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<?
require_once($_SERVER['DOCUMENT_ROOT'].'/assets/inc/functions.includes.php');
$categories = get_categories();
$education_questions = get_education_questions();
function sub_question_recursive($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
}
}
}
$granttype = $_GET['apptype'];
?>
<? include_once("{$_SERVER["DOCUMENT_ROOT"]}/header.php"); ?>
<script type="text/javascript" charset="utf-8" src="/assets/js/jquery-1.4.2.min.js"></script>
<script type="text/javascript" src="/assets/js/application_verify.js"></script>
<script>
$(document).ready( function() {
$('.subcategory,.subtext,#education_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);
if(granttype == 'education') {
$('#education_questions').show().find('input,select,textarea').removeAttr('disabled');
} else {
$('#education_questions').hide().find('input,select,textarea').attr('disabled','disabled');
}
});
<?php
foreach($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');
});";
}
if(!empty($_REQUEST)) {
echo "$('input:radio[name=category_id]').filter('[value={$_REQUEST['category_id']}]').click();\n";
}
?>
});
</script>
<style>
.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; border-bottom:1px solid #333333; height:15px}
.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 { float:left; width:40%; }
.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; }
</style>
</head>
<body>
<div id="size">
<div id="logo"></div>
<div id="text">
<div id="text_">
<div style="margin-left: 32px;margin-right:32px;">
<table cellpadding="2" cellspacing="0" border="0">
<tr>
<td>
<p class="header">USA Funding Applications Registration Form</p>
<p><i>The information you enter below is confidential and is only made available to a USA Funding
Applications Specialist.</i></p>
<p class="header">Step 1 of 3: Tell us about <u>You</u> and <u>Your Funding Needs</u></p>
<form action="https://www.usafundingapplications.org/order_new.php" method="POST" name="application" onSubmit="return verify(this);">
<fieldset>
<table cellpadding="2" cellspacing="0" class="questions">
<tr>
<td class="q">First Name:</td>
<td class="a"><input type="text" name="cc_fname" size="20"></td>
<td class="q">Last Name:</td>
<td class="a"><input type="text" name="cc_lname" size="20"></td>
</tr>
<tr>
<td class="q">Street Address:</td>
<td class="a"><input type="text" name="cc_addr" size="20"></td>
<td class="q">City:</td>
<td class="a"><input type="text" name="cc_city" size="20"></td>
</tr>
<tr>
<td class="q">State:</td>
<td class="a">
<select name="cc_state">
<option selected>Select</option>
<option value="AK">Alaska</option>
<option value="AL">Alabama</option>
<option value="AR">Arkansas</option>
<option value="AZ">Arizona</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DC">District of Columbia</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="IA">Iowa</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="MA">Massachusetts</option>
<option value="MD">Maryland</option>
<option value="ME">Maine</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MO">Missouri</option>
<option value="MS">Mississippi</option>
<option value="MT">Montana</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="NE">Nebraska</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NV">Nevada</option>
<option value="NY">New York</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VI">Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="VT">Vermont</option>
<option value="WA">Washington</option>
<option value="WI">Wisconsin</option>
<option value="WV">West Virginia</option>
<option value="WY">Wyoming</option>
</select>
</td>
<td class="q">Zip:</td>
<td class="a"><input type="text" name="cc_zip" size="10"></td>
</tr>
<tr>
<td class="q">Gender:</td>
<td class="a">
<select name="app_gender">
<option selected>Select...</option>
<option value="M">Male</option>
<option value="F">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">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>
<tr>
<td class="q">Day Phone:</td>
<td class="a"><input type="text" id="cc_phonearea" name="cc_phonearea" size="3" maxlength="3" onKeyUp="tab_phone('cc_phonearea','cc_phoneprefix');">-<input type="text" id="cc_phoneprefix" name="cc_phoneprefix" size="3" maxlength="3" onKeyUp="tab_phone('cc_phoneprefix','cc_phoneextension');">-<input type="text" id="cc_phoneextension" name="cc_phoneextension" size="4" maxlength="4"></td>
<td colspan="2" class="q"> </td>
</tr>
</table>
<table cellpadding="0" cellspacing="0" class="questions">
<tr>
<td class="q">Citizenship Status:
<select name="app_citizenship">
<option selected>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>
</fieldset>
<br />
<fieldset>
<table cellpadding="2" cellspacing="0" class="questions">
<tr>
<td colspan="2" class="q">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'];?>" />
<label for="<?=$sub_id.'-'.$subcat['slug'];?>"><?=$subcat['name'];?></label>
</div>
<?
} ?>
</td></tr>
</table><?
}
?>
</td>
</tr>
</table>
<table cellpadding="0" cellspacing="0" border="0" class="form_table" id="education_questions">
<?php foreach($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>
<table cellpadding="1" cellspacing="0" class="questions">
<tr>
<td class="q">How much money are you going to need?
<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 - $100,000</option>
<?
if ($granttype != 'business')
{
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="2" cellspacing="0" class="questions">
<tr>
<td class="q">Describe what you will use the money for:</td>
</tr>
<tr>
<td class="a"><textarea name="app_usedescription" cols="64" rows="6"></textarea></td>
</tr>
<tr>
<td class="q">What unique things would separate you from other applicants applying for this money?</td>
</tr>
<tr>
<td class="a"><textarea name="app_uniqueness" cols="64" rows="6"></textarea></td>
</tr>
</table>
</fieldset>
<br />
<fieldset>
<table cellpadding="2" cellspacing="0" class="questions">
<tr>
<td class="q">What Email address would you like to use for your Username for your Online Funding Application Account?</td>
</tr>
<tr>
<td class="a"><input type="text" name="cc_email" size="30"> <i>(ie. yourmail@hotmail.com)</i></td>
</tr>
<tr>
<td class="a"><i>** Your email is safe. We hate spam as much as you do!!</i></td>
</tr>
<tr>
<td class="a"><i>** Your <u>Email</u> will be <u>your username</u> for the USA Funding Applications website. Please double check it to be sure it is accurate!</i></td>
</tr>
</table>
</fieldset>
<center><input type="submit" value="" style="background:url(/assets/images/submit.jpg) top center no-repeat;width:144px;height:63px;border:0px;margin:20px auto;cursor:pointer"></center>
<input type="hidden" name="application" value="application">
<input type="hidden" name="tc" value="<?= $tc; ?>">
<?= $trackerformparams; ?>
</form>
</td>
</tr>
</table>
</div>
</div>
<? include_once("footer.php");