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<?php
session_start();
foreach($_GET as $k=>$v) {
$_SESSION[$k] = $v;
}
//header("Location: /");
require_once($_SERVER['DOCUMENT_ROOT'].'/assets/includes/php_header.php');
$tc = (isset($_GET['tc'])) ? $_GET['tc'] : 'none' ;
$title = $_SITE_NAME." : Application";
$categories = get_categories();
$business_questions = get_business_questions();
/*function sub_question_recursive($q) {
global $education_questions;
if(isset($education_questions['subquestions'][$q])) {
foreach($education_questions['subquestions'][$q] as $s=>$d) { ?>
<div class="<?= $q;?>_sub" style="padding:5px 5px 5px 20px;display:block;clear:both;">
<?= $d['name'];?><br/>
<?php if($d['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $s;?>" id="<?= $s;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $s;?>" id="<?= $s;?>_no" /> No</label>
<br/>
<?php } elseif(strpos($d['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$d['type']);
$range_limits = explode('-',$pieces[1]);
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
} ?>
<select name="<?= $s;?>" id="<?= $s;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php
}
?>
</select>
<?php
}
if(isset($education_questions['subquestions'][$s]))
{
sub_question_recursive($s);
}
?>
</div>
<?php
}
}
}
function sub_question_recursive_disability($q) {
global $disability_questions;
if(isset($disability_questions['subquestions'][$q])) {
foreach($disability_questions['subquestions'][$q] as $k=>$data) {
foreach($data as $s=>$d) { ?>
<div class="<?= $q;?>_sub" style="padding:5px 5px 5px 20px;display:block;clear:both;">
<?= $d['name'];?><br/>
<?php if($d['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $s;?>" id="<?= $s;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $s;?>" id="<?= $s;?>_no" /> No</label>
<br/>
<?php } elseif(strpos($d['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$d['type']);
$range_limits = explode('-',$pieces[1]);
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
} ?>
<select name="<?= $s;?>" id="<?= $s;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php
}
?>
</select>
<?php
} elseif($d['type']=='textarea') {
?>
<textarea name="<?= $s;?>" id="<?= $s;?>"></textarea>
<?php
} elseif(strpos($d['type'],'select') > -1) {
$select = array();
$pieces = explode(':',$d['type']);
$more_pieces = explode('|',$pieces[1]);
?>
<select name="<?= $s;?>" id="<?= $s;?>">
<option value="">Select</option>
<?php foreach($more_pieces as $p) { ?>
<option value="<?= $p;?>"><?= $p;?></option>
<?php } ?>
</select>
<?php
}
if(isset($disability_questions['subquestions'][$s]))
{
sub_question_recursive_disability($s);
}
?>
</div>
<?php
}
}
}
} */
include('assets/includes/header2.php'); ?>
<style type="text/css">
<!--
.logoTop {background:url("assets/images/box_top.png") no-repeat top center; height:116px; width:1000px; float:left}
div#content, #footer {width:100%; margin:0}
#page {width:1000px; margin:0 auto}
#orderForm h2 {font-family:Arial, Helvetica, sans-serif; font-size:18px; font-weight:bold; margin:0px; }
#orderForm .container {width:100%}
#orderForm .text {border:1px solid #ccc}
#orderForm legend {background: url("assets/images/ttl_bg.png") top left no-repeat; width:217px; height:18px; padding:1px 0px 0px 5px; margin:0px 6px; font:bold 8pt/120% verdana; text-transform:uppercase;}
#orderForm label {cursor:pointer;margin:2px}
#orderForm fieldset {border:3px double #ccc; width:60%; float:left; margin:3px 0 3px 1%; padding:0;
-webkit-border-radius: 6px;
-moz-border-radius: 6px;
border-radius: 6px;
}
#orderForm fieldset table {width:96%; margin:10px 2%}
#orderForm fieldset td {font:8.5pt/120% verdana; height:22px}
#orderForm fieldset input,
#orderForm fieldset select {
font:11pt/120% verdana;
border:1px solid #ccc;
padding:2px 3px;
-webkit-border-radius: 4px;
-moz-border-radius: 4px;
border-radius: 4px;
}
#orderForm fieldset input {width:auto}
#orderForm fieldset select {width:178px}
#orderForm fieldset .radio {width:20px}
#orderForm fieldset .sml {width:50px}
#orderForm fieldset .zip {width:50px}
#orderForm textarea {width:96%; height:125px;}
#orderForm label {
display:inline-block;
padding:2px 3px;
border:1px solid #669999;
-webkit-border-radius: 4px;
-moz-border-radius: 4px;
border-radius: 4px;
-webkit-transition: all 0.2s;
-moz-transition: all 0.2s;
transition: all 0.2s;
}
#orderForm label:hover, .radio-focus {
border:1px solid #3366cc;
background:#3366cc;
color:white;
}
#orderForm .wht {border:1px solid #fff;}
#one_column {width:95%; margin:20px 2.5%}
#orderForm fieldset table.smlClear select {width:98%}
#orderForm fieldset table.smlClear {float:left; width:165px}
#orderForm label {padding:3px}
#orderForm fieldset .gender .radio {width:18px}
@media screen and (max-width : 1024px) {
#orderForm fieldset table.smlClear {float:left; width:150px}
#orderForm fieldset .gender .radio {width:15px}
#orderForm fieldset .gender {font-size:12px}
}
@media screen and (max-width : 768px) {
#orderForm fieldset table.smlClear {float:left; width:130px}
#orderForm fieldset .gender .radio {width:0}
#orderForm fieldset .gender {font-size:9px}
#orderForm label {margin:0 2px; padding:2px 3px}
}
@media screen and (max-width : 520px) {
#orderForm fieldset table.smlClear {float:left; width:130px}
#orderForm fieldset .gender .radio {width:0}
#orderForm fieldset .gender {font-size:9px}
#orderForm label {margin:0 2px}
}
.grayBox {background-color:#f2f2f2; text-align:left; font:9pt/120% verdana; height:1800px; width:30%; float:left; padding:1.5%; margin:10px 1.5%}
.data {background:url("/assets/images/box_middle.png") repeat-y; width:1000px; float:left}
.man, .woman {background-repeat:no-repeat; background-position:2px 2px;}
.man {background-image:url("/lp2/assets/images/men.png");}
.woman {background-image:url("/lp2/assets/images/women.png");}
-->
</style>
<link href="lp2/assets/css/responsive.css" type="text/css" rel="stylesheet" />
<script type="text/javascript">
// Create an associative array of 'pretty name' values
var prettynames = {
cc_fname:"First Name",
cc_lname:"Last Name",
cc_addr:"Address",
cc_city:"City",
cc_state:"State",
cc_country:"Country",
cc_zip:"Zip",
cc_phonearea:"Phone Number Area Code",
cc_phoneprefix:"Phone Number Prefix",
cc_phoneextension:"Phone Number Ending",
cc_email:"Email Address",
app_gender:"Gender",
app_age:"Your age",
app_citizenship:"Citizenship",
app_funding_type:"What type of funding you are looking for?",
category_id:"Funding Category",
app_amount_needed:"How much money are you going to need?",
app_usedescription:"How do you want to use the money?",
app_uniqueness:"Why should the funder select you?",
app_married:"What is your martial status?",
app_dual_income:"Do you have a dual income household?",
app_employ: "What is your current employment status?",
app_house_income: "What is your total household income?",
app_previous_experience: "Tell us about any previous funding application experience you've had.",
app_community: "How will your project help in your community?",
app_hear: "How did you hear about us?",
app_refr: "Who referred you?",
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?",
when_denied:"When were you denied?",
why_denied:"Why were you denied?",
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?"
};
var optional =[ "app_married", "app_dual_income", "app_employ", "app_house_income",
"app_previous_experience", "app_community", "app_hear", "app_refr", "subcategories[]"];
// 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.
f.cc_phonearea.requiredlength = 3;
f.cc_phonearea.numeric = true;
f.cc_phoneprefix.requiredlength = 3;
f.cc_phoneprefix.numeric = true;
f.cc_phoneextension.requiredlength = 4;
f.cc_phoneextension.numeric = true;
f.cc_zip.requiredlength = 5;
f.cc_zip.numeric = true;
var msg;
var empty_fields = "";
var errors = "";
var requiredarr = new Array('category_id','cc_fname','cc_lname','cc_addr','cc_city','cc_state','cc_zip','cc_phonearea','cc_phoneextension','cc_phoneprefix','cc_email','app_age','app_amount_needed','app_citizenship','app_gender','app_uniqueness','app_usedescription');
for (var i=0; i < f.length; i++)
{
var required = true;
var element = f.elements[i];
if($.inArray(element.name, requiredarr) == -1) {
continue;
}
//document.getElementById('errorconsole').innerHTML += element.name + ":" + element.type + "<br>";
if(required) {
if ((element.name == 'cc_email')) {
if(/(.+)@(.+){2,}\.(.+){2,}/.test(element.value)) {
//valid email
} else {
errors += "- Please enter a valid email address\n";
}
} else if ((element.type == 'text' || element.type == 'textarea'))
{
if ( (element.value == null || element.value == "") || isblank(element.value) )
{
empty_fields += "\n " + prettynames[element.name];
continue;
}
if (element.numeric)
{
var v = parseFloat(element.value);
if (isNaN(v))
{
errors +="- The field " + prettynames[element.name] + " must be a number\n";
}
}
if ( (element.requiredlength > 0) && (element.value.length != element.requiredlength) )
{
errors += "- The field " + prettynames[element.name] + " must be " + element.requiredlength + " digits long\n";
}
}
else if (element.type == 'select-one')
{
// The first option, option[0] can not be selected
if ( (element.value == null || element.value == "" || element.selectedIndex == 0) || isblank(element.value) )
{
empty_fields += "\n " + prettynames[element.name];
continue;
}
}
else if (element.type == 'radio')
{
if (!$('[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;
}
</script>
<script language="javascript">
var ids=new Array();
ids[0]="busgrants";
ids[1]="edugrants";
ids[2]="comgrants";
ids[3]="pergrants";
ids[4]="reagrants";
function switchid(id){
hideallids();
showdiv(id);
}
function hideallids(){
//loop through the array and hide each element by id
for (var i=0;i<ids.length;i++){
hidediv(ids[i]);
}
}
function hidediv(id) {
//safe function to hide an element with a specified id
if (document.getElementById) { // DOM3 = IE5, NS6
document.getElementById(id).style.display = 'none';
}
else {
if (document.layers) { // Netscape 4
document.id.display = 'none';
}
else { // IE 4
document.all.id.style.display = 'none';
}
}
}
function showdiv(id) {
//safe function to show an element with a specified id
if (document.getElementById) { // DOM3 = IE5, NS6
document.getElementById(id).style.display = 'block';
}
else {
if (document.layers) { // Netscape 4
document.id.display = 'block';
}
else { // IE 4
document.all.id.style.display = 'block';
}
}
}
$(document).ready(function(){
$('.subcategory,.subtext,#education_questions').hide().find('input,select,textarea').attr('disabled','disabled');
$('input[name=category_id]').click(function() {
$('.subcategory,.subtext').slideUp().find('input,select,textarea').attr('disabled','disabled');
$(this).parent().find('.subcategory,.subtext').slideDown().find('input,select,textarea').removeAttr('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>');
} 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>');
}
if(granttype == 'education') {
$('#education_questions').show('slow').find('input,select,textarea').removeAttr('disabled');
} else {
$('#education_questions').hide('slow').find('input,select,textarea').attr('disabled','disabled');
}
$('select[name=app_amount_needed]').val(amount_needed);
});
<?php
/*foreach($education_questions['subquestions'] as $slug=>$data) {
echo "$('.".$slug."_sub').hide().find('input,select,textarea').attr('disabled','disabled');";
echo "$('#".$slug."_yes').click(function() {
$('.".$slug."_sub').slideDown().find('input,select,textarea').removeAttr('disabled');
});";
echo "$('#".$slug."_no').click(function() {
$('.".$slug."_sub').slideUp().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($_REQUEST)) {
echo "$('input:radio[name=category_id]').filter(function() { return $(this).val()=='{$_REQUEST['category_id']}'; }).click();\n";
}
?>
<?php
//if(apptype is set) { click on that apptype and hide the rest }
if(!empty($_SESSION['apptype'])) {
switch($_SESSION['apptype']) {
case 'education_tuition_funding':
?>
$('#main-categories').find('tr').hide();
$('#2-education').parents('tr:first').show();
$('#2-education').click();
<?php
break;
case 'real_estate_funding':
?>
$('#main-categories').find('tr').hide();
$('#5-real-estate').parents('tr:first').show();
$('#5-real-estate').click();
<?php
break;
case 'business_funding':
?>
$('#main-categories').find('tr').hide();
$('#1-business').parents('tr:first').show();
$('#1-business').click();
<?php
break;
case 'personal_funding':
?>
$('#main-categories').find('tr').hide();
$('#4-personal').parents('tr:first').show();
$('#4-personal').click();
<?php
break;
}
}
?>
$('.gender input:radio').css('visibility','hidden');
$('[name="subcategories[]"]').click(function() {
if($(this).is(':checked')) {
$(this).siblings('label').addClass('radio-focus');
} else {
$(this).siblings('label').removeClass('radio-focus');
}
}).hide();
$('[name="category_id"]').click(function() {
console.log(this);
$('.radio-focus').removeClass('radio-focus');
if($(this).is(':checked')) {
$(this).siblings('label').addClass('radio-focus');
}
}).hide();
});
function TabNext(me,num,next) {
if(me.value.length==num) {
$(next).focus();
}
}
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)
{
$(me).parents('tr:first').find('[name=cc_city]').attr('type','hidden');
$(me).parents('tr:first').find('[name=cc_state]').attr('type','hidden');
if(!data.error) {
$(me).parents('tr:first').find('[name=cc_city]').val(data.city);
$(me).parents('tr:first').find('[name=cc_state]').val(data.state);
$(me).parents('tr:first').find('[name=cc_city]').parent().find('span').html(data.city + ', ' + data.state);
} else {
$(me).parents('tr:first').find('[name=cc_city]').parent().find('span').show().html(data.error + ' If you are sure this is the right zip code. Click <a href="#" onclick="$(this).parents(\'td:first\').find(\'input[type=hidden]\').attr(\'type\',\'text\'); return false;">Here</a>.');
}
},error: function(jqXHR, textStatus, errorThrown) {
}
});
}
}
$(document).ready(function(){
$('input[name=phone_full]').formatter({
'pattern': '({{999}}) {{999}}-{{9999}}',
'persistent': false
});
});
</script>
<!--INFO AREA + BOX MIDDLE-->
<div id="orderForm" class="data">
<h2><?=$_SITE_NAME;?> Registration Form</h2>
<!--COLUMN-->
<div id="one_column" class="terms">
<div style="padding:0px; margin:0px;">
<form action="https://<?= $_SERVER['SERVER_NAME'].'/order'?>" method="post" name="apply" onsubmit="return verify(this);">
<div class="container">
<div class="grayBox">Please fill out the fields. Try to be as detailed as possible for each of the questions. Your information is confidential and will only be used in researching new funding opportunities for you to apply. We want to provide the most up-to-date information to you to help you succeed in your funding endeavors.</div>
<fieldset>
<legend>PERSONAL PROFILE</legend>
<table cellpadding="3" cellspacing="0" border="0">
<tr>
<td colspan="2">First Name</td>
<td colspan="2">Last Name</td>
</tr>
<tr>
<td colspan="2"><input type="text" class="text" name="cc_fname" value="<?= ($_REQUEST['cc_fname']) ? $_REQUEST['cc_fname'] : null; ?>" /></td>
<td colspan="2"><input type="text" class="text" name="cc_lname" value="<?= ($_REQUEST['cc_lname']) ? $_REQUEST['cc_lname'] : null; ?>" /></td>
</tr>
<tr>
<td>Zip</td>
<td colspan="3">City, State</td>
</tr>
<tr>
<td><input type="tel" class="third" maxlength="5" id="id-cc-zip" name="cc_zip" onkeyup="checkZip($(this).val(),this);" value="<?= isset($_REQUEST['cc_zip']) ? $_REQUEST['cc_zip'] : null;?>" /></td>
<td colspan="3">
<span>City and State will appear here automatically</span>
<input type="hidden" name="cc_city" placeholder="City" value="<?= $_POST['cc_city'];?>" />
<input type="hidden" name="cc_state" placeholder="State" onkeyup="$(this).val($(this).val().toUpperCase());" maxlength="2" value="<?= $_POST['cc_state'];?>" />
</td>
</tr>
<tr>
<td colspan="2">Address</td>
<td colspan="2">Country</td>
</tr>
<tr>
<td colspan="2"><input type="text" class="text" name="cc_addr" value="<?= ($_REQUEST['cc_addr']) ? $_REQUEST['cc_addr'] : null; ?>" /></td>
<td colspan="2">
<select name="cc_country" id="id-cc-country">
<option>Select...</option>
<option value="US" selected>U.S.A.</option>
</select>
</td>
</tr>
<tr>
<td colspan="2">Email</td>
<td colspan="2">Phone Number</td>
</tr>
<tr>
<td colspan="2"><input type="text" class="text" name="cc_email" value="<?= ($_REQUEST['cc_email']) ? $_REQUEST['cc_email'] : null; ?>" /></td>
<td colspan="2"><input type="tel" class="full" name="phone_full" value="<?= $_REQUEST['phone_full'];?>" /></td>
</tr>
</table>
</fieldset>
<fieldset>
<legend>TELL US ABOUT YOURSELF</legend>
<table class="smlClear" cellpadding="4" cellspacing="4" border="0" style="border-collapse:separate">
<tr>
<td>Citizenship</td>
</tr>
<tr>
<td>
<select name="app_citizenship">
<option>Select...</option>
<option value="U.S. Citizen">U.S. Citizen</option>
<option value="Resident Alien">Resident Alien</option>
<option value="Green Card Holder">Green Card Holder</option>
<option value="Permanent Resident">Permanent Resident</option>
<option value="Not Sure">Not Sure</option>
</select>
</td>
</tr>
</table>
<table class="smlClear" cellpadding="4" cellspacing="4" border="0" style="border-collapse:separate">
<tr>
<td>Age</td>
</tr>
<tr>
<td>
<input type="tel" class="third" name="app_age" maxlength="3" style="width:130px;" />
<?php /*
<select name="app_age">
<option>Select...</option>
<option value="18-25">18-25</option>
<option value="26-34">26-34</option>
<option value="35-49">35-49</option>
<option value="50-65">50-65</option>
<option value="66-80">66-80</option>
<option value="80+">80 +</option>
</select>
*/ ?>
</td>
</tr>
</table>
<table class="smlClear" cellpadding="4" cellspacing="4" border="0" style="border-collapse:separate">
<tr>
<td>Gender</td>
</tr>
<tr>
<td class="gender">
<select name="app_gender">
<option value="">Select</option>
<option value="M">Male</option>
<option value="F">Female</option>
</select>
<?php /*
<label class="man"><input type="radio" name="app_gender" class="radio" value="male" />male</label>
<label class="woman"><input type="radio" name="app_gender" class="radio" value="female" />female</label>
*/ ?>
</td>
</tr>
</table>
<div style="clear:both;"></div>
<?php /*<table class="smlClear" cellpadding="4" cellspacing="4" border="0" style="border-collapse:separate">
<tr>
<td>Married</td>
</tr>
<tr>
<td>
<select name="app_married">
<option>Select...</option>
<option value="R">Married</option>
<option value="U">Unmarried</option>
</select>
</td>
</tr>
</table>
<table class="smlClear" cellpadding="4" cellspacing="4" border="0" style="border-collapse:separate">
<tr>
<td>Dual Income</td>
</tr>
<tr>
<td>
<select name="app_dual_income">
<option>Select...</option>
<option value="Y">Yes</option>
<option value="N">No</option>
</select>
</td>
</tr>
</table>
<table class="smlClear" cellpadding="4" cellspacing="4" border="0" style="border-collapse:separate">
<tr>
<td colspan="6">Household Income:</td>
</tr>
<tr>
<td colspan="6">
<select name="app_house_income">
<option>Select...</option>
<option>10,000</option>
<option>$10,000 - $25,000</option>
<option>$25,000 - $50,000</option>
<option>$50,000 - $75,000</option>
<option>$75,000 - $100,000</option>
<option>$100,000 - $150,000</option>
<option>$150,000 +</option>
</select>
</td>
</tr>
</table>
<div style="clear:both;"></div>
<table cellpadding="4" cellspacing="4" border="0" style="border-collapse:separate">
<tr>
<td colspan="6">Employment Status</td>
</tr>
<tr>
<td colspan="6" style="margin-left:30px" id="employment">
<label><input type="radio" class="radio" name="app_employ" value="full" />Full Time</label>
<label><input type="radio" class="radio" name="app_employ" value="part" />Part Time</label>
<label><input type="radio" class="radio" name="app_employ" value="self" />Self Employed</label>
<label><input type="radio" class="radio" name="app_employ" value="unem" />Unemployed</label>
<label><input type="radio" class="radio" name="app_employ" value="stud" />Student</label>
<label><input type="radio" class="radio" name="app_employ" value="retr" />Retired</label>
</td>
</tr>
</table> */?>
</fieldset>
<fieldset>
<legend>FUNDING</legend>
<table cellpadding="3" cellspacing="0" border="0">
<tr>
<td>How much money are you looking for?</td>
<td>
<select name="app_amount_needed">
<option>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 - $100,000</option>
<?
if ($granttype != 'business_funding')
{
echo "<option value=\"$100,000 or More\">\$100,000 or More</option>";
}
else
{
?>
<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 +">$1,000,000 +</option>
<?
}
?>
</select>
</td>
</tr>
</table>
<table cellpadding="3" cellspacing="0" border="0">
<tr>
<td>Choose which funding category you are interested in</td>
</tr>
<tr>
<td>
<?php if(!empty($categories)) {?>
<table id="main-categories" cellpadding="2" cellspacing="3" class="grant_category">
<?php
function get_subcats($cat,$categories) {
$subcats = array();
foreach($categories['subcategories'] as $key=>$value) {
if(isset($value['categories'][$cat])) {
$subcats[$key] = $categories['subcategories'][$key];
}
}
return $subcats;
}
foreach($categories['categories'] as $key=>$cat) {
$subcats = get_subcats($key,$categories);
?>
<tr>
<td>
<input type="radio" name="category_id" id="<?= $key;?>-<?= $cat['slug'];?>" class="<?= $cat['slug'];?>" value="<?= $key;?>" <?= (isset($_REQUEST['category_id']) && $_REQUEST['category_id']==$key) ? 'checked=true' : null;?> />
<label for="<?= $key;?>-<?= $cat['slug'];?>" title="<?= $cat['name'];?> - <?= $cat['description'];?>"><img src="/lp2/assets/images/label_<?= $cat['slug'];?>.jpg" /></label>
<p><?= $cat['description'];?></p>
<?php foreach($subcats as $k=>$c) { ?>
<div class="subcategory <?= $cat['slug'];?>">
<input id="<?= $cat['slug'];?>-<?= $k;?>-<?= $c['slug'];?>" type="checkbox" name="subcategories[]" value="<?= $k;?>" <?= (isset($_REQUEST['subcategories']) && in_array($k,$_REQUEST['subcategories'])) ? 'checked=true' : null;?> />
<label for="<?= $cat['slug'];?>-<?= $k;?>-<?= $c['slug'];?>"><?= $c['name'];?></label>
</div>
<?php } ?>
<?php if($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 is no funding to pay off your credit cards or debt.</p>
<?php }?>
</td>
</tr>
<?php } ?>
</table>
<?php }?>
</td>
</tr>
<tr>
<td>What are you looking to do with the money?</td>
</tr>
<tr>
<td><textarea name="app_usedescription"></textarea></td>
</tr>
<!-- <tr>
<td>Have you applied for funding before? Please tell us about your experience.</td>
</tr>
<tr>
<td><textarea name="app_previous_experience"></textarea></td>
</tr> -->
</table>
<?php if($_SESSION['apptype']=='business_funding') { ?>
<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="business_questions">
<tr>
<td>What are the major financial needs for your business? <i>(Check all that apply)</i></td>
</tr>
<?php foreach($business_questions['questions'] as $slug=>$data) {?>
<tr>
<td>
<label><input type="checkbox" value="1" name="<?= $slug;?>" id="<?= $slug;?>_yes" style="vertical-align:middle;" /> <?= $data['name'];?></label>
</td>
</tr>
<?php } ?>
</table>
<?php } ?>
<?php /*<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="disability_questions">
<?php foreach($disability_questions['questions'] as $slug=>$data) {?>
<tr>
<td><?= $data['name'];?></td>
</tr>
<tr>
<td>
<?php if($data['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $slug;?>" id="<?= $slug;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $slug;?>" id="<?= $slug;?>_no" /> No</label>
<?php } elseif(strpos($data['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$data['type']);
$range_limits = explode('-',$pieces[1]);
if($range_limits[0] > $range_limits[1]) {
for($i=$range_limits[0]; $i>=$range_limits[1]; $i--) {
$range[$i] = $i;
}
} else {
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
}
}
?>
<select name="<?= $slug;?>" id="<?= $slug;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php }?>
</select>
<?php } elseif($data['type']=='textarea') {
?>
<textarea name="<?= $slug;?>" id="<?= $slug;?>"></textarea>
<?php
}
sub_question_recursive_disability($slug);
?>
</td>
</tr>
<?php } ?>
</table>
<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="education_questions">
<?php foreach($education_questions['questions'] as $slug=>$data) {?>
<tr>
<td><?= $data['name'];?></td>
</tr>
<tr>
<td>
<?php if($data['type']=='bool') {?>
<label><input type="radio" value="1" name="<?= $slug;?>" id="<?= $slug;?>_yes" /> Yes</label>
<label><input type="radio" value="0" name="<?= $slug;?>" id="<?= $slug;?>_no" /> No</label>
<?php } elseif(strpos($data['type'],'range') > -1) {
$range = array();
$pieces = explode(':',$data['type']);
$range_limits = explode('-',$pieces[1]);
if($range_limits[0] > $range_limits[1]) {
for($i=$range_limits[0]; $i>=$range_limits[1]; $i--) {
$range[$i] = $i;
}
} else {
for($i=$range_limits[0]; $i<=$range_limits[1]; $i++) {
$range[$i] = $i;
}
}
?>
<select name="<?= $slug;?>" id="<?= $slug;?>">
<option value="">Select</option>
<?php foreach($range as $i=>$j) {?>
<option value="<?= $i;?>"><?= $j;?></option>
<?php }?>
</select>
<?php }
sub_question_recursive($slug);
?>
</td>
</tr>
<?php } ?>
</table>*/ ?>
</fieldset>
<fieldset>
<legend>YOUR FUNDING NEEDS</legend>
<table cellpadding="3" cellspacing="0" border="0">
<!-- <tr>
<td>Does your project fulfill a need in your community? If so, how?</td>
</tr>
<tr>
<td><textarea name="app_community"></textarea></td>
</tr> -->
<tr>
<td>Why would a funder pick you instead of someone else? What sets you apart from other funders?</td>
</tr>
<tr>
<td><textarea name="app_uniqueness"></textarea></td>
</tr>
</table>
</fieldset>
<fieldset class="wht" style="float:right">
<table cellpadding="3" cellspacing="0" border="0">
<?php /*
<tr>
<td>
<div style="width:600px; margin:20px 0px; text-align:left;"><p><input type="checkbox" checked name="" value="" /> Yes, please keep me up-to-date on new funding opportunities via email as they are found by the <?=$_SITE_NAME;?> Research Team. Your email will only be used by <?=$_SITE_NAME;?> to help you in your research and application needs. You will receive an email to help us confirm your registration to our research team. Please reply back to it and add us to your contacts! We look forward to working with you!</p></div>
</td>
</tr>
*/ ?>
<tr>
<td align="center">
<input type="submit" style="background:url('/assets/images/b_applytoday.png') no-repeat scroll center top transparent; border:0px none; cursor:pointer; width:200px; height:50px;" value="" />
<input type="hidden" name="tc" value="<?= $tc; ?>" />
<?= $trackerformparams; ?>
</td>
</tr>
</table>
</fieldset>
</div>
</form>
</div> <!--end centered div-->
</div> <!--end one column-->
<div style="clear:both;"></div>
</div> <!--end info area-->
<!--INCLUDE FOOTER-->
<?php include('assets/includes/footer.php'); ?>