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<?php
require_once($_SERVER['DOCUMENT_ROOT'].'/inc/php_header.php');
$categories = get_categories();
$business_questions = get_business_questions();
$granttype = $_GET['apptype'];
?>
<?php include($_SERVER['DOCUMENT_ROOT'].'/v4/header.php'); ?>
<?php include($_SERVER['DOCUMENT_ROOT'].'/v4/sidebar3.php'); ?>
<div class="main">
<div class="main_">
<script type="text/javascript">
$(document).ready( function() {
$('.subcategory,.subtext,#education_questions,#business_questions').hide().find('input,select,textarea').attr('disabled','disabled');
$('input[name=category_id]').click( function() {
var show_class = $(this).attr('class');
var subcat_elements = $('.subcategory[class~='+show_class+']');
$('.subcategory').hide().find('input,select,textarea').attr('disabled', 'disabled');
if(subcat_elements.length > 0) {
$('#subcategories').show();
subcat_elements.show().find('input,select,textarea').removeAttr('disabled');
} else {
$('#subcategories').hide().find('input,select,textarea').attr('disabled', 'disabled');
}
var granttype = this.className;
$('#granttype_input').val(granttype);
var amount_needed = $('select[name=app_amount_needed]').val();
if(granttype == 'business') {
$('#amount_needed').html('<select name="app_amount_needed"><option selected>Select</option><option value="$500 - $10,000">$500 - $10,000</option><option value="$10,000 - $25,000">$10,000 - $25,000</option><option value="$25,000 - $50,000">$25,000 - $50,000</option><option value="$50,000 - $100,000">$50,000 - $100,000</option><option value="$100,000 - $250,000">$100,000 - $250,000</option><option value="$250,000 - $500,000">$250,000 - $500,000</option><option value="$500,000 - $1,000,000">$500,000 - $1,000,000</option><option value="$1,000,000 +">$1,000,000 +</option></select>');
$('#business_questions').show('slow').find('input,select,textarea').removeAttr('disabled');
} else {
$('#amount_needed').html('<select name="app_amount_needed"><option selected>Select</option><option value="$500 - $10,000">$500 - $10,000</option><option value="$10,000 - $25,000">$10,000 - $25,000</option><option value="$25,000 - $50,000">$25,000 - $50,000</option><option value="$50,000 - $100,000">$50,000 - $100,000</option><option value="$100,000 or More">$100,000 or More</option></select>');
$('#business_questions').hide('slow').find('input,select,textarea').attr('disabled','disabled');
}
/*if(granttype == 'education') {
$('#education_questions').show().find('input,select,textarea').removeAttr('disabled');
} else {
$('#education_questions').hide().find('input,select,textarea').attr('disabled','disabled');
}*/
/*if(granttype == 'personal') {
$('#disability_questions').show().find('input,select,textarea').removeAttr('disabled');
} else {
$('#disability_questions').hide().find('input,select,textarea').attr('disabled','disabled');
}*/
});
<?php
/*foreach($education_questions['subquestions'] as $slug=>$data) {
echo "$('.".$slug."_sub').hide().find('input,select,textarea').attr('disabled','disabled');";
echo "$('#".$slug."_yes').click(function() {
$('.".$slug."_sub').show().find('input,select,textarea').removeAttr('disabled');
});";
echo "$('#".$slug."_no').click(function() {
$('.".$slug."_sub').hide().find('input,select,textarea').attr('disabled','disabled');
});";
}*/
/*foreach($disability_questions['subquestions'] as $slug=>$data) {
echo "$('.".$slug."_sub').hide().find('input,select,textarea').attr('disabled','disabled');";
echo "$('#".$slug."_yes').click(function() {
$('.".$slug."_sub').slideDown().find('input,select,textarea').removeAttr('disabled');
});";
echo "$('#".$slug."_no').click(function() {
$('.".$slug."_sub').slideUp().find('input,select,textarea').attr('disabled','disabled');
});";
}*/
if(!empty($_REQUEST['category_id'])) {
echo "$('input:radio[name=category_id]').filter(function() { return $(this).val()=='{$_REQUEST['category_id']}'; }).click();\n";
echo "$('input:radio[name=category_id]').not(':checked').each(function() { $(this).parents('tr:first').hide(); });";
} elseif($_REQUEST['apptype']) {
echo "$('input:radio.".$_REQUEST['apptype']."').click();";
echo "$('input:radio[name=category_id]').not(':checked').each(function() { $(this).parents('tr:first').hide(); });";
}
?>
});
// Create an associative array of 'pretty name' values
var prettynames = {
category_id:"Funding Category",
cc_fname:"First Name",
cc_lname:"Last Name",
cc_addr:"Address",
cc_city:"City",
cc_state:"State",
cc_zip:"Zip",
cc_phonearea:"Phone Number Area Code",
cc_phoneprefix:"Phone Number Prefix",
cc_phoneextension:"Phone Number Ending",
phone_full:"Phone Number",
cc_email:"Email Address",
app_gender:"Gender",
app_citizenship:"Citizenship",
app_age:"Your age",
app_amount_needed:"The amount needed",
app_usedescription:"Describe what you will use the money for",
app_uniqueness:"Uniqueness",
diploma:"Do you have a high school diploma or GED?",
online_business:"Would you like to start an online business to make money while you go to school if we could help pay for your training?",
serious_scale:"In a scale of 1-10 how serious are you about getting a degree online?",
college:"Have you gone to college?",
degree:"Do you have a degree?",
willing_second_degree:"Are you willing to get a second degree in business?",
have_computer:"Do you have access to a computer for taking the online classes and working on your business?",
/*applied_ssd:"Have you ever applied for Social Security Disability?",
currently_applying:"If yes, \"Are you currently receiving Social Security benefits?\"",
denied_ssd:"Have you been denied for Social Security Disability?",
stopped_work:"Have you stopped working because of a disability?",
why_cant_work:"If yes, \"Why can't you work right now?\"",
out_of_work_12_months:"Do you expect to be out of work for at least 12 months?",
treatment:"Are you currently receiving treatment from a doctor?",
worked_5_years:"Have you worked approximately five of the last ten years?",
have_attorney:"Do you have an attorney helping you with this case?"*/
};
// Utility function that returns true if a string contains only
// whitespace characters
// Taken from "Javascript: The Definitive Guide" pg. 264
function isblank(s)
{
for (var i=0; i < s.length; i++)
{
var c = s.charAt(i);
if ((c!=' ') && (c != '\n') && (c != ''))
{
return false;
}
}
return true;
}
// Credit Card Validation Javascript
// copyright 12th May 2003, by Stephen Chapman, Felgall Pty Ltd
// You have permission to copy and use this javascript provided that
// the content of the script is not changed in any way.
function validateCreditCard(s) {
// remove non-numerics
var v = "0123456789";
var w = "";
for (i=0; i < s.length; i++) {
x = s.charAt(i);
if (v.indexOf(x,0) != -1)
w += x;
}
// validate number
j = w.length / 2;
if (j < 6.5 || j > 8 || j == 7) return false;
k = Math.floor(j);
m = Math.ceil(j) - k;
c = 0;
for (i=0; i<k; i++) {
a = w.charAt(i*2+m) * 2;
c += a > 9 ? Math.floor(a/10 + a%10) : a;
}
for (i=0; i<k+m; i++) c += w.charAt(i*2+1-m) * 1;
return (c%10 == 0);
}
function verify(f)
{
// Taken from "Javascript: The Definitive Guide" pg. 264.
// Modified heavily to suit our needs
// Loop through each element of the form and validate each item
//
// Set the parameters for each field to be valid
// If a field doesn't have any modifiers it is assumed to be
// a text field that can not be blank.
var msg;
var empty_fields = "";
var errors = "";
for (var i=0; i < f.length; i++)
{
var element = f.elements[i];
//document.getElementById('errorconsole').innerHTML += element.name + ":" + element.type + "<br>";
if($(element).is(':hidden')) {
continue;
}
if ((element.name == 'cc_email')) {
if(/(.+)@(.+){2,}\.(.+){2,}/.test(element.value)) {
//valid email
} else {
errors += "- Please enter a valid email address\n";
}
} else if ((element.type == 'tel' || element.type == 'number' || element.type == 'text' || element.type == 'textarea') && (element.name != 'granttype_other'))
{
if ( (element.value == null || element.value == "") || isblank(element.value) )
{
empty_fields += "\n " + prettynames[element.name];
continue;
}
if (element.numeric)
{
var v = parseFloat(element.value);
if (isNaN(v))
{
errors +="- The field " + prettynames[element.name] + " must be a number\n";
}
}
if ( (element.requiredlength > 0) && (element.value.length != element.requiredlength) )
{
errors += "- The field " + prettynames[element.name] + " must be " + element.requiredlength + " digits long\n";
}
}
else if (element.type == 'select-one')
{
// The first option, option[0] can not be selected
if ( (element.value == null || element.value == "" || element.selectedIndex == 0) || isblank(element.value) )
{
empty_fields += "\n " + prettynames[element.name];
continue;
}
}
else if (element.type == 'radio')
{
if (!$('[name='+element.name+']:checked').val() && empty_fields.indexOf(prettynames[element.name]) == -1)
{
empty_fields += "\n " + prettynames[element.name];
continue;
}
}
}
if (!empty_fields && !errors) { return true; }
msg = "__________________________________\n\n";
msg += "The form was not submitted because of the following error(s).\n";
msg += "Please correct these error(s) and re-submit.\n";
msg += "__________________________________\n\n";
if (empty_fields)
{
msg += "- The following required field(s) are empty:" + empty_fields + "\n";
if (errors) { msg += "\n"; }
}
msg += errors;
alert(msg);
return false;
}
function checkZip(zip,me) {
zip = zip.replace(/[^0-9]/g,'');
if(zip.length==5) {
var str = 'zip='+encodeURIComponent(zip);
$.ajax
({
cache: false,
type: "POST",
dataType:"json",
data: str,
url: "/php/ZipToCity.php",
success: function(data)
{
if(!data.error) {
$('[name=cc_city]').val(data.city);
$('[name=cc_state]').val(data.state);
}
},error: function(jqXHR, textStatus, errorThrown) {
}
});
}
}
$(document).ready(function(){
$('input[name=phone_full]').formatter({
'pattern': '({{999}}) {{999}}-{{9999}}',
'persistent': false
});
});
</script>
<style>
<!--
body {margin:0px auto;background-color:#FFFFFF}
body table {margin:0px auto}
.header {font:bold 10pt verdana}
.gray {width:100px;background-color:#dbd7d6;text-align:center}
.white {width:590px;background-color:#ffffff;text-align:left;font:8pt verdana;padding-top:10px}
#base {list-style-type:none;text-align:center;margin:0px auto}
#base li {display:inline;padding:4px;font:7.5pt/120% verdana}
#base a:link, #base a:visited {color:#000000;text-decoration:none}
#base a:hover, #base a:active {color:#666666;text-decoration:underline}
#white {color:#fff}
.questions {width:580px;color:#000;margin-bottom:10px; padding: 8px;}
.questions input {font: 8pt verdana;display:inline;margin:1px 3px;color:#000;background-color:#f8f8f8}
.questions select {font: 8pt verdana;margin:1px 3px;color:#000;background-color:#f8f8f8}
.q {font:bold 8pt verdana;}
.a {font:normal 8pt verdana;}
.s {font:normal 7pt verdana;}
.gray img {margin:5px}
.white p {padding-left:10px}
.white img {padding:0px 0px 5px 10px;border:0px}
table span {font:bold 8pt verdana;color:#000}
ol {margin-left:40px}
.grant_category { margin-bottom:15px; width:95% }
.grant_category .txt {cursor:pointer; border-bottom:1px dotted #333333; margin-bottom:5px}
.grant_category .img {background-repeat:no-repeat; background-position:0px 2px; padding-left:50px; height:41px !important}
.grant_category .col {width:33%}
.grant_category .hrd {font-weight:bold; text-transform:uppercase;}
.grant_category .hrd span {font-weight:normal; text-transform:none; font-style:italic}
table#main-categories td { border-top:1px dotted #333333; padding:7px 0; }
table#main-categories td.first { border-top:none; }
.category { }
.subcategory { }
.grant_category input { margin:0; }
.grant_category label { font-weight: normal; text-transform: uppercase; cursor: pointer; }
.grant_category p { font-size: 9px; margin-left:24px; }
.questions td.q, .questions td.a { float:left; display:table-cell; width:47%; }
input, select, textarea { font-size: 16px !important; }
-->
</style>
<link href="responsive.css" rel="stylesheet" type="text/css" />
<h1>USA Grant Applications Registration Form</h1>
<p><i>The information you enter below is confidential and is only made available to a USA Grant Applications
Specialist. It is used to help the USA Grant Research team to find new funding opportunities for you.</i></p>
<p class="header">Step 1 of 3: Tell us about <u>You</u> and <u>Your Funding Needs</u></p>
<form action="/order.php" method="post" name="application" target="_top" onSubmit="return verify(this);">
<table cellpadding="2" cellspacing="0" class="questions">
<tr>
<td class="q">First Name:</td>
<td class="a"><input type="text" name="cc_fname" value="<?= $_REQUEST['cc_fname'];?>"></td>
<td class="q">Last Name:</td>
<td class="a"><input type="text" name="cc_lname" value="<?= $_REQUEST['cc_lname'];?>"></td>
</tr>
<tr>
<td class="q">Street Address:</td>
<td class="a" colspan="3"><input type="text" name="cc_addr" value="<?= $_REQUEST['cc_addr'];?>"></td>
</tr>
<tr>
<td class="q">Zip:</td>
<td class="a"><input type="tel" name="cc_zip" maxlength="5" id="id-cc-zip" onkeyup="checkZip($(this).val(),this);" value="<?= $_REQUEST['cc_zip'];?>"></td>
</tr>
<tr>
<td class="q">City:</td>
<td class="a" colspan="3"><input type="text" name="cc_city" value="<?= $_REQUEST['cc_city'];?>"></td>
</tr>
<tr>
<td class="q">State:</td>
<td class="a" colspan="3">
<select name="cc_state">
<option selected>Select...</option>
<option value="AK" <?= ($_REQUEST['cc_state']=='AK') ? 'selected' : '';?>>Alaska</option>
<option value="AL" <?= ($_REQUEST['cc_state']=='AL') ? 'selected' : '';?>>Alabama</option>
<option value="AR" <?= ($_REQUEST['cc_state']=='AR') ? 'selected' : '';?>>Arkansas</option>
<option value="AZ" <?= ($_REQUEST['cc_state']=='AZ') ? 'selected' : '';?>>Arizona</option>
<option value="CA" <?= ($_REQUEST['cc_state']=='CA') ? 'selected' : '';?>>California</option>
<option value="CO" <?= ($_REQUEST['cc_state']=='CO') ? 'selected' : '';?>>Colorado</option>
<option value="CT" <?= ($_REQUEST['cc_state']=='CT') ? 'selected' : '';?>>Connecticut</option>
<option value="DC" <?= ($_REQUEST['cc_state']=='DC') ? 'selected' : '';?>>District of Columbia</option>
<option value="DE" <?= ($_REQUEST['cc_state']=='DE') ? 'selected' : '';?>>Delaware</option>
<option value="FL" <?= ($_REQUEST['cc_state']=='FL') ? 'selected' : '';?>>Florida</option>
<option value="GA" <?= ($_REQUEST['cc_state']=='GA') ? 'selected' : '';?>>Georgia</option>
<option value="HI" <?= ($_REQUEST['cc_state']=='HI') ? 'selected' : '';?>>Hawaii</option>
<option value="IA" <?= ($_REQUEST['cc_state']=='IA') ? 'selected' : '';?>>Iowa</option>
<option value="ID" <?= ($_REQUEST['cc_state']=='ID') ? 'selected' : '';?>>Idaho</option>
<option value="IL" <?= ($_REQUEST['cc_state']=='IL') ? 'selected' : '';?>>Illinois</option>
<option value="IN" <?= ($_REQUEST['cc_state']=='IN') ? 'selected' : '';?>>Indiana</option>
<option value="KS" <?= ($_REQUEST['cc_state']=='KS') ? 'selected' : '';?>>Kansas</option>
<option value="KY" <?= ($_REQUEST['cc_state']=='KY') ? 'selected' : '';?>>Kentucky</option>
<option value="LA" <?= ($_REQUEST['cc_state']=='LA') ? 'selected' : '';?>>Louisiana</option>
<option value="MA" <?= ($_REQUEST['cc_state']=='MA') ? 'selected' : '';?>>Massachusetts</option>
<option value="MD" <?= ($_REQUEST['cc_state']=='MD') ? 'selected' : '';?>>Maryland</option>
<option value="ME" <?= ($_REQUEST['cc_state']=='ME') ? 'selected' : '';?>>Maine</option>
<option value="MI" <?= ($_REQUEST['cc_state']=='MI') ? 'selected' : '';?>>Michigan</option>
<option value="MN" <?= ($_REQUEST['cc_state']=='MN') ? 'selected' : '';?>>Minnesota</option>
<option value="MO" <?= ($_REQUEST['cc_state']=='MO') ? 'selected' : '';?>>Missouri</option>
<option value="MS" <?= ($_REQUEST['cc_state']=='MS') ? 'selected' : '';?>>Mississippi</option>
<option value="MT" <?= ($_REQUEST['cc_state']=='MT') ? 'selected' : '';?>>Montana</option>
<option value="NC" <?= ($_REQUEST['cc_state']=='NC') ? 'selected' : '';?>>North Carolina</option>
<option value="ND" <?= ($_REQUEST['cc_state']=='ND') ? 'selected' : '';?>>North Dakota</option>
<option value="NE" <?= ($_REQUEST['cc_state']=='NE') ? 'selected' : '';?>>Nebraska</option>
<option value="NH" <?= ($_REQUEST['cc_state']=='NH') ? 'selected' : '';?>>New Hampshire</option>
<option value="NJ" <?= ($_REQUEST['cc_state']=='NJ') ? 'selected' : '';?>>New Jersey</option>
<option value="NM" <?= ($_REQUEST['cc_state']=='NM') ? 'selected' : '';?>>New Mexico</option>
<option value="NV" <?= ($_REQUEST['cc_state']=='NV') ? 'selected' : '';?>>Nevada</option>
<option value="NY" <?= ($_REQUEST['cc_state']=='NY') ? 'selected' : '';?>>New York</option>
<option value="OH" <?= ($_REQUEST['cc_state']=='OH') ? 'selected' : '';?>>Ohio</option>
<option value="OK" <?= ($_REQUEST['cc_state']=='OK') ? 'selected' : '';?>>Oklahoma</option>
<option value="OR" <?= ($_REQUEST['cc_state']=='OR') ? 'selected' : '';?>>Oregon</option>
<option value="PA" <?= ($_REQUEST['cc_state']=='PA') ? 'selected' : '';?>>Pennsylvania</option>
<option value="PR" <?= ($_REQUEST['cc_state']=='PR') ? 'selected' : '';?>>Puerto Rico</option>
<option value="RI" <?= ($_REQUEST['cc_state']=='RI') ? 'selected' : '';?>>Rhode Island</option>
<option value="SC" <?= ($_REQUEST['cc_state']=='SC') ? 'selected' : '';?>>South Carolina</option>
<option value="SD" <?= ($_REQUEST['cc_state']=='SD') ? 'selected' : '';?>>South Dakota</option>
<option value="TN" <?= ($_REQUEST['cc_state']=='TN') ? 'selected' : '';?>>Tennessee</option>
<option value="TX" <?= ($_REQUEST['cc_state']=='TX') ? 'selected' : '';?>>Texas</option>
<option value="UT" <?= ($_REQUEST['cc_state']=='UT') ? 'selected' : '';?>>Utah</option>
<option value="VA" <?= ($_REQUEST['cc_state']=='VA') ? 'selected' : '';?>>Virginia</option>
<option value="VT" <?= ($_REQUEST['cc_state']=='VT') ? 'selected' : '';?>>Vermont</option>
<option value="WA" <?= ($_REQUEST['cc_state']=='WA') ? 'selected' : '';?>>Washington</option>
<option value="WI" <?= ($_REQUEST['cc_state']=='WI') ? 'selected' : '';?>>Wisconsin</option>
<option value="WV" <?= ($_REQUEST['cc_state']=='WV') ? 'selected' : '';?>>West Virginia</option>
<option value="WY" <?= ($_REQUEST['cc_state']=='WY') ? 'selected' : '';?>>Wyoming</option>
</select>
</td>
</tr>
<tr>
<td class="q">Gender:</td>
<td class="a">
<select name="app_gender">
<option selected>Select...</option>
<option value="M" <?= ($_REQUEST['app_gender']=='M') ? 'selected' : '';?>>Male</option>
<option value="F" <?= ($_REQUEST['app_gender']=='F') ? 'selected' : '';?>>Female</option>
</select>
</td>
<td class="q">What is<br />your age?</td>
<td class="a">
<select name="app_age">
<option selected>Select...</option>
<option value="18-25" <?= ($_REQUEST['app_age']=='18-25') ? 'selected' : '';?>>18-25</option>
<option value="26-34" <?= ($_REQUEST['app_age']=='26-34') ? 'selected' : '';?>>26-34</option>
<option value="35-49" <?= ($_REQUEST['app_age']=='35-49') ? 'selected' : '';?>>35-49</option>
<option value="50-65" <?= ($_REQUEST['app_age']=='50-65') ? 'selected' : '';?>>50-65</option>
<option value="66-80" <?= ($_REQUEST['app_age']=='66-80') ? 'selected' : '';?>>66-80</option>
<option value="80+" <?= ($_REQUEST['app_age']=='80+') ? 'selected' : '';?>>80 +</option>
</select>
</td>
</tr>
<tr>
<td class="q">Citizenship</td>
<td class="a" colspan="3">
<select name="app_citizenship">
<option value="" <?= (isset($_REQUEST['app_citizenship']) && $_REQUEST['app_citizenship']=='') ? 'selected="selected"' : null;?>>Select</option>
<option value="citizen" <?= (isset($_REQUEST['app_citizenship']) && $_REQUEST['app_citizenship']=='citizen') ? 'selected="selected"' : null;?>>U.S. Citizen</option>
<option value="resident" <?= (isset($_REQUEST['app_citizenship']) && $_REQUEST['app_citizenship']=='resident') ? 'selected="selected"' : null;?>>Resident Alien</option>
<option value="greencard" <?= (isset($_REQUEST['app_citizenship']) && $_REQUEST['app_citizenship']=='greencard') ? 'selected="selected"' : null;?>>Green Card Holder</option>
<option value="permanent" <?= (isset($_REQUEST['app_citizenship']) && $_REQUEST['app_citizenship']=='permanent') ? 'selected="selected"' : null;?>>Permanent Resident</option>
<option value="unsure" <?= (isset($_REQUEST['app_citizenship']) && $_REQUEST['app_citizenship']=='unsure') ? 'selected="selected"' : null;?>>Not Sure</option>
</select>
</td>
</tr>
<tr>
<td class="q">Day Phone:</td>
<td class="a phoneBox"><input type="tel" name="phone_full" value="<?= $_REQUEST['phone_full'];?>" /></td>
</tr>
</table>
<table cellpadding="2" cellspacing="0" class="questions">
<tr>
<td colspan="2" class="q" style="width:auto;float:none;">Choose which funding area you are interested in</td>
</tr>
<tr>
<td>
<?
if(!empty($categories['categories'])) {
?><table id="main-categories" cellpadding="2" cellspacing="0" class="grant_category"><?
$first = true;
foreach ($categories['categories'] as $id => $cat) { ?>
<tr>
<td <?= ($first) ? 'class="first"' : null; $first = false; ?>>
<input type="radio" name="category_id" id="<?=$id.'-'.$cat['slug'];?>" class="<?=$cat['slug'];?>" value="<?=$id;?>" />
<label for="<?=$id.'-'.$cat['slug'];?>" title="<?=$cat['name'];?><?=($cat['description'] != '') ? ' - '.$cat['description'] : null;?>"><?=$cat['name'];?></label>
<?=($cat['description'] != '') ? '<p>'.$cat['description'].'</p>' : null;?>
<?php if($cat['slug']=='personal') { ?>
<p class="subtext" style="clear:left;padding-top: 5px;margin: 0px 10px;font-size: 10px;font-style: italic;">*There are many Personal Assistance Programs that you can apply for as long as you meet the criteria, however there no Funding to pay off your credit cards or debt.</p>
<?php }?>
</td>
</tr>
<?
}
?></table><?
}
if(!empty($categories['subcategories'])) { ?>
<table id="subcategories" class="grant_category" cellpadding="2" cellspacing="0" style="display:none;">
<tr>
<td class="hrd" >Suggested Sub-Categories <span>(Check all that apply)</span></td>
</tr>
<tr><td style="padding-top:5px;"><?
foreach ($categories['subcategories'] as $sub_id => $subcat) { ?>
<div class="subcategory <?=implode(' ', $subcat['categories']);?>">
<input id="<?=$sub_id.'-'.$subcat['slug'];?>" type="checkbox" name="subcategories[]" value="<?=$subcat['id'];?>" <?= (!empty($_REQUEST['subcategories']) && in_array($subcat['id'],$_REQUEST['subcategories'])) ? 'checked' : '';?> />
<label for="<?=$sub_id.'-'.$subcat['slug'];?>"><?=$subcat['name'];?></label>
</div>
<?
} ?>
</td></tr>
</table><?
}
?>
</td>
</tr>
</table>
<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="business_questions">
<tr>
<td>What are the major financial needs for your business? <i>(Check all that apply)</i></td>
</tr>
<?php foreach($business_questions['questions'] as $slug=>$data) {?>
<tr>
<td>
<label><input type="checkbox" value="1" name="<?= $slug;?>" id="<?= $slug;?>_yes" style="vertical-align:middle;" <?= (!empty($_REQUEST[$slug])) ? 'checked' : '';?> /> <?= $data['name'];?></label>
</td>
</tr>
<?php } ?>
</table>
<table cellpadding="1" cellspacing="0" class="questions">
<tr>
<td>How much money are you going to need?
<select name="app_amount_needed">
<option selected>Select...</option>
<option value="$500-$10,000" <?= ($_REQUEST['app_amount_needed']=='$500-$10,000') ? 'selected' : '';?>>$500 - $10,000</option>
<option value="$10,000 - $25,000" <?= ($_REQUEST['app_amount_needed']=='$10,000 - $25,000') ? 'selected' : '';?>>$10,000 - $25,000</option>
<option value="$25,000 - $50,000" <?= ($_REQUEST['app_amount_needed']=='$25,000 - $50,000') ? 'selected' : '';?>>$25,000 - $50,000</option>
<option value="$50,000 - $100,000" <?= ($_REQUEST['app_amount_needed']=='$50,000 - $100,000') ? 'selected' : '';?>>$50,000 - $100,000</option>
<?
if ($granttype != 'business')
{
echo "<option value=\"$100,000 or More\" ".(($_REQUEST['app_amount_needed']=='$100,000 or More') ? 'selected' : '').">\$100,000 or More</option>";
}
else
{
?>
<option value="$100,000 - $250,000" <?= ($_REQUEST['app_amount_needed']=='$100,000 - $250,000') ? 'selected' : '';?>>$100,000 - $250,000</option>
<option value="$250,000 - $500,000" <?= ($_REQUEST['app_amount_needed']=='$250,000 - $500,000') ? 'selected' : '';?>>$250,000 - $500,000</option>
<option value="$500,000 - $1,000,000" <?= ($_REQUEST['app_amount_needed']=='$500,000 - $1,000,000') ? 'selected' : '';?>>$500,000 - $1,000,000</option>
<option value="$1,000,000 +" <?= ($_REQUEST['app_amount_needed']=='$1,000,000 +') ? 'selected' : '';?>>$1,000,000 +</option>
<?
}
?>
</select>
</td>
</tr>
</table>
<table cellpadding="2" cellspacing="0" class="questions">
<tr>
<td colspan="2">
Describe what you will use the money for:
<textarea name="app_usedescription" cols="64" rows="6"><?= $_REQUEST['app_usedescription'];?></textarea>
</td>
</tr>
<tr>
<td colspan="2">
What unique things would separate you from other applicants applying for this money?
<textarea name="app_uniqueness" cols="64" rows="6"><?= $_REQUEST['app_uniqueness'];?></textarea>
</td>
</tr>
</table>
<table cellpadding="2" cellspacing="0" class="questions">
<tr>
<td class="q" style="width:auto;float:none;">What Email address would you like to use for your Username for your Online Funding Application Account?</td>
</tr>
<tr>
<td class="a" style="width:auto;float:none;"><input type="text" name="cc_email" size="30" value="<?= $_REQUEST['cc_email'];?>"> <i>(ie. yourmail@hotmail.com)</i></td>
</tr>
<tr>
<td class="a" style="width:auto;float:none;"><input type="text" name="cc_email_confirm" size="30" value=""> <i>Please confirm your email address</i></td>
</tr>
<tr>
<td class="s"><i>** Your email is safe. We hate spam as much as you do!!</i></td>
</tr>
<tr>
<td class="s"><i>** Your <u>Email</u> will be <u>your username</u> for the USA Grant Applications website. Please double check it to be sure it is accurate!</i></td>
</tr>
<tr>
<td>
<input type='checkbox' name="inform_me" value="1" checked /> Yes, I want to receive emails on New Funding Opportunities as well as New Tips!
</td>
</tr>
</table>
<center><input type="submit" value="" style="background:url(images/submit.jpg) top center no-repeat;width:144px;height:63px;border:0px;margin:20px auto;cursor:pointer"></center>
<input type="hidden" name="tc" value="<?= $tc; ?>">
<input type="hidden" name="form_version" value="v4" />
<input type="hidden" name="form_filled_out" value="/v4/4a.php" />
<?= $trackerformparams; ?>
</form>
</div>
</div>
<?php include($_SERVER['DOCUMENT_ROOT'].'/v4/footer.php'); ?>