<p>
A map of your support network is
essential. Let's build yours.
</p>
<p>
Think about the people in your life.
</p>
<button type="button" class="btn btn-primary btn-block s1">OK. Let's go!</button>
</div>
<div class="panel hidden s2">
<h5>Part 1 of 4: Person</h5>
<p>
What is the name of a friend or family
member in your social support network?
</p>
<blockquote class="blockquote">
"Aunt Jean is in my network. I talk to her a lot."
</blockquote>
<button type="button" class="btn btn-primary btn-block s2">OK. I got it.</button>
</div>
<div class="panel hidden s3">
<h5>Part 2 of 4: Distance</h5>
<p>
How close are you to this person? By
close we mean someone you feel
emotionally close to or who is someone
you can rely on. This includes someone
who may live far away.
</p>
<img src="..." class="img-fluid" alt="Emotional distance diagram">
<blockquote class="blockquote">
"Aunt Jean is very distant
emotionally. She is kind but I cannot
tell her my true feelings."
</blockquote>
<button type="button" class="btn btn-primary btn-block s3">OK. I got it.</button>
</div>
<div class="panel hidden s4">
<h5>Part 3 of 4: Influence</h5>
<p>
How does this person influence your life?
</p>
<div class="media">
<img class="d-flex mr-3" src="..." alt="Practical support icon">
<div class="media-body">
Practical support is concrete help
such as babysitting, helping you
find work, etc.
</div>
</div>
<div class="media">
<img class="d-flex mr-3" src="..." alt="Emotional support icon">
<div class="media-body">
Emotional support includes things
like listening to you and letting
you share your feelings.
</div>
</div>
<blockquote class="blockquote">
"Aunt Jean makes me feel positive. She
makes me laugh with her stories."
</blockquote>
<button type="button" class="btn btn-primary btn-block s4">OK. I got it.</button>
</div>
<div class="panel hidden s5">
<h5>Part 4 of 4: Support</h5>
<p>
What kind of support does this person
provide?
</p>
<div class="media">
<img class="d-flex mr-3" src="..." alt="Practical support icon">
<div class="media-body">
Practical support is concrete help
such as babysitting, helping you
find work, etc.
</div>
</div>
<div class="media">
<img class="d-flex mr-3" src="..." alt="Emotional support icon">
<div class="media-body">
Emotional support includes things
like listening to you and letting
you share your feelings.
</div>
</div>
<blockquote class="blockquote">
"Aunt Jean provides a lot of practical
support for me because she sends me
money if I need it."
</blockquote>
<button type="button" class="btn btn-primary btn-block s5">OK. I got it.</button>
</div>
<div class="panel hidden s6">
<h5>Support Provider</h5>
<p>
Here's how "Aunt Jean" will appear as
an example on the map.
</p>
<div class="media">
<img class="d-flex mr-3" src="..." alt="Support provider icon">
<div class="media-body">
<ul>
<li><strong>Name: Aunt Jean</strong></li>
<li>Influence: Very Positive</li>
<li>Support: Practical</li>
</ul>
</div>
</div>
<div class="media">
<img class="d-flex mr-3" src="..." alt="Location icon">
<div class="media-body">
<ul>
<li>Distance: Very Distant</li>
<li>(from Me) Emotionally</li>
</ul>
</div>
</div>
<p>
Now, it's time to build your map with
your support providers. Four spots are
provided but you can add others.
</p>
<div class="alert alert-warning" role="alert">
<strong>Don't forget the paper version!</strong>
<p>Please copy this information to your worksheet.</p>
</div>
<div class="alert alert-info" role="alert">
<strong>Are you done?</strong> Swipe left to move on.
</div>
</div>
</div>
</div>
<div class="swiper-slide">
<div class="container myth-fact">
<div class="progress">
<div class="progress-bar" role="progressbar"
aria-valuenow="0" aria-valuemin="0" aria-valuemax="100"></div>
</div>
<div class="panel s0">
<h1>Myth/Fact</h1>
<p>Let's play the Myth/Fact Quiz game!</p>
<button type="button" class="btn btn-primary btn-block s1">
Got it. Let's go!
</button>
</div>
<div class="panel hidden s1">
<h1>True or False?</h1>
<p>
You can get HIV by kissing someone who has it.
</p>
<button type="button" class="btn btn-secondary btn-block s2-true">True</button>
<button type="button" class="btn btn-secondary btn-block s2-false">False</button>
<div class="alert alert-danger hidden answer" role="alert">
<div>
<strong>False:</strong> You cannot get HIV by kissing someone who has it.
</div>
</div>
<div class="alert alert-danger text-center wrong-answer hidden" role="alert">
<p>Oops! You missed this one.</p>
<button class="btn btn-primary btn-block s2">
Here's Why
</button>
</div>
<div class="alert alert-success text-center right-answer hidden" role="alert">
<p>You got it right! Nice job.</p>
<button class="btn btn-primary btn-block s2">Learn More</button>
</div>
</div>
<div class="panel hidden s2">
<h1>HIV and Kissing</h1>
<video controls>
<source src="video/mythfact01.mp4" type="video/mp4"></source>
<source src="video/mythfact01.webm" type="video/webm"></source>
</video>
<p>
You cannot get HIV by kissing someone who has
it. Saliva may contain HIV but not in
sufficient quantities to transmit the
virus. HIV, the virus that causes AIDS, is
spread through unsafe sex and needle or
syringe sharing where blood is passed.
</p>
<button class="btn btn-primary btn-block s3">
Got it. Let's move on.
</button>
</div>
<div class="panel hidden s3">
<h1>Remember</h1>
<p>It's up to you!</p>
<div class="alert alert-info text-center" role="alert">
<p>
<strong>You're done!</strong> Swipe to move on.
</p>
<button class="btn btn-primary btn-block s0">I want to try again.</button>
</div>
</div>
</div><!-- end .container -->
</div>
<div class="swiper-slide">
<div class="container feeling">
<div class="progress">
<div class="progress-bar" role="progressbar"
aria-valuenow="0" aria-valuemin="0" aria-valuemax="100"></div>
</div>
<div class="panel s0">
<h1>How are you feeling today?</h1>
<div class="row">
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f600.svg" />
</figure>
</div>
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f602.svg" />
</figure>
</div>
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f610.svg" />
</figure>
</div>
</div>
<div class="row">
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f644.svg" />
</figure>
</div>
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f61d.svg" />
</figure>
</div>
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f643.svg" />
</figure>
</div>
</div>
<div class="row">
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f621.svg" />
</figure>
</div>
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f607.svg" />
</figure>
</div>
<div class="col">
<figure class="figure">
<img width="64" height="64" src="img/emojione/1f912.svg" />
</figure>
</div>
</div>
</div><!-- end .panel.s0 -->
<div class="panel hidden s1">
<div class="media">
<img class="d-flex mr-3" width="64" height="64" src="img/emojione/1f600.svg" />
<div class="media-body">
<h5 class="mt-0">You're feeling <strong>happy</strong>!</h5>
Lorem ipsum dolor sit amet, consectetur
adipiscing elit. Proin posuere faucibus
risus, ullamcorper placerat enim ultrices
finibus. Quisque fermentum justo elit, eu
pharetra enim malesuada vitae. Proin
mattis congue bibendum. Vivamus id tempus
odio, a sollicitudin augue. Duis quis
porttitor lorem.
</div>
</div>
<div class="alert alert-info text-center" role="alert">
<p><strong>You're done!</strong> Swipe to move on.</p>
<button type="button" class="btn btn-primary btn-block s0">
I want to try again.
</button>
</div>
</div>
</div><!-- end .container -->
</div>
<div class="swiper-slide">
<div class="container">
<div class="progress">
<div class="progress-bar" role="progressbar"
aria-valuenow="0" aria-valuemin="0" aria-valuemax="100"></div>
</div>
<h1>Safety Plan</h1>
<form>
<div class="form-group row">
<label for="inputEmail3" class="col-sm-2 col-form-label">Email</label>
<div class="col-sm-10">
<input type="email" class="form-control form-control-sm" id="inputEmail3" placeholder="Email" />
</div>
</div>
<div class="form-group row">
<label for="inputPassword3" class="col-sm-2 col-form-label">Password</label>
<div class="col-sm-10">
<input type="password" class="form-control form-control-sm" id="inputPassword3" placeholder="Password" />
</div>
</div>
<fieldset class="form-group row">
<legend class="col-form-legend col-sm-2">Radios</legend>
<div class="col-sm-10">
<div class="form-check">
<label class="form-check-label">
<input class="form-check-input" type="radio" name="gridRadios" id="gridRadios1" value="option1" checked="" />
Option one is this and that—be sure to include why it's great
</label>
</div>
<div class="form-check">
<label class="form-check-label">
<input class="form-check-input" type="radio" name="gridRadios" id="gridRadios2" value="option2" />
Option two can be something else and selecting it will deselect option one
</label>
</div>
<div class="form-check disabled">
<label class="form-check-label">
<input class="form-check-input" type="radio" name="gridRadios" id="gridRadios3" value="option3" disabled="" />
Option three is disabled
</label>
</div>
</div>
</fieldset>
<div class="form-group row">
<label class="col-sm-2">Checkbox</label>
<div class="col-sm-10">
<div class="form-check">
<label class="form-check-label">
<input class="form-check-input" type="checkbox" /> Check me out
</label>
</div>
</div>
</div>
<div class="form-group row">
<button type="button" class="btn btn-primary btn-block">I'm Done</button>
</div>
</form>
</div><!-- end .container -->
</div>
</div>
</div>
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