I made this and figured i would post it sense i used other peoples items to get this working. [file name=myapplication___Copy.zip size=11083]http://www.chronoengine.com/images/fbfiles/files/myapplication___Copy.zip[/file]
Thanks!
Max
Max
I have a quick question: This is my first time I am using this component so I am an extreme novice.
1)I used this template but then I changed things for what I needed, but when i look at the Auto Generate, i still see the field title from the original template
2) also, is this the correct way to add in the field title= lname=Last Name
Any help would be appreciated
1)I used this template but then I changed things for what I needed, but when i look at the Auto Generate, i still see the field title from the original template
2) also, is this the correct way to add in the field title= lname=Last Name
Any help would be appreciated
Hi Dionysus,
I didn't test this code of course, can't understand #1, bu tfor #2, it should be like this :
fname=First name
lname=Last name
this will take effect at emails only!
Cheers
Max
I didn't test this code of course, can't understand #1, bu tfor #2, it should be like this :
fname=First name
lname=Last name
this will take effect at emails only!
Cheers
Max
Hi Admin,
Thanks for #2
As for #1:
I changed the field title for my use: here is the page:
http://www.ccldp.com/index.php?option=com_chronocontact&Itemid=40
So I created new field titles and created an e-mail template.
When I filled in the information and hit submit, I get the form e-mailed to me, but only a few inputted information comes out.
Attach is a screen shot of how it appears
Thanks for #2
As for #1:
I changed the field title for my use: here is the page:
http://www.ccldp.com/index.php?option=com_chronocontact&Itemid=40
So I created new field titles and created an e-mail template.
When I filled in the information and hit submit, I get the form e-mailed to me, but only a few inputted information comes out.
Attach is a screen shot of how it appears
Hi, if you changed the HTML fields names then you should reflect this to the email template code also, this has nothing to do with the fields titles, fields titles are for "fields titles" email only!
please read the tooltip beside the email template box!
Cheers
Max
please read the tooltip beside the email template box!
Cheers
Max
please paste here both your HTML and email template code!
Here is the Html
And here is the E-mail template:
and here is the Auto Generate tag
<html>
<style type="text/css">
<!--
.style1 {font-size: small}
.style2 {color: #22165e}
.style10 {color: #22165e; font-size: small; }
#apDiv1 {
position:absolute;
left:206px;
top:138px;
width:129px;
height:17px;
z-index:1;
}
.style11 {color: #FFFFFF}
.style13 {font-size: 18px}
.style14 {font-size: 18px; font-weight: bold; }
.style16 {font-size: 24px; font-weight: bold; }
.style17 {color: #000000}
-->
</style>
</head>
<body>
<p><strong>Personal Information</strong></p>
<table width="750" border="0">
<tr>
<td width="49">Name:</td>
<td width="150"><form name="form1" method="post" action="">
<input name="lname" type="text" id="lname" size="20" maxlength="50">
</form></td>
<td width="158"><form name="form2" method="post" action="">
<input name="fname" type="text" id="fname" size="20" maxlength="50">
</form></td>
<td width="158"><form name="form3" method="post" action="">
<input name="mname" type="text" id="mname" size="15" maxlength="50">
</form></td>
<td width="80">Date of Birth</td>
<td width="115"><form name="form4" method="post" action="">
<input name="dob" type="text" id="dob" size="15">
</form></td>
</tr>
<tr>
<td> </td>
<td>Last</td>
<td>First</td>
<td>Middle</td>
<td> </td>
<td>(MM/DD/YYYY)</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="118">Home Address</td>
<td width="235"><form name="form5" method="post" action="">
<input name="homeaddress" type="text" id="homeaddress" size="30" maxlength="50">
</form></td>
<td width="82"><form name="form6" method="post" action="">
<input name="homeapt" type="text" id="homeapt" size="10">
</form></td>
<td width="158"><form name="form7" method="post" action="">
<input name="homecity" type="text" id="homecity" size="20" maxlength="50">
</form></td>
<td width="45"><form name="form8" method="post" action="">
<input name="homestate" type="text" id="homestate" size="5" maxlength="25">
</form></td>
<td width="86"><form name="form9" method="post" action="">
<input name="homezip" type="text" id="homezip" size="10">
</form></td>
</tr>
<tr>
<td> </td>
<td>Street Number</td>
<td>Apt#</td>
<td>City </td>
<td>State</td>
<td>Zip Code</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Home Phone</td>
<td><form name="form10" method="post" action="">
<input name="homephone" type="text" id="homephone" size="25">
</form></td>
<td>E-Mail Addtress</td>
<td><form name="form11" method="post" action="">
<input name="homeemail" type="text" id="homeemail" size="25" maxlength="50">
</form></td>
</tr>
</table>
<p><strong>Current Employment </strong></p>
<table width="750" border="0">
<tr>
<td width="74" scope="col"><div class="style10">Employer:</div></td>
<th width="204" scope="col"> <label>
<input name="cemployer" type="text" id="empname43" size="34" maxlength="100">
</label> </th>
<td width="137" scope="col"> </td>
<th width="92" scope="col"> </th>
<th width="50" scope="col"> </th>
<td width="167"> </td>
</tr>
<tr>
<td scope="col"><div class="style10">Title:</div></td>
<th scope="col"><input name="cmtitle" type="text" id="jobtitle42" size="34" maxlength="50"></th>
<td scope="col">Date(s) of Service</td>
<th colspan="3" scope="col"><form name="form12" method="post" action="">
<div align="left">
<input name="cmdos" type="text" id="cmdos" size="35">
</div>
</form></th>
</tr>
<tr>
<td height="2" colspan="6" scope="col">
<div class="style10"></div>
<div align="left"></div></td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="97">Work Address</td>
<td width="256"><form name="form5" method="post" action="">
<input name="cmaddress" type="text" id="cmaddress" size="30" maxlength="50">
</form></td>
<td width="82"><form name="form6" method="post" action="">
<input name="cmsuite" type="text" id="cmsuite" size="10">
</form></td>
<td width="159"><form name="form7" method="post" action="">
<input name="cmcity" type="text" id="cmcity" size="20" maxlength="50">
</form></td>
<td width="44"><form name="form8" method="post" action="">
<input name="cmstate" type="text" id="cmstate" size="5" maxlength="25">
</form></td>
<td width="86"><form name="form9" method="post" action="">
<input name="cmzip" type="text" id="cmzip" size="10">
</form></td>
</tr>
<tr>
<td> </td>
<td>Street Number</td>
<td>Suite#</td>
<td>City </td>
<td>State</td>
<td>Zip Code</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Work Phone</td>
<td><form name="form13" method="post" action="">
<input name="cmphone" type="text" id="cmphone" size="25">
</form></td>
<td>Work Fax</td>
<td><form name="form15" method="post" action="">
<input name="cmfax" type="text" id="cmfax" size="25">
</form></td>
<td>Mobile Phone</td>
<td><form name="form14" method="post" action="">
<input name="cmmobile" type="text" id="cmmobile">
</form></td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Work E-mail</td>
<td><form name="form16" method="post" action="">
<input name="cmemail" type="text" id="cmemail" size="25" maxlength="50">
</form></td>
<td>Work Hours</td>
<td><form name="form17" method="post" action="">
<input name="cmhours" type="text" id="cmhours" size="25">
</form></td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Duties and Responsibilities</td>
</tr>
<tr>
<td><form name="form18" method="post" action="">
<textarea name="cmdr" cols="80" id="cmdr"></textarea>
</form></td>
</tr>
</table>
<p><br>
<span class="style14"> Previous Corrections Experience</span><br>
<em>Please provide information about your other corrections experience. Include
any specialization (eg, juvenile justice, gang intervention, sunstance abuse,
etc)</em><br>
<br>
</p>
<table width="750" border="0">
<tr>
<td>Employer</td>
<td>Title</td>
<td>Duties and Responsibilities</td>
<td>Date(s) of Service</td>
</tr>
<tr>
<td><form name="form19" method="post" action="">
<input name="pceemployer1" type="text" id="pceemployer1" size="25" maxlength="50">
</form></td>
<td><form name="form22" method="post" action="">
<input name="pcetitle1" type="text" id="pcetitle1" size="25" maxlength="50">
</form></td>
<td><form name="form25" method="post" action="">
<textarea name="pcmdr1" cols="25" id="pcmdr1"></textarea>
</form></td>
<td><form name="form28" method="post" action="">
<input name="pcmdos1" type="text" id="pcmdos1" size="20">
</form></td>
</tr>
<tr>
<td><form name="form20" method="post" action="">
<input name="pceemployer2" type="text" id="pceemployer2" size="25" maxlength="50">
</form></td>
<td><form name="form23" method="post" action="">
<input name="pcetitle2" type="text" id="pcetitle2" size="25" maxlength="50">
</form></td>
<td><form name="form26" method="post" action="">
<textarea name="pcmdr2" cols="25" id="pcmdr2"></textarea>
</form></td>
<td><form name="form29" method="post" action="">
<input name="pcmdos2" type="text" id="pcmdos2" size="20">
</form></td>
</tr>
<tr>
<td><form name="form21" method="post" action="">
<input name="pceemployer3" type="text" id="pceemployer3" size="25" maxlength="50">
</form></td>
<td><form name="form24" method="post" action="">
<input name="pcetitle3" type="text" id="pcetitle3" size="25" maxlength="50">
</form></td>
<td><form name="form27" method="post" action="">
<textarea name="pcmdr3" cols="25" id="pcmdr3"></textarea>
</form></td>
<td><form name="form30" method="post" action="">
<input name="pcmdos3" type="text" id="pcmdos3" size="20">
</form></td>
</tr>
</table>
<p>Education<br>
Please check highest level attained.<br>
</p>
<table width="750" border="0">
<tr>
<td width="21"> <form action="" method="post" name="ged" id="ged">
<input name="eged" type="checkbox" id="eged" value="checkbox">
</form></td>
<td width="926">GED</td>
<td width="96"> <form name="form34" method="post" action="">
<input name="eaa" type="checkbox" id="eaa" value="checkbox">
</form></td>
<td width="888">Associate of Arts (2years)</td>
<td width="96"> <form name="form35" method="post" action="">
<input name="emaster" type="checkbox" id="emaster" value="checkbox">
</form></td>
<td width="952">Master's Degree</td>
</tr>
<tr>
<td><form name="form32" method="post" action="">
<input name="ehcd" type="checkbox" id="ehcd" value="checkbox">
</form></td>
<td>High School Diploma</td>
<td><form name="form36" method="post" action="">
<input name="ebd" type="checkbox" id="ebd" value="checkbox">
</form></td>
<td>Bachelor's Degree</td>
<td><form name="form37" method="post" action="">
<input name="epd" type="checkbox" id="epd" value="checkbox">
</form></td>
<td>Professional Degree</td>
</tr>
<tr>
<td><form name="form33" method="post" action="">
<input name="esc" type="checkbox" id="esc" value="checkbox">
</form></td>
<td>Some College</td>
<td><form name="form38" method="post" action="">
<input name="esgw" type="checkbox" id="esgw" value="checkbox">
</form></td>
<td>Some Graduate Work</td>
<td><form name="form39" method="post" action="">
<input name="eo" type="checkbox" id="eo5" value="checkbox">
</form></td>
<td>Other (Specify Below): </td>
</tr>
<tr>
<td colspan="6"><form name="form31" method="post" action="">
<input name="eod" type="text" id="eod" size="120">
</form></td>
</tr>
</table>
<br>
<br>
<br>
<br>
<br>
<em>Please provide specific information about institutions of higher education
and/or specialized training programs attended, beginning with the most recent.</em><br>
<br>
<table width="750" bordercolor="#000000">
<tr>
<td width="20"> </td>
<td width="160">
<div class="style10">Name</div></td>
<td width="150"><div class="style10">Area of Concentration</div></td>
<td width="160"><div class="style10">Dates(s) Attended</div></td>
<td width="256"><div class="style10">Certificate or Degree</div></td>
</tr>
<tr>
<td width="20">1.</td>
<td><form name="form40" method="post" action="">
<input name="hgname1" type="text" id="hgname1" size="25" maxlength="50">
</form></td>
<td><input name="hgaoc1" type="text" id="hgaoc1" size="25" maxlength="50">
</label> </td>
<td> <label>
<input name="hgdates1" type="text" id="hgdates1" size="25">
</label> </td>
<td> <label>
<input name="hgcod1" type="text" id="hgcod1" size="25" maxlength="50">
</label> </td>
</tr>
<tr>
<td width="20">2.</td>
<td><form name="form41" method="post" action="">
<input name="hgname2" type="text" id="hgname2" size="25" maxlength="50">
</form></td>
<td><input name="hgaoc2" type="text" id="hgaoc2" size="25" maxlength="50"></td>
<td><input name="hgdates2" type="text" id="hgdates2" size="25"></td>
<td><input name="hgcod2" type="text" id="hgcod2" size="25" maxlength="50"></td>
</tr>
<tr>
<td width="20">3.</td>
<td>
<form name="form42" method="post" action="">
<input name="hgname3" type="text" id="hgname3" size="25" maxlength="50">
</form></td>
<td><input name="hgaoc1" type="text" id="hgaoc1" size="25" maxlength="50"></td>
<td><input name="hgdates3" type="text" id="hgdates3" size="25"></td>
<td><input name="hgcod3" type="text" id="hgcod3" size="25" maxlength="50"></td>
</tr>
</table>
<p> </p>
<table width="750" border="0">
<tr>
<td colspan="6">Have you ever recieved academic credit for any course in the
University of Southern California's School of Public </td>
</tr>
<tr>
<td colspan="2">Administration; School of Policy, Planning, and Development;
or School of Social Work? </td>
<td width="26"> <form name="form43" method="post" action="">
<input type="radio" name="racy" value="radiobutton">
</form></td>
<td width="33">YES</td>
<td width="20"> <form name="form44" method="post" action="">
<input type="radio" name="racn" value="radiobutton">
</form></td>
<td width="107">NO</td>
</tr>
<tr>
<td colspan="6">If yes, indicate course(s), credit hours, where taken, and
dates:</td>
</tr>
<tr>
<td colspan="6"><form name="form45" method="post" action="">
<textarea name="racd" cols="80" id="racd"></textarea>
</form></td>
</tr>
<tr>
<td colspan="2">Have you ever participated in any DCI program?</td>
<td> <form name="form43" method="post" action="">
<input type="radio" name="racdciy" value="radiobutton">
</form></td>
<td>YES</td>
<td> <form name="form44" method="post" action="">
<input type="radio" name="racdcin" value="radiobutton">
</form></td>
<td>NO</td>
</tr>
<tr>
<td width="121">If yes, give dates: </td>
<td width="417"><form name="form46" method="post" action="">
<input name="textfield" type="text" size="50">
</form></td>
<td colspan="4"> </td>
</tr>
</table>
<p><strong>Organization and Leadership Activities</strong><br>
<em>Please list your current participation in political, community, professional,
social, religious and/or other activities.</em></p>
<table width="750" border="0">
<tr>
<td>Orgization</td>
<td>Role</td>
<td>Monthly Time Commitment</td>
</tr>
<tr>
<td><form name="form47" method="post" action="">
<input name="olaorg1" type="text" id="olaorg1" size="35" maxlength="50">
</form></td>
<td><form name="form48" method="post" action="">
<input name="olarole1" type="text" id="olarole1" size="30" maxlength="50">
</form></td>
<td><form name="form49" method="post" action="">
<input name="olamtc1" type="text" id="olamtc1" size="30" maxlength="50">
</form></td>
</tr>
<tr>
<td><form name="form50" method="post" action="">
<input name="olaorg2" type="text" id="olaorg2" size="35" maxlength="50">
</form></td>
<td><form name="form51" method="post" action="">
<input name="olarole2" type="text" id="olarole2" size="30" maxlength="50">
</form></td>
<td><form name="form52" method="post" action="">
<input name="olamtc2" type="text" id="olamtc2" size="30" maxlength="50">
</form></td>
</tr>
<tr>
<td><form name="form53" method="post" action="">
<input name="olaorg3" type="text" id="olaorg3" size="35" maxlength="50">
</form></td>
<td><form name="form54" method="post" action="">
<input name="olarole3" type="text" id="olarole3" size="30" maxlength="50">
</form></td>
<td><form name="form55" method="post" action="">
<input name="olamtc3" type="text" id="olamtc3" size="30" maxlength="50">
</form></td>
</tr>
</table>
<p><em>Please attach a statement of note more then two pages articulating your
personal reasons and goals for participating in the CCLD Program. Discuss highlights
of recent responsibilities and achievements: What was/were the greatest challenge(s)
and what steps did you take to overcome it/them? What outcomes do you anticipate
as a result of your participation in the CCLD Program? (Please double space
your remarks.)</em></p>
<form name="form56" enctype="multipart/form-data" method="post" action="">
<input name="file_name_1" type="file" id="file_name_1">
</form>
<table width="750" border="0">
<tr>
<td><em>Please provide contact information for two people who will evaluate
your leadership potential. (Professional references preferred. You should
inform them that we may be contacting them via phone or e-mail in connection
with this program)</em></td>
</tr>
<tr>
<td><form name="form57" method="post" action="">
<textarea name="prrd" cols="100" id="prrd"></textarea>
</form></td>
</tr>
</table>
<p> </p>
<table width="750" border="0">
<tr>
<td>How did you learn about the CCLD Program?</td>
</tr>
<tr>
<td><form name="form58" method="post" action="">
<input name="ccldpd" type="text" id="ccldpd" size="105">
</form></td>
</tr>
</table>
<br>
<br>
<table width="750" border="0">
<tr>
<td colspan="2">I hereby verify that the above information is true and correct
to the best of my knowledge.</td>
</tr>
<tr>
<td width="139"><form name="form59" method="post" action="">
<input name="ccldai" type="text" id="ccldai" size="20">
</form></td>
<td width="601"><form name="form60" method="post" action="">
<input name="ccldasd" type="text" id="ccldasd">
</form></td>
</tr>
<tr>
<td>Initials </td>
<td>DATE : </td>
</tr>
</table>
<br>
<table width="750" border="0">
<tr>
<td width="199"><input type="submit" name="submit" id="submit2" value="Submit"></td>
<td width="541"> </td>
</tr>
</table>
<p> </p>
<p> </p>
<p><br>
</p>
<div align="left"></div>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
</body>
</html>
And here is the E-mail template:
<html>
<style type="text/css">
<!--
.style1 {font-size: small}
.style2 {color: #22165e}
.style10 {color: #22165e; font-size: small; }
#apDiv1 {
position:absolute;
left:206px;
top:138px;
width:129px;
height:17px;
z-index:1;
}
.style11 {color: #FFFFFF}
.style13 {font-size: 18px}
.style14 {font-size: 18px; font-weight: bold; }
.style16 {font-size: 24px; font-weight: bold; }
.style17 {color: #000000}
-->
</style>
</head>
<body>
<p><strong>Personal Information</strong></p>
<table width="750" border="0">
<tr>
<td width="49">Name:</td>
<td width="150"> {lname}</td>
<td width="158">{fname}</td>
<td width="158">{mname}</td>
<td width="80">Date of Birth</td>
<td width="115">{dob}</td>
</tr>
<tr>
<td> </td>
<td>Last</td>
<td>First</td>
<td>Middle</td>
<td> </td>
<td>(MM/DD/YYYY)</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="118">Home Address</td>
<td width="235">{homeaddress}</td>
<td width="82">{homeapt}</td>
<td width="158">{homecity}</td>
<td width="45">{homestate}</td>
<td width="86">{homezip}</td>
</tr>
<tr>
<td> </td>
<td>Street Number</td>
<td>Apt#</td>
<td>City </td>
<td>State</td>
<td>Zip Code</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Home Phone</td>
<td>{homephone}</td>
<td>E-Mail Addtress</td>
<td>{homeemail}</td>
</tr>
</table>
<p><strong>Current Employment </strong></p>
<table width="750" border="0">
<tr>
<td width="74" scope="col">Employer:</td>
<th colspan="5" scope="col"><div align="left">{cemployer}</div></tr>
<tr>
<td scope="col"><div class="style10">Title:</div></td>
<th width="204" scope="col"><div align="left">{cmtitle}</div></th>
<td width="137" scope="col">Date(s) of Service</td>
<th colspan="3" scope="col">{cmdos}</td>
</tr>
<tr>
<td height="2" colspan="6" scope="col"> <div class="style10"></div>
<div align="left"></div></td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="97">Work Address</td>
<td width="256">{cmaddress}</td>
<td width="82">{cmsuite}</td>
<td width="159">{cmcity}</td>
<td width="44">{cmstate}</td>
<td width="86">{cmzip}</td>
</tr>
<tr>
<td> </td>
<td>Street Number</td>
<td>Suite#</td>
<td>City </td>
<td>State</td>
<td>Zip Code</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="123">Work Phone</td>
<td width="131">{cmphone}</td>
<td width="108">Work Fax</td>
<td width="88">{cmfax}</td>
<td width="145">Mobile Phone</td>
<td width="129">{cmmobile}</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="124">Work E-mail</td>
<td width="129">{cmemail}</td>
<td width="109">Work Hours</td>
<td width="370">{cmhours}</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Duties and Responsibilities</td>
</tr>
<tr>
<td>{cmdr}</td>
</tr>
</table>
<p><br>
<span class="style14"> Previous Corrections Experience</span><br>
<em>Please provide information about your other corrections experience. Include
any specialization (eg, juvenile justice, gang intervention, sunstance abuse,
etc)</em><br>
<br>
</p>
<table width="750" border="0">
<tr>
<td>Employer</td>
<td>Title</td>
<td>Duties and Responsibilities</td>
<td>Date(s) of Service</td>
</tr>
<tr>
<td>{pceemployer1}</td>
<td>{pcetitle1}</td>
<td>{pcmdr1}</td>
<td>{pcmdos1}</td>
</tr>
<tr>
<td>{pceemployer2}</td>
<td>{pcetitle2}</td>
<td>{pcmdr2}</td>
<td>{pcmdos2}</td>
</tr>
<tr>
<td>{pceemployer3}</td>
<td>{pcetitle3}</td>
<td>{pcmdr3}</td>
<td>{pcmdos3}</td>
</tr>
</table>
<p>Education<br>
Please check highest level attained.<br>
</p>
<table width="750" border="0">
<tr>
<td width="21">{eged} </td>
<td width="926">GED</td>
<td width="96">{eaa} </td>
<td width="888">Associate of Arts (2years)</td>
<td width="96">{emaster} </td>
<td width="952">Master's Degree</td>
</tr>
<tr>
<td>{ehcd}</td>
<td>High School Diploma</td>
<td>{ebd}</td>
<td>Bachelor's Degree</td>
<td>{epd}</td>
<td>Professional Degree</td>
</tr>
<tr>
<td>{esc}</td>
<td>Some College</td>
<td>{esgw}</td>
<td>Some Graduate Work</td>
<td>{eo}</td>
<td>Other (Specify Below): </td>
</tr>
<tr>
<td colspan="6">{eod}</td>
</tr>
</table>
<br>
<br>
<br>
<br>
<br>
<em>Please provide specific information about institutions of higher education
and/or specialized training programs attended, beginning with the most recent.</em><br>
<br>
<table width="750" bordercolor="#000000">
<tr>
<td width="20"> </td>
<td width="160">
<div class="style10">Name</div></td>
<td width="150"><div class="style10">Area of Concentration</div></td>
<td width="160"><div class="style10">Dates(s) Attended</div></td>
<td width="256"><div class="style10">Certificate or Degree</div></td>
</tr>
<tr>
<td width="20">1.</td>
<td>{hgname1}</td>
<td>{hgaoc1}</td>
<td> <label>{hgdates1} </label> </td>
<td> <label>{hgcod1} </label> </td>
</tr>
<tr>
<td width="20">2.</td>
<td>{hgname2}</td>
<td>{hgaoc2}</td>
<td>{hgdates2}</td>
<td>{hgcod2}</td>
</tr>
<tr>
<td width="20">3.</td>
<td>{hgname3}</td>
<td>{hgaoc3}</td>
<td>{hgdates3}</td>
<td>{hgcod}</td>
</tr>
</table>
<br>
<br>
<table width="750" border="0">
<tr>
<td colspan="6">Have you ever recieved academic credit for any course in the
University of Southern California's School of Public </td>
</tr>
<tr>
<td colspan="2">Administration; School of Policy, Planning, and Development;
or School of Social Work? </td>
<td width="26">{racy} </td>
<td width="33">YES</td>
<td width="20">{racn} </td>
<td width="107">NO</td>
</tr>
<tr>
<td colspan="6">If yes, indicate course(s), credit hours, where taken, and
dates:</td>
</tr>
<tr>
<td colspan="6">{racd}</td>
</tr>
<tr>
<td colspan="2">Have you ever participated in any DCI program?</td>
<td>{racdciy} </td>
<td>YES</td>
<td>{racdcin} </td>
<td>NO</td>
</tr>
<tr>
<td width="121">If yes, give dates: </td>
<td width="417">{racdcid}</td>
<td colspan="4"> </td>
</tr>
</table>
<p><strong>Organization and Leadership Activities</strong><br>
<em>Please list your current participation in political, community, professional,
social, religious and/or other activities.</em></p>
<table width="750" border="0">
<tr>
<td>Orgization</td>
<td>Role</td>
<td>Monthly Time Commitment</td>
</tr>
<tr>
<td>{olaorg1}</td>
<td>{olarole1}</td>
<td>{olamtc1}</td>
</tr>
<tr>
<td>{olaorg2}</td>
<td>{olarole2}</td>
<td>{olamtc2}</td>
</tr>
<tr>
<td>{olaorg3}</td>
<td>{olarole3}</td>
<td>{olamtc1}</td>
</tr>
</table>
<p><em>Please attach a statement of note more then two pages articulating your
personal reasons and goals for participating in the CCLD Program. Discuss highlights
of recent responsibilities and achievements: What was/were the greatest challenge(s)
and what steps did you take to overcome it/them? What outcomes do you anticipate
as a result of your participation in the CCLD Program? (Please double space
your remarks.)</em></p>
<form name="form56" enctype="multipart/form-data" method="post" action="">
<input name="file_name_1" type="file" id="file_name_1">
</form>
<table width="750" border="0">
<tr>
<td><em>Please provide contact information for two people who will evaluate
your leadership potential. (Professional references preferred. You should
inform them that we may be contacting them via phone or e-mail in connection
with this program)</em></td>
</tr>
<tr>
<td>{prrd}</td>
</tr>
</table>
<p> </p>
<table width="750" border="0">
<tr>
<td>How did you learn about the CCLD Program?</td>
</tr>
<tr>
<td>{ccldpd}</td>
</tr>
</table>
<br>
<br>
<table width="750" border="0">
<tr>
<td colspan="2">I hereby verify that the above information is true and correct
to the best of my knowledge.</td>
</tr>
<tr>
<td width="139">{ccldai}</td>
<td width="601">{ccldasd}</td>
</tr>
<tr>
<td>Initials </td>
<td>DATE : </td>
</tr>
</table>
<br>
<table width="750" border="0">
<tr>
<td width="199"><input type="submit" name="submit" id="submit2" value="Submit"></td>
<td width="541"> </td>
</tr>
</table>
<p> </p>
<p> </p>
<p><br>
</p>
<div align="left"></div>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
</body>
</html>
and here is the Auto Generate tag
<?php
global $database;
srand((double)microtime()*10000);
$inum = "I" . substr(base64_encode(md5(rand())), 0, 16);
$database->setQuery( "INSERT INTO #__chronoforms_1 VALUES (
'' , '".$inum."','". date('Y-m-d')." - ".date("H:i:s")."', '".$_SERVER['REMOTE_ADDR']."' , '".mosGetParam($_POST,'lastname','')."' , '".mosGetParam($_POST,'middleinitial','')."' , '".mosGetParam($_POST,'firstname','')."' , '".mosGetParam($_POST,'presaddress','')."' , '".mosGetParam($_POST,'prescity','')."' , '".mosGetParam($_POST,'presstate','')."' , '".mosGetParam($_POST,'preszip','')."' , '".mosGetParam($_POST,'permaddress','')."' , '".mosGetParam($_POST,'permcity','')."' , '".mosGetParam($_POST,'permstate','')."' , '".mosGetParam($_POST,'permzip','')."' , '".mosGetParam($_POST,'homephone','')."' , '".mosGetParam($_POST,'contactphone','')."' , '".mosGetParam($_POST,'prevnames','')."' , '".mosGetParam($_POST,'email','')."' , '".mosGetParam($_POST,'contacttime','')."' , '".mosGetParam($_POST,'avmonth','')."' , '".mosGetParam($_POST,'avday','')."' , '".mosGetParam($_POST,'avyear','')."' , '".mosGetParam($_POST,'weekholi','')."' , '".mosGetParam($_POST,'rotateshift','')."' , '".mosGetParam($_POST,'oncall','')."' , '".mosGetParam($_POST,'anyshift','')."' , '".mosGetParam($_POST,'shiftdays','')."' , '".mosGetParam($_POST,'shiftevenings','')."' , '".mosGetParam($_POST,'shiftnights','')."' , '".mosGetParam($_POST,'fullreg','')."' , '".mosGetParam($_POST,'fulltemp','')."' , '".mosGetParam($_POST,'partreg','')."' , '".mosGetParam($_POST,'parttemp','')."' , '".mosGetParam($_POST,'positionapplied','')."' , '".mosGetParam($_POST,'salarydesired','')."' , '".mosGetParam($_POST,'learnofposition','')."' , '".mosGetParam($_POST,'employ','')."' , '".mosGetParam($_POST,'18yrs','')."' , '".mosGetParam($_POST,'citizen','')."' , '".mosGetParam($_POST,'crime','')."' , '".mosGetParam($_POST,'crimeexplain','')."' , '".mosGetParam($_POST,'abuse','')."' , '".mosGetParam($_POST,'abuseexplain','')."' , '".mosGetParam($_POST,'sanct','')."' , '".mosGetParam($_POST,'sanctexplain','')."' , '".mosGetParam($_POST,'highname','')."' , '".mosGetParam($_POST,'highstudy','')."' , '".mosGetParam($_POST,'highyear','')."' , '".mosGetParam($_POST,'highgrad','')."' , '".mosGetParam($_POST,'highdegree','')."' , '".mosGetParam($_POST,'colname','')."' , '".mosGetParam($_POST,'colstudy','')."' , '".mosGetParam($_POST,'colyear','')."' , '".mosGetParam($_POST,'colgrad','')."' , '".mosGetParam($_POST,'coldegree','')."' , '".mosGetParam($_POST,'colname2','')."' , '".mosGetParam($_POST,'colstudy2','')."' , '".mosGetParam($_POST,'colyear2','')."' , '".mosGetParam($_POST,'colgrad2','')."' , '".mosGetParam($_POST,'coldegree2','')."' , '".mosGetParam($_POST,'othercourses','')."' , '".mosGetParam($_POST,'areaspecial','')."' , '".mosGetParam($_POST,'officeskills','')."' , '".mosGetParam($_POST,'wordsper','')."' , '".mosGetParam($_POST,'equipoperated','')."' , '".mosGetParam($_POST,'dutyskills','')."' , '".mosGetParam($_POST,'procert','')."' , '".mosGetParam($_POST,'procerttype','')."' , '".mosGetParam($_POST,'prolicense','')."' , '".mosGetParam($_POST,'lictype','')."' , '".mosGetParam($_POST,'procertstate','')."' , '".mosGetParam($_POST,'licno','')."' , '".mosGetParam($_POST,'certmonth','')."' , '".mosGetParam($_POST,'certday','')."' , '".mosGetParam($_POST,'certyear','')."' , '".mosGetParam($_POST,'licstate','')."' , '".mosGetParam($_POST,'licmonth','')."' , '".mosGetParam($_POST,'licday','')."' , '".mosGetParam($_POST,'licyear','')."' , '".mosGetParam($_POST,'procert2','')."' , '".mosGetParam($_POST,'procerttype2','')."' , '".mosGetParam($_POST,'prolicense2','')."' , '".mosGetParam($_POST,'lictype2','')."' , '".mosGetParam($_POST,'procertstate2','')."' , '".mosGetParam($_POST,'licno2','')."' , '".mosGetParam($_POST,'certmonth2','')."' , '".mosGetParam($_POST,'certday2','')."' , '".mosGetParam($_POST,'certyear2','')."' , '".mosGetParam($_POST,'licstate2','')."' , '".mosGetParam($_POST,'licmonth2','')."' , '".mosGetParam($_POST,'licday2','')."' , '".mosGetParam($_POST,'licyear2','')."' , '".mosGetParam($_POST,'jobtitle','')."' , '".mosGetParam($_POST,'frommonth','')."' , '".mosGetParam($_POST,'fromyear','')."' , '".mosGetParam($_POST,'tomonth','')."' , '".mosGetParam($_POST,'toyear','')."' , '".mosGetParam($_POST,'empname','')."' , '".mosGetParam($_POST,'supername','')."' , '".mosGetParam($_POST,'jobaddress','')."' , '".mosGetParam($_POST,'jobphone','')."' , '".mosGetParam($_POST,'jobsalary','')."' , '".mosGetParam($_POST,'maycontact','')."' , '".mosGetParam($_POST,'jobduties','')."' , '".mosGetParam($_POST,'leaving','')."' , '".mosGetParam($_POST,'jobtitle2','')."' , '".mosGetParam($_POST,'frommonth2','')."' , '".mosGetParam($_POST,'fromyear2','')."' , '".mosGetParam($_POST,'tomonth2','')."' , '".mosGetParam($_POST,'toyear2','')."' , '".mosGetParam($_POST,'empname2','')."' , '".mosGetParam($_POST,'supername2','')."' , '".mosGetParam($_POST,'jobaddress2','')."' , '".mosGetParam($_POST,'jobphone2','')."' , '".mosGetParam($_POST,'jobsalary2','')."' , '".mosGetParam($_POST,'maycontact2','')."' , '".mosGetParam($_POST,'jobduties2','')."' , '".mosGetParam($_POST,'leaving2','')."' , '".mosGetParam($_POST,'jobtitle3','')."' , '".mosGetParam($_POST,'frommonth3','')."' , '".mosGetParam($_POST,'fromyear3','')."' , '".mosGetParam($_POST,'tomonth3','')."' , '".mosGetParam($_POST,'toyear3','')."' , '".mosGetParam($_POST,'empname3','')."' , '".mosGetParam($_POST,'supername3','')."' , '".mosGetParam($_POST,'jobaddress3','')."' , '".mosGetParam($_POST,'jobphone3','')."' , '".mosGetParam($_POST,'jobsalary3','')."' , '".mosGetParam($_POST,'maycontact3','')."' , '".mosGetParam($_POST,'jobduties3','')."' , '".mosGetParam($_POST,'leaving3','')."' , '".mosGetParam($_POST,'jobtitle4','')."' , '".mosGetParam($_POST,'frommonth4','')."' , '".mosGetParam($_POST,'fromyear4','')."' , '".mosGetParam($_POST,'tomonth4','')."' , '".mosGetParam($_POST,'toyear4','')."' , '".mosGetParam($_POST,'empname4','')."' , '".mosGetParam($_POST,'supername4','')."' , '".mosGetParam($_POST,'jobaddress4','')."' , '".mosGetParam($_POST,'jobphone4','')."' , '".mosGetParam($_POST,'jobsalary4','')."' , '".mosGetParam($_POST,'maycontact4','')."' , '".mosGetParam($_POST,'jobduties4','')."' , '".mosGetParam($_POST,'leaving4','')."' , '".mosGetParam($_POST,'nameandrela','')."' , '".mosGetParam($_POST,'reftitle','')."' , '".mosGetParam($_POST,'compname','')."' , '".mosGetParam($_POST,'reftele','')."' , '".mosGetParam($_POST,'nameandrela2','')."' , '".mosGetParam($_POST,'reftitle2','')."' , '".mosGetParam($_POST,'compname2','')."' , '".mosGetParam($_POST,'reftele2','')."' , '".mosGetParam($_POST,'nameandrela3','')."' , '".mosGetParam($_POST,'reftitle3','')."' , '".mosGetParam($_POST,'compname3','')."' , '".mosGetParam($_POST,'reftele3','')."' , '".mosGetParam($_POST,'submit','')."');" );
if (!$database->query()) {
echo "<script> alert('".$database->getErrorMsg()."'); window.history.go(-1); </script>
";
}
?>
well, you HTML is full of form tags like this :
<form name="form1" method="post" action="">
all this should be removed and the closing tags also and the code cleaned!
Max
<form name="form1" method="post" action="">
all this should be removed and the closing tags also and the code cleaned!
Max
</form>, having one form tag will make the form doesn't work, you have many of them!🙂
Thanks.. I removed all of those tags and they are still not working.
Here is the revised html form
Here is the revised html form
<html>
<style type="text/css">
<!--
.style1 {font-size: small}
.style2 {color: #22165e}
.style10 {color: #22165e; font-size: small; }
#apDiv1 {
position:absolute;
left:206px;
top:138px;
width:129px;
height:17px;
z-index:1;
}
.style11 {color: #FFFFFF}
.style13 {font-size: 18px}
.style14 {font-size: 18px; font-weight: bold; }
.style16 {font-size: 24px; font-weight: bold; }
.style17 {color: #000000}
-->
</style>
</head>
<body>
<p><strong>Personal Information</strong></p>
<table width="750" border="0">
<tr>
<td width="49">Name:</td>
<td width="150"><input name="lname" type="text" id="lname" size="20" maxlength="50"></td>
<td width="158"><input name="fname" type="text" id="fname" size="20" maxlength="50"></td>
<td width="158"><input name="mname" type="text" id="mname" size="15" maxlength="50"></td>
<td width="80">Date of Birth</td>
<td width="115"><input name="dob" type="text" id="dob" size="15"></td>
</tr>
<tr>
<td> </td>
<td>Last</td>
<td>First</td>
<td>Middle</td>
<td> </td>
<td>(MM/DD/YYYY)</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="118">Home Address</td>
<td width="235"><input name="homeaddress" type="text" id="homeaddress" size="30" maxlength="50"></td>
<td width="82"><input name="homeapt" type="text" id="homeapt" size="10"></td>
<td width="158"><input name="homecity" type="text" id="homecity" size="20" maxlength="50"></td>
<td width="45"><input name="homestate" type="text" id="homestate" size="5" maxlength="25"></td>
<td width="86"><input name="homezip" type="text" id="homezip" size="10"></td>
</tr>
<tr>
<td> </td>
<td>Street Number</td>
<td>Apt#</td>
<td>City </td>
<td>State</td>
<td>Zip Code</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Home Phone</td>
<td><input name="homephone" type="text" id="homephone" size="25"></td>
<td>E-Mail Addtress</td>
<td><input name="homeemail" type="text" id="homeemail" size="25" maxlength="50"></td>
</tr>
</table>
<p><strong>Current Employment </strong></p>
<table width="750" border="0">
<tr>
<td width="74" scope="col"><div class="style10">Employer:</div></td>
<th width="204" scope="col"><input name="cemployer" type="text" id="empname43" size="34" maxlength="100"></th>
<td width="137" scope="col"> </td>
<th width="92" scope="col"> </th>
<th width="50" scope="col"> </th>
<td width="167"> </td>
</tr>
<tr>
<td scope="col"><div class="style10">Title:</div></td>
<th scope="col"><input name="cmtitle" type="text" id="jobtitle42" size="34" maxlength="50"></th>
<td scope="col">Date(s) of Service</td>
<th colspan="3" scope="col">
<div align="left"><input name="cmdos" type="text" id="cmdos" size="35">
</div></th>
</tr>
<tr>
<td height="2" colspan="6" scope="col">
<div class="style10"></div>
<div align="left"></div></td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td width="97">Work Address</td>
<td width="256"><input name="cmaddress" type="text" id="cmaddress" size="30" maxlength="50"></td>
<td width="82"><input name="cmsuite" type="text" id="cmsuite" size="10"></td>
<td width="159"><input name="cmcity" type="text" id="cmcity" size="20" maxlength="50"></td>
<td width="44"><input name="cmstate" type="text" id="cmstate" size="5" maxlength="25"></td>
<td width="86"><input name="cmzip" type="text" id="cmzip" size="10"></td>
</tr>
<tr>
<td> </td>
<td>Street Number</td>
<td>Suite#</td>
<td>City </td>
<td>State</td>
<td>Zip Code</td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Work Phone</td>
<td><input name="cmphone" type="text" id="cmphone" size="25"></td>
<td>Work Fax</td>
<td><input name="cmfax" type="text" id="cmfax" size="25"></td>
<td>Mobile Phone</td>
<td><input name="cmmobile" type="text" id="cmmobile"></td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Work E-mail</td>
<td><input name="cmemail" type="text" id="cmemail" size="25" maxlength="50"></td>
<td>Work Hours</td>
<td><input name="cmhours" type="text" id="cmhours" size="25"></td>
</tr>
</table>
<table width="750" border="0">
<tr>
<td>Duties and Responsibilities</td>
</tr>
<tr>
<td><textarea name="cmdr" cols="80" id="cmdr"></textarea></td>
</tr>
</table>
<p><br>
<span class="style14"> Previous Corrections Experience</span><br>
<em>Please provide information about your other corrections experience. Include
any specialization (eg, juvenile justice, gang intervention, sunstance abuse,
etc)</em><br>
<br>
</p>
<table width="750" border="0">
<tr>
<td>Employer</td>
<td>Title</td>
<td>Duties and Responsibilities</td>
<td>Date(s) of Service</td>
</tr>
<tr>
<td><input name="pceemployer1" type="text" id="pceemployer1" size="25" maxlength="50"></td>
<td><input name="pcetitle1" type="text" id="pcetitle1" size="25" maxlength="50"></td>
<td><textarea name="pcmdr1" cols="25" id="pcmdr1"></textarea></td>
<td><input name="pcmdos1" type="text" id="pcmdos1" size="20"></td>
</tr>
<tr>
<td><input name="pceemployer2" type="text" id="pceemployer2" size="25" maxlength="50"></td>
<td><input name="pcetitle2" type="text" id="pcetitle2" size="25" maxlength="50"></td>
<td><textarea name="pcmdr2" cols="25" id="pcmdr2"></textarea></td>
<td><input name="pcmdos2" type="text" id="pcmdos2" size="20"></td>
</tr>
<tr>
<td><input name="pceemployer3" type="text" id="pceemployer3" size="25" maxlength="50"></td>
<td><input name="pcetitle3" type="text" id="pcetitle3" size="25" maxlength="50"></td>
<td><textarea name="pcmdr3" cols="25" id="pcmdr3"></textarea></td>
<td><input name="pcmdos3" type="text" id="pcmdos3" size="20"></td>
</tr>
</table>
<p>Education<br>
Please check highest level attained.<br>
</p>
<table width="750" border="0">
<tr>
<td width="21"><input name="eged" type="checkbox" id="eged" value="checkbox"></td>
<td width="926">GED</td>
<td width="96"><input name="eaa" type="checkbox" id="eaa" value="checkbox"></td>
<td width="888">Associate of Arts (2years)</td>
<td width="96"><input name="emaster" type="checkbox" id="emaster" value="checkbox"></td>
<td width="952">Master's Degree</td>
</tr>
<tr>
<td><input name="ehcd" type="checkbox" id="ehcd" value="checkbox"></td>
<td>High School Diploma</td>
<td><input name="ebd" type="checkbox" id="ebd" value="checkbox"></td>
<td>Bachelor's Degree</td>
<td><input name="epd" type="checkbox" id="epd" value="checkbox"></td>
<td>Professional Degree</td>
</tr>
<tr>
<td><input name="esc" type="checkbox" id="esc" value="checkbox"></td>
<td>Some College</td>
<td><input name="esgw" type="checkbox" id="esgw" value="checkbox"></td>
<td>Some Graduate Work</td>
<td><input name="eo" type="checkbox" id="eo5" value="checkbox"></td>
<td>Other (Specify Below): </td>
</tr>
<tr>
<td colspan="6"><input name="eod" type="text" id="eod" size="120"></td>
</tr>
</table>
<br>
<br>
<br>
<br>
<br>
<em>Please provide specific information about institutions of higher education
and/or specialized training programs attended, beginning with the most recent.</em><br>
<br>
<table width="750" bordercolor="#000000">
<tr>
<td width="20"> </td>
<td width="160">
<div class="style10">Name</div></td>
<td width="150"><div class="style10">Area of Concentration</div></td>
<td width="160"><div class="style10">Dates(s) Attended</div></td>
<td width="256"><div class="style10">Certificate or Degree</div></td>
</tr>
<tr>
<td width="20">1.</td>
<td><input name="hgname1" type="text" id="hgname1" size="25" maxlength="50"></td>
<td><input name="hgaoc1" type="text" id="hgaoc1" size="25" maxlength="50"></td>
<td><input name="hgdates1" type="text" id="hgdates1" size="25"></td>
<td><input name="hgcod1" type="text" id="hgcod1" size="25" maxlength="50"></td>
</tr>
<tr>
<td width="20">2.</td>
<td><input name="hgname2" type="text" id="hgname2" size="25" maxlength="50"></td>
<td><input name="hgaoc2" type="text" id="hgaoc2" size="25" maxlength="50"></td>
<td><input name="hgdates2" type="text" id="hgdates2" size="25"></td>
<td><input name="hgcod2" type="text" id="hgcod2" size="25" maxlength="50"></td>
</tr>
<tr>
<td width="20">3.</td>
<td><input name="hgname3" type="text" id="hgname3" size="25" maxlength="50"></td>
<td><input name="hgaoc1" type="text" id="hgaoc1" size="25" maxlength="50"></td>
<td><input name="hgdates3" type="text" id="hgdates3" size="25"></td>
<td><input name="hgcod3" type="text" id="hgcod3" size="25" maxlength="50"></td>
</tr>
</table>
<p> </p>
<table width="750" border="0">
<tr>
<td colspan="6">Have you ever recieved academic credit for any course in the
University of Southern California's School of Public </td>
</tr>
<tr>
<td colspan="2">Administration; School of Policy, Planning, and Development;
or School of Social Work? </td>
<td width="26"><input type="radio" name="racy" value="radiobutton"></td>
<td width="33">YES</td>
<td width="20"><input type="radio" name="racn" value="radiobutton"></td>
<td width="107">NO</td>
</tr>
<tr>
<td colspan="6">If yes, indicate course(s), credit hours, where taken, and
dates:</td>
</tr>
<tr>
<td colspan="6"><textarea name="racd" cols="80" id="racd"></textarea></td>
</tr>
<tr>
<td colspan="2">Have you ever participated in any DCI program?</td>
<td><input type="radio" name="racdciy" value="radiobutton"></td>
<td>YES</td>
<td><input type="radio" name="racdcin" value="radiobutton"></td>
<td>NO</td>
</tr>
<tr>
<td width="121">If yes, give dates: </td>
<td width="417"><input name="textfield" type="text" size="50"></td>
<td colspan="4"> </td>
</tr>
</table>
<p><strong>Organization and Leadership Activities</strong><br>
<em>Please list your current participation in political, community, professional,
social, religious and/or other activities.</em></p>
<table width="750" border="0">
<tr>
<td>Orgization</td>
<td>Role</td>
<td>Monthly Time Commitment</td>
</tr>
<tr>
<td><input name="olaorg1" type="text" id="olaorg1" size="35" maxlength="50"></td>
<td><input name="olarole1" type="text" id="olarole1" size="30" maxlength="50"></td>
<td><input name="olamtc1" type="text" id="olamtc1" size="30" maxlength="50"></td>
</tr>
<tr>
<td><input name="olaorg2" type="text" id="olaorg2" size="35" maxlength="50"></td>
<td><input name="olarole2" type="text" id="olarole2" size="30" maxlength="50"></td>
<td><input name="olamtc2" type="text" id="olamtc2" size="30" maxlength="50"></td>
</tr>
<tr>
<td><input name="olaorg3" type="text" id="olaorg3" size="35" maxlength="50"></td>
<td><input name="olarole3" type="text" id="olarole3" size="30" maxlength="50"></td>
<td><input name="olamtc3" type="text" id="olamtc3" size="30" maxlength="50"></td>
</tr>
</table>
<p><em>Please attach a statement of note more then two pages articulating your
personal reasons and goals for participating in the CCLD Program. Discuss highlights
of recent responsibilities and achievements: What was/were the greatest challenge(s)
and what steps did you take to overcome it/them? What outcomes do you anticipate
as a result of your participation in the CCLD Program? (Please double space
your remarks.)</em></p>
<input name="file_name_1" type="file" id="file_name_1">
<table width="750" border="0">
<tr>
<td><em>Please provide contact information for two people who will evaluate
your leadership potential. (Professional references preferred. You should
inform them that we may be contacting them via phone or e-mail in connection
with this program)</em></td>
</tr>
<tr>
<td><textarea name="prrd" cols="100" id="prrd"></textarea></td>
</tr>
</table>
<p> </p>
<table width="750" border="0">
<tr>
<td>How did you learn about the CCLD Program?</td>
</tr>
<tr>
<td><input name="ccldpd" type="text" id="ccldpd" size="105"></td>
</tr>
</table>
<br>
<br>
<table width="750" border="0">
<tr>
<td colspan="2">I hereby verify that the above information is true and correct
to the best of my knowledge.</td>
</tr>
<tr>
<td width="139"><input name="ccldai" type="text" id="ccldai" size="20"></td>
<td width="601"><input name="ccldasd" type="text" id="ccldasd"></td>
</tr>
<tr>
<td>Initials </td>
<td>DATE : </td>
</tr>
</table>
<br>
<table width="750" border="0">
<tr>
<td width="199"><input type="submit" name="submit" id="submit2" value="Submit"></td>
<td width="541"> </td>
</tr>
</table>
<p> </p>
<p> </p>
<p><br>
</p>
<div align="left"></div>
<p> </p>
<p> </p>
<p> </p>
<p> </p>
</body>
</html>
Hi, please remove teh HTML and BODY opening and closing tags also, PayPal to use where exactly ?
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