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asolove/gist:191162

Created September 22, 2009 15:35
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gistfile1.htm
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html>
<head>
<title></title>
<link href="/stylesheets/reset_min.css" media="screen" rel="stylesheet" type="text/css" />
<link href="/stylesheets/apply.css" media="screen" rel="stylesheet" type="text/css" />
<link href="/stylesheets/login.css" media="screen" rel="stylesheet" type="text/css" />
<link href="/stylesheets/program.css" media="screen" rel="stylesheet" type="text/css" />
<script>
<![--
function validate() {
return new Validator("application-form");
}
--]>
</head>
<body>
<div id='container'>
<div id='header'></div>
<div>
<div id='flash'></div>
<h1 class='register'>
Start a new SMART application.
</h1>
<div class='register'>
<form action="/apply/applicants" onclick="return validate();" class="new_applicant" id="new_applicant" method="post"><div style="margin:0;padding:0"><input name="authenticity_token" type="hidden" value="KULlbmwBTpz7yThkQUqlv7IkybvRgZ16DC7r9hqkg9c=" /></div>
<!-- %fieldset -->
<!-- %legend Personal Information -->
<div class='required'>
<label for="applicant_first_name">First Name</label>
<input id="applicant_first_name" name="applicant[first_name]" size="30" type="text" />
</div>
<div class='required'>
<label for="applicant_last_name">Last Name</label>
<input id="applicant_last_name" name="applicant[last_name]" size="30" type="text" />
</div>
<div class='required spacer'>
<label for="applicant_email">Email Address</label>
<input id="applicant_email" name="applicant[email]" size="30" type="text" />
</div>
<div class='required'>
<label for="applicant_email_confirmation">Repeat Email Address</label>
<input id="applicant_email_confirmation" name="applicant[email_confirmation]" size="30" type="text" />
</div>
<div class='required spacer'>
<label for="applicant_password">Password</label>
<input id="applicant_password" name="applicant[password]" size="30" type="password" />
<div class='hint'>Must be between 4 and 40 characters in length.</div>
</div>
<div class='required'>
<label for="applicant_password_confirmation">Repeat Password</label>
<input id="applicant_password_confirmation" name="applicant[password_confirmation]" size="30" type="password" />
</div>
<div class='required spacer'>
<label>Citizenship Status</label>
<fieldset class='inline_group'>
<input id="applicant_citizen_citizen_by_birth" name="applicant[citizen]" type="radio" value="citizen_by_birth" />
<label for="applicant_citizen_citizen_by_birth">I am a US citizen born in the US or a US territory/possession</label>
<div>
<input id="applicant_citizen_citizen_naturalized" name="applicant[citizen]" type="radio" value="citizen_naturalized" />
<label for="applicant_citizen_citizen_nationalized">I am a US citizen not born in the US or a US territory/possession</label>
</div>
<div>
<input id="applicant_citizen_neither" name="applicant[citizen]" onclick="alert('You must be a US citizen to be eligible for an SMART Scholarship. If you are not a US citizen, you will not be able to submit your application and be considered for a Scholarship.');" type="radio" value="neither" />
<label for="applicant_citizen_neither">I am not a US citizen</label>
</div>
</fieldset>
<div class='hint'>
All applicants must be US citizens.
</div>
</div>
<div class='required spacer'>
<label for="applicant_birth_date">Birth Date</label>
<fieldset class='inline_group'>
<select id="applicant_birth_date_2i" name="applicant[birth_date(2i)]">
<option value=""></option>
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
<select id="applicant_birth_date_3i" name="applicant[birth_date(3i)]">
<option value=""></option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<select id="applicant_birth_date_1i" name="applicant[birth_date(1i)]">
<option value=""></option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</option>
<option value="1950">1950</option>
<option value="1951">1951</option>
<option value="1952">1952</option>
<option value="1953">1953</option>
<option value="1954">1954</option>
<option value="1955">1955</option>
<option value="1956">1956</option>
<option value="1957">1957</option>
<option value="1958">1958</option>
<option value="1959">1959</option>
<option value="1960">1960</option>
<option value="1961">1961</option>
<option value="1962">1962</option>
<option value="1963">1963</option>
<option value="1964">1964</option>
<option value="1965">1965</option>
<option value="1966">1966</option>
<option value="1967">1967</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
<option value="2012">2012</option>
<option value="2013">2013</option>
<option value="2014">2014</option>
</select>
</fieldset>
<div class='hint'>
You must be 18 years old as of August 1, 2010 to apply.
</div>
</div>
<div class='required spacer'>
<label for="applicant_employment">Employment</label>
<select id="applicant_employment" name="applicant[employment]"><option value=""></option>
<option value="dod_civ">DoD civilian employee</option>
<option value="dod_con">DoD contracted employee</option>
<option value="military">Active duty United States military</option>
<option value="none">None of the above</option></select>
<div class='hint'>
Select your
<u>current</u>
employment status
</div>
</div>
<div class='required'>
<label for="applicant_apply_last_year">Did you apply last year?</label>
<fieldset class="inline_group" object="#&lt;Applicant:0xabf2598&gt;"><input id="applicant_apply_last_year_true" name="applicant[apply_last_year]" type="radio" value="true" /><label for="applicant_apply_last_year_true">Yes</label><input id="applicant_apply_last_year_false" name="applicant[apply_last_year]" type="radio" value="false" /><label for="applicant_apply_last_year_false">No</label></fieldset>
</div>
<div class='required'>
<label for="applicant_current_smart_scholar">Are you a current SMART Scholar applying for a follow-on award?</label>
<fieldset class="inline_group" object="#&lt;Applicant:0xabf2598&gt;"><input id="applicant_current_smart_scholar_true" name="applicant[current_smart_scholar]" type="radio" value="true" /><label for="applicant_current_smart_scholar_true">Yes</label><input id="applicant_current_smart_scholar_false" name="applicant[current_smart_scholar]" type="radio" value="false" /><label for="applicant_current_smart_scholar_false">No</label></fieldset>
</div>
<div>
<label for="applicant_award_cohort_year">If so, select your Award Cohort Year:</label>
<select id="applicant_award_cohort_year" name="applicant[award_cohort_year]"><option value=""></option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009">2009</option></select>
</div>
<div class='required spacer'>
<label>Information Sharing</label>
<div class='inline_checkbox'>
<div><input name="applicant[sharing]" type="hidden" value="0" /><input id="applicant_sharing" name="applicant[sharing]" type="checkbox" value="1" /></div>
<label for="applicant_sharing">I understand my application informatio
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