/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
* Includes a Form with javascript
* @param {Object} formId
* @param {Object} initialHeight
* @param {Object} iframeCode
*/
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
this.formId = formId;
this.initialHeight = initialHeight;
this.iframeCode = iframeCode;
this.frame = null;
this.timeInterval= 200;
this.appendTo = appendTo || false;
// initialize function for object
this.init = function(){
this.createFrame();
this.addFrameContent(this.iframeCode);
};
// Create the frame
this.createFrame = function(){
var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\">";
if(this.appendTo === false){
document.write(htmlCode);
}else{
var tmp = document.createElement('div');
tmp.innerHTML = htmlCode;
var a = this.appendTo;
document.getElementById(a).appendChild(tmp.firstChild);
}
// also get the frame for future use.
this.frame = document.getElementById(this.formId);
// set the time on the on load event of the frame
this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
};
// add event function for different browsers
this.addEvent = function( obj, type, fn ) {
if ( obj.attachEvent ) {
obj["e"+type+fn] = fn;
obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
obj.attachEvent( "on"+type, obj[type+fn] );
}
else{
obj.addEventListener( type, fn, false );
}
};
this.addFrameContent = function (string){
string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"><'+'div id="recaptcha_div"><'+'/div>'+
'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
' }<'+'/script>');
string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
frameDocument.document.open();
frameDocument.document.write(string);
setTimeout( function(){
frameDocument.document.close();
try{
if('JotFormFrameLoaded' in window){
JotFormFrameLoaded();
}
}catch(e){}
},200);
};
this.setTimer = function(){
var self = this;
this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
};
this.changeHeight = function (){
var actualHeight = this.getBodyHeight();
var currentHeight = this.getViewPortHeight();
if(actualHeight === undefined){
this.frame.style.height = "100%";
if(!this.frame.style.minHeight){
this.frame.style.minHeight = "300px";
}
}else if (Math.abs(actualHeight - currentHeight) > 18){
this.frame.style.height = (actualHeight)+"px";
}
this.setTimer();
};
this.bindMethod = function(method, scope) {
return function() {
method.apply(scope,arguments);
};
};
this.getBodyHeight = function (){
var height;
var scrollHeight;
var offsetHeight;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.document.height){
height = this.frame.contentWindow.document.height;
//Emre: to prevent "iframe height" problem (61059)
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
} else if (this.frame.contentWindow.document.body){
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
if (scrollHeight && offsetHeight){
height = Math.max(scrollHeight, offsetHeight);
}
}
}catch(e){ }
return height;
};
this.getViewPortHeight = function(){
var height = 0;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.window.innerHeight)
{
height = this.frame.contentWindow.window.innerHeight - 18;
}
else if ((this.frame.contentWindow.document.documentElement) &&
(this.frame.contentWindow.document.documentElement.clientHeight))
{
height = this.frame.contentWindow.document.documentElement.clientHeight;
}
else if ((this.frame.contentWindow.document.body) &&
(this.frame.contentWindow.document.body.clientHeight))
{
height = this.frame.contentWindow.document.body.clientHeight;
}
}catch(e){ }
return height;
};
this.init();
}
FrameBuilder.get = [];
var i10484728869 = new FrameBuilder("10484728869", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2410\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:5px;\n }\n .form-label-right{\n width:150px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:white;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:0px;\n width:690px;\n background:white;\n color:grey !important;\n font-family:Helvetica;\n font-size:12px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2410\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n JotForm.setCalendar(\"111\");\n JotForm.setCalendar(\"112\");\n JotForm.setCalendar(\"113\");\n JotForm.setCalendar(\"114\");\n });\n\n clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" enctype=\"multipart\/form-data\" name=\"form_10484728869\" id=\"10484728869\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"10484728869\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_16\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_16\" class=\"form-header\">\n General Information\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_66\">\n <div id=\"cid_66\" class=\"form-input-wide\">\n <div id=\"text_66\" class=\"form-html\">\n Please provide the following information for the primary contact of your team.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_97\">\n <label class=\"form-label-left\" id=\"label_97\" for=\"input_97\">\n Name of Company\/Project<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_97\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_97\" name=\"q97_nameOf\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_0\">\n <label class=\"form-label-left\" id=\"label_0\" for=\"input_0\">\n First Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_0\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_0\" name=\"q0_firstName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_65\">\n <label class=\"form-label-left\" id=\"label_65\" for=\"input_65\">\n Last Name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_65\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_65\" name=\"q65_lastName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_1\">\n <label class=\"form-label-left\" id=\"label_1\" for=\"input_1\">\n Phone Number<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_1\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_1\" name=\"q1_phoneNumber\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_2\">\n <label class=\"form-label-left\" id=\"label_2\" for=\"input_2\">\n E-mail<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_2\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Email]\" id=\"input_2\" name=\"q2_email\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_3\">\n <label class=\"form-label-left\" id=\"label_3\" for=\"input_3\">\n Street Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_3\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_3\" name=\"q3_streetAddress\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_67\">\n <label class=\"form-label-left\" id=\"label_67\" for=\"input_67\">\n City<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_67\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_67\" name=\"q67_city\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_68\">\n <label class=\"form-label-left\" id=\"label_68\" for=\"input_68\"> State <\/label>\n <div id=\"cid_68\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_68\" name=\"q68_state\">\n <option> <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_69\">\n <label class=\"form-label-left\" id=\"label_69\" for=\"input_69\">\n Country<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_69\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_69\" name=\"q69_country\">\n <option> <\/option>\n <option value=\"United States\"> United States <\/option>\n <option value=\"Abkhazia\"> Abkhazia <\/option>\n <option value=\"Afghanistan\"> Afghanistan <\/option>\n <option value=\"Albania\"> Albania <\/option>\n <option value=\"Algeria\"> Algeria <\/option>\n <option value=\"American Samoa\"> American Samoa <\/option>\n <option value=\"Andorra\"> Andorra <\/option>\n <option value=\"Angola\"> Angola <\/option>\n <option value=\"Anguilla\"> Anguilla <\/option>\n <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n <option value=\"Argentina\"> Argentina <\/option>\n <option value=\"Armenia\"> Armenia <\/option>\n <option value=\"Aruba\"> Aruba <\/option>\n <option value=\"Australia\"> Australia <\/option>\n <option value=\"Austria\"> Austria <\/option>\n <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n <option value=\"The Bahamas\"> The Bahamas <\/option>\n <option value=\"Bahrain\"> Bahrain <\/option>\n <option value=\"Bangladesh\"> Bangladesh <\/option>\n <option value=\"Barbados\"> Barbados <\/option>\n <option value=\"Belarus\"> Belarus <\/option>\n <option value=\"Belgium\"> Belgium <\/option>\n <option value=\"Belize\"> Belize <\/option>\n <option value=\"Benin\"> Benin <\/option>\n <option value=\"Bermuda\"> Bermuda <\/option>\n <option value=\"Bhutan\"> Bhutan <\/option>\n <option value=\"Bolivia\"> Bolivia <\/option>\n <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n <option value=\"Botswana\"> Botswana <\/option>\n <option value=\"Brazil\"> Brazil <\/option>\n <option value=\"Brunei\"> Brunei <\/option>\n <option value=\"Bulgaria\"> Bulgaria <\/option>\n <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n <option value=\"Burundi\"> Burundi <\/option>\n <option value=\"Cambodia\"> Cambodia <\/option>\n <option value=\"Cameroon\"> Cameroon <\/option>\n <option value=\"Canada\"> Canada <\/option>\n <option value=\"Cape Verde\"> Cape Verde <\/option>\n <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n <option value=\"Central African Republic\"> Central African Republic <\/option>\n <option value=\"Chad\"> Chad <\/option>\n <option value=\"Chile\"> Chile <\/option>\n <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n <option value=\"Republic of China\"> Republic of China <\/option>\n <option value=\"Christmas Island\"> Christmas Island <\/option>\n <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n <option value=\"Colombia\"> Colombia <\/option>\n <option value=\"Comoros\"> Comoros <\/option>\n <option value=\"Congo\"> Congo <\/option>\n <option value=\"Cook Islands\"> Cook Islands <\/option>\n <option value=\"Costa Rica\"> Costa Rica <\/option>\n <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n <option value=\"Croatia\"> Croatia <\/option>\n <option value=\"Cuba\"> Cuba <\/option>\n <option value=\"Cyprus\"> Cyprus <\/option>\n <option value=\"Czech Republic\"> Czech Republic <\/option>\n <option value=\"Denmark\"> Denmark <\/option>\n <option value=\"Djibouti\"> Djibouti <\/option>\n <option value=\"Dominica\"> Dominica <\/option>\n <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n <option value=\"Ecuador\"> Ecuador <\/option>\n <option value=\"Egypt\"> Egypt <\/option>\n <option value=\"El Salvador\"> El Salvador <\/option>\n <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n <option value=\"Eritrea\"> Eritrea <\/option>\n <option value=\"Estonia\"> Estonia <\/option>\n <option value=\"Ethiopia\"> Ethiopia <\/option>\n <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n <option value=\"Fiji\"> Fiji <\/option>\n <option value=\"Finland\"> Finland <\/option>\n <option value=\"France\"> France <\/option>\n <option value=\"French Polynesia\"> French Polynesia <\/option>\n <option value=\"Gabon\"> Gabon <\/option>\n <option value=\"The Gambia\"> The Gambia <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Germany\"> Germany <\/option>\n <option value=\"Ghana\"> Ghana <\/option>\n <option value=\"Gibraltar\"> Gibraltar <\/option>\n <option value=\"Greece\"> Greece <\/option>\n <option value=\"Greenland\"> Greenland <\/option>\n <option value=\"Grenada\"> Grenada <\/option>\n <option value=\"Guam\"> Guam <\/option>\n <option value=\"Guatemala\"> Guatemala <\/option>\n <option value=\"Guernsey\"> Guernsey <\/option>\n <option value=\"Guinea\"> Guinea <\/option>\n <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n <option value=\"Guyana Guyana\"> Guyana Guyana <\/option>\n <option value=\"Haiti Haiti\"> Haiti Haiti <\/option>\n <option value=\"Honduras\"> Honduras <\/option>\n <option value=\"Hong Kong\"> Hong Kong <\/option>\n <option value=\"Hungary\"> Hungary <\/option>\n <option value=\"Iceland\"> Iceland <\/option>\n <option value=\"India\"> India <\/option>\n <option value=\"Indonesia\"> Indonesia <\/option>\n <option value=\"Iran\"> Iran <\/option>\n <option value=\"Iraq\"> Iraq <\/option>\n <option value=\"Ireland\"> Ireland <\/option>\n <option value=\"Israel\"> Israel <\/option>\n <option value=\"Italy\"> Italy <\/option>\n <option value=\"Jamaica\"> Jamaica <\/option>\n <option value=\"Japan\"> Japan <\/option>\n <option value=\"Jersey\"> Jersey <\/option>\n <option value=\"Jordan\"> Jordan <\/option>\n <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n <option value=\"Kenya\"> Kenya <\/option>\n <option value=\"Kiribati\"> Kiribati <\/option>\n <option value=\"North Korea\"> North Korea <\/option>\n <option value=\"South Korea\"> South Korea <\/option>\n <option value=\"Kosovo\"> Kosovo <\/option>\n <option value=\"Kuwait\"> Kuwait <\/option>\n <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n <option value=\"Laos\"> Laos <\/option>\n <option value=\"Latvia\"> Latvia <\/option>\n <option value=\"Lebanon\"> Lebanon <\/option>\n <option value=\"Lesotho\"> Lesotho <\/option>\n <option value=\"Liberia\"> Liberia <\/option>\n <option value=\"Libya\"> Libya <\/option>\n <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n <option value=\"Lithuania\"> Lithuania <\/option>\n <option value=\"Luxembourg\"> Luxembourg <\/option>\n <option value=\"Macau\"> Macau <\/option>\n <option value=\"Macedonia\"> Macedonia <\/option>\n <option value=\"Madagascar\"> Madagascar <\/option>\n <option value=\"Malawi\"> Malawi <\/option>\n <option value=\"Malaysia\"> Malaysia <\/option>\n <option value=\"Maldives\"> Maldives <\/option>\n <option value=\"Mali\"> Mali <\/option>\n <option value=\"Malta\"> Malta <\/option>\n <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n <option value=\"Mauritania\"> Mauritania <\/option>\n <option value=\"Mauritius\"> Mauritius <\/option>\n <option value=\"Mayotte\"> Mayotte <\/option>\n <option value=\"Mexico\"> Mexico <\/option>\n <option value=\"Micronesia\"> Micronesia <\/option>\n <option value=\"Moldova\"> Moldova <\/option>\n <option value=\"Monaco\"> Monaco <\/option>\n <option value=\"Mongolia\"> Mongolia <\/option>\n <option value=\"Montenegro\"> Montenegro <\/option>\n <option value=\"Montserrat\"> Montserrat <\/option>\n <option value=\"Morocco\"> Morocco <\/option>\n <option value=\"Mozambique\"> Mozambique <\/option>\n <option value=\"Myanmar\"> Myanmar <\/option>\n <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n <option value=\"Namibia\"> Namibia <\/option>\n <option value=\"Nauru\"> Nauru <\/option>\n <option value=\"Nepal\"> Nepal <\/option>\n <option value=\"Netherlands\"> Netherlands <\/option>\n <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n <option value=\"New Caledonia\"> New Caledonia <\/option>\n <option value=\"New Zealand\"> New Zealand <\/option>\n <option value=\"Nicaragua\"> Nicaragua <\/option>\n <option value=\"Niger\"> Niger <\/option>\n <option value=\"Nigeria\"> Nigeria <\/option>\n <option value=\"Niue\"> Niue <\/option>\n <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n <option value=\"Norway\"> Norway <\/option>\n <option value=\"Oman\"> Oman <\/option>\n <option value=\"Pakistan\"> Pakistan <\/option>\n <option value=\"Palau\"> Palau <\/option>\n <option value=\"Palestine\"> Palestine <\/option>\n <option value=\"Panama\"> Panama <\/option>\n <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n <option value=\"Paraguay\"> Paraguay <\/option>\n <option value=\"Peru\"> Peru <\/option>\n <option value=\"Philippines\"> Philippines <\/option>\n <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n <option value=\"Poland\"> Poland <\/option>\n <option value=\"Portugal\"> Portugal <\/option>\n <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n <option value=\"Qatar\"> Qatar <\/option>\n <option value=\"Romania\"> Romania <\/option>\n <option value=\"Russia\"> Russia <\/option>\n <option value=\"Rwanda\"> Rwanda <\/option>\n <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n <option value=\"Saint Helena\"> Saint Helena <\/option>\n <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n <option value=\"Saint Martin\"> Saint Martin <\/option>\n <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n <option value=\"Samoa\"> Samoa <\/option>\n <option value=\"San Marino\"> San Marino <\/option>\n <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n <option value=\"Senegal\"> Senegal <\/option>\n <option value=\"Serbia\"> Serbia <\/option>\n <option value=\"Seychelles\"> Seychelles <\/option>\n <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n <option value=\"Singapore\"> Singapore <\/option>\n <option value=\"Slovakia\"> Slovakia <\/option>\n <option value=\"Slovenia\"> Slovenia <\/option>\n <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n <option value=\"Somalia\"> Somalia <\/option>\n <option value=\"Somaliland\"> Somaliland <\/option>\n <option value=\"South Africa\"> South Africa <\/option>\n <option value=\"South Ossetia\"> South Ossetia <\/option>\n <option value=\"Spain\"> Spain <\/option>\n <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n <option value=\"Sudan\"> Sudan <\/option>\n <option value=\"Suriname\"> Suriname <\/option>\n <option value=\"Svalbard\"> Svalbard <\/option>\n <option value=\"Swaziland\"> Swaziland <\/option>\n <option value=\"Sweden\"> Sweden <\/option>\n <option value=\"Switzerland\"> Switzerland <\/option>\n <option value=\"Syria\"> Syria <\/option>\n <option value=\"Taiwan\"> Taiwan <\/option>\n <option value=\"Tajikistan\"> Tajikistan <\/option>\n <option value=\"Tanzania\"> Tanzania <\/option>\n <option value=\"Thailand\"> Thailand <\/option>\n <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n <option value=\"Togo\"> Togo <\/option>\n <option value=\"Tokelau\"> Tokelau <\/option>\n <option value=\"Tonga\"> Tonga <\/option>\n <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n <option value=\"Tunisia\"> Tunisia <\/option>\n <option value=\"Turkey\"> Turkey <\/option>\n <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n <option value=\"Tuvalu\"> Tuvalu <\/option>\n <option value=\"Uganda\"> Uganda <\/option>\n <option value=\"Ukraine\"> Ukraine <\/option>\n <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n <option value=\"United Kingdom\"> United Kingdom <\/option>\n <option value=\"Uruguay\"> Uruguay <\/option>\n <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n <option value=\"Vanuatu\"> Vanuatu <\/option>\n <option value=\"Vatican City\"> Vatican City <\/option>\n <option value=\"Venezuela\"> Venezuela <\/option>\n <option value=\"Vietnam\"> Vietnam <\/option>\n <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n <option value=\"Western Sahara\"> Western Sahara <\/option>\n <option value=\"Yemen\"> Yemen <\/option>\n <option value=\"Zambia\"> Zambia <\/option>\n <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\"> Company URL (if you have one) <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_19\" name=\"q19_companyUrl\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_22\">\n <label class=\"form-label-left\" id=\"label_22\" for=\"input_22\">\n Please identify the sector that most closely identifies with your company. If none of the options is applicable, select \"other\"<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_22\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_22_0\" name=\"q22_pleaseIdentify[]\" value=\"Clean Technology \/ Environmental\" \/>\n <label for=\"input_22_0\"> Clean Technology \/ Environmental <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_22_1\" name=\"q22_pleaseIdentify[]\" value=\"Education\" \/>\n <label for=\"input_22_1\"> Education <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_22_2\" name=\"q22_pleaseIdentify[]\" value=\"Community Building\" \/>\n <label for=\"input_22_2\"> Community Building <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_22_3\" name=\"q22_pleaseIdentify[]\" value=\"Social Finance\" \/>\n <label for=\"input_22_3\"> Social Finance <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_22_4\" name=\"q22_pleaseIdentify[]\" value=\"Public Health\" \/>\n <label for=\"input_22_4\"> Public Health <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_22_5\" name=\"q22_pleaseIdentify[]\" value=\"Other\" \/>\n <label for=\"input_22_5\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_24\">\n <label class=\"form-label-left\" id=\"label_24\" for=\"input_24\"> If \"other\" please explain <\/label>\n <div id=\"cid_24\" class=\"form-input\">\n <textarea id=\"input_24\" class=\"form-textarea\" name=\"q24_ifother\" cols=\"40\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_96\">\n <div id=\"cid_96\" class=\"form-input-wide\">\n <div id=\"text_96\" class=\"form-html\">\n <p>\n Please check the appropriate box to be considered for applicable grants. See website for details.\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_118\">\n <label class=\"form-label-left\" id=\"label_118\" for=\"input_118\"> Click to edit <\/label>\n <div id=\"cid_118\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_118_0\" name=\"q118_clickTo118[]\" value=\"RHD Social Finance Prize Applicant\" \/>\n <label for=\"input_118_0\"> RHD Social Finance Prize Applicant <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_118_1\" name=\"q118_clickTo118[]\" value=\"Sid ben Ami Fellowship Applicant\" \/>\n <label for=\"input_118_1\"> Sid ben Ami Fellowship Applicant <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_17\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_17\" class=\"form-header\">\n Your Idea Explained\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <div id=\"cid_10\" class=\"form-input-wide\">\n <div id=\"text_10\" class=\"form-html\">\n Please answer the questions below concisely and thoroughly.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_100\">\n <label class=\"form-label-left\" id=\"label_100\" for=\"input_100\">\n In 50 words or less, what significant unmet social need is your company addressing?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_100\" class=\"form-input\">\n <textarea id=\"input_100\" class=\"form-textarea validate[required]\" name=\"q100_in50\" cols=\"40\" rows=\"7\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_20\">\n <label class=\"form-label-left\" id=\"label_20\" for=\"input_20\">\n What innovative product, service, or business model are you developing to address this need?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_20\" class=\"form-input\">\n <textarea id=\"input_20\" class=\"form-textarea validate[required]\" name=\"q20_whatInnovative\" cols=\"40\" rows=\"12\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_38\">\n <label class=\"form-label-left\" id=\"label_38\" for=\"input_38\">\n How can your social objectives be sustained in a for-profit model?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_38\" class=\"form-input\">\n <textarea id=\"input_38\" class=\"form-textarea validate[required]\" name=\"q38_howCan\" cols=\"40\" rows=\"12\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_27\">\n <label class=\"form-label-left\" id=\"label_27\" for=\"input_27\">\n Describe your business model. Who are your customers? Why will they pay?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_27\" class=\"form-input\">\n <textarea id=\"input_27\" class=\"form-textarea validate[required]\" name=\"q27_describeYour\" cols=\"40\" rows=\"12\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_101\">\n <label class=\"form-label-left\" id=\"label_101\" for=\"input_101\">\n How will you reach your customers?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_101\" class=\"form-input\">\n <textarea id=\"input_101\" class=\"form-textarea validate[required]\" name=\"q101_howWill\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_95\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_95\" class=\"form-header\">\n Stage of Development\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_39\">\n <label class=\"form-label-left\" id=\"label_39\" for=\"input_39\">\n How long have you been working on this company?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_39\" class=\"form-input\">\n <textarea id=\"input_39\" class=\"form-textarea validate[required]\" name=\"q39_howLong\" cols=\"40\" rows=\"5\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_40\">\n <label class=\"form-label-left\" id=\"label_40\" for=\"input_40\">\n How far along are you in planning your business? (If you have a business plan you will be able to attach it at the end of this application.)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_40\" class=\"form-input\">\n <textarea id=\"input_40\" class=\"form-textarea validate[required]\" name=\"q40_howFar\" cols=\"40\" rows=\"12\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_110\">\n <div id=\"cid_110\" class=\"form-input-wide\">\n <div id=\"text_110\" class=\"form-html\">\n Please complete the timeline of product development below with past and projected dates.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_111\">\n <label class=\"form-label-left\" id=\"label_111\" for=\"input_111\">\n Idea<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_111\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"month_111\" name=\"q111_idea[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_111\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"day_111\" name=\"q111_idea[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"04\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_111\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"year_111\" name=\"q111_idea[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_111\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_111_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_111_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_112\">\n <label class=\"form-label-left\" id=\"label_112\" for=\"input_112\">\n Prototype<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_112\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"month_112\" name=\"q112_prototype[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_112\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"day_112\" name=\"q112_prototype[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"04\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_112\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"year_112\" name=\"q112_prototype[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_112\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_112_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_112_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_113\">\n <label class=\"form-label-left\" id=\"label_113\" for=\"input_113\">\n Beta<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_113\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"month_113\" name=\"q113_beta[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_113\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"day_113\" name=\"q113_beta[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"04\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_113\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"year_113\" name=\"q113_beta[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_113\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_113_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_113_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_114\">\n <label class=\"form-label-left\" id=\"label_114\" for=\"input_114\">\n Commercial Product<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_114\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"month_114\" name=\"q114_commercialProduct[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_114\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"day_114\" name=\"q114_commercialProduct[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"04\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_114\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"year_114\" name=\"q114_commercialProduct[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_114\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_114_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_114_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li id=\"cid_98\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_98\" class=\"form-header\">\n Company Structure\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <label class=\"form-label-left\" id=\"label_11\" for=\"input_11\">\n Do you have a company?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_11\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_11_0\" name=\"q11_doYou[]\" value=\"Yes\" \/>\n <label for=\"input_11_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_11_1\" name=\"q11_doYou[]\" value=\"No\" \/>\n <label for=\"input_11_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_12\">\n <label class=\"form-label-left\" id=\"label_12\" for=\"input_12\"> If yes, is it a corporation or a limited liability company? <\/label>\n <div id=\"cid_12\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_12_0\" name=\"q12_ifYes[]\" value=\"Corporation\" \/>\n <label for=\"input_12_0\"> Corporation <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_12_1\" name=\"q12_ifYes[]\" value=\"Limited Liability Company\" \/>\n <label for=\"input_12_1\"> Limited Liability Company <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_12_2\" name=\"q12_ifYes[]\" value=\"Other\" \/>\n <label for=\"input_12_2\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_41\">\n <label class=\"form-label-left\" id=\"label_41\" for=\"input_41\">\n How much cash (not sweat equity) have you and\/or others invested in this idea so far?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_41\" class=\"form-input\">\n <textarea id=\"input_41\" class=\"form-textarea validate[required]\" name=\"q41_howMuch\" cols=\"40\" rows=\"12\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_99\">\n <label class=\"form-label-left\" id=\"label_99\" for=\"input_99\">\n If you have received funding other than from owners and family members, (i.e. angel investors, government agencies), list your three largest investors and their percentage ownership<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_99\" class=\"form-input\">\n <textarea id=\"input_99\" class=\"form-textarea validate[required]\" name=\"q99_ifYou\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_42\">\n <label class=\"form-label-left\" id=\"label_42\" for=\"input_42\">\n How much money do you need to get your business to the next step? Where do you anticipate raising the funds? How do you anticipate using it? If available, please attach a budget for the next 12 months<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_42\" class=\"form-input\">\n <textarea id=\"input_42\" class=\"form-textarea validate[required]\" name=\"q42_howMuch42\" cols=\"40\" rows=\"12\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_70\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_70\" class=\"form-header\">\n Your Team\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_71\">\n <div id=\"cid_71\" class=\"form-input-wide\">\n <div id=\"text_71\" class=\"form-html\">\n We strongly encourage our incubator entrants to be part of a team. You can apply by yourself; but we are more likely to accept proposals from small teams. If you are solo and we really like your idea, we may recommend other people who can join your team.\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_72\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_72\" class=\"form-header\">\n Team Member No. 1 (Primary Contact)\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_74\">\n <label class=\"form-label-left\" id=\"label_74\" for=\"input_74\">\n Full Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_74\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_74\" name=\"q74_fullName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_75\">\n <label class=\"form-label-left\" id=\"label_75\" for=\"input_75\">\n What is your current role in developing the business and what do you expect your role to be going forward?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_75\" class=\"form-input\">\n <textarea id=\"input_75\" class=\"form-textarea validate[required]\" name=\"q75_whatIs\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_76\">\n <label class=\"form-label-left\" id=\"label_76\" for=\"input_76\">\n What percentage of your time are you currently spending on this project, and how much do you anticipate spending over the next couple of years?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_76\" class=\"form-input\">\n <textarea id=\"input_76\" class=\"form-textarea validate[required]\" name=\"q76_whatPercentage\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_91\">\n <label class=\"form-label-left\" id=\"label_91\" for=\"input_91\">\n What is the source of your passion and domain expertise?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_91\" class=\"form-input\">\n <textarea id=\"input_91\" class=\"form-textarea validate[required]\" name=\"q91_whatIs91\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_77\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_77\" class=\"form-header\">\n Team Member No. 2\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_81\">\n <label class=\"form-label-left\" id=\"label_81\" for=\"input_81\"> Full Name <\/label>\n <div id=\"cid_81\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_81\" name=\"q81_fullName81\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_84\">\n <label class=\"form-label-left\" id=\"label_84\" for=\"input_84\"> What is your current role in developing the business and what do you expect your role to be going forward? <\/label>\n <div id=\"cid_84\" class=\"form-input\">\n <textarea id=\"input_84\" class=\"form-textarea\" name=\"q84_whatIs84\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_86\">\n <label class=\"form-label-left\" id=\"label_86\" for=\"input_86\"> What percentage of your time are you currently spending on this project, and how much do you anticipate spending over the next couple of years? <\/label>\n <div id=\"cid_86\" class=\"form-input\">\n <textarea id=\"input_86\" class=\"form-textarea\" name=\"q86_whatPercentage86\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_92\">\n <label class=\"form-label-left\" id=\"label_92\" for=\"input_92\"> What is the source of your passion and domain expertise? <\/label>\n <div id=\"cid_92\" class=\"form-input\">\n <textarea id=\"input_92\" class=\"form-textarea\" name=\"q92_whatIs92\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_102\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_102\" class=\"form-header\">\n Your Team (Continued)\n <\/h2>\n <\/div>\n <\/li>\n <li id=\"cid_78\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_78\" class=\"form-header\">\n Team Member No. 3\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_80\">\n <label class=\"form-label-left\" id=\"label_80\" for=\"input_80\"> Full Name <\/label>\n <div id=\"cid_80\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_80\" name=\"q80_fullName80\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_85\">\n <label class=\"form-label-left\" id=\"label_85\" for=\"input_85\"> What is your current role in developing the business and what do you expect your role to be going forward? <\/label>\n <div id=\"cid_85\" class=\"form-input\">\n <textarea id=\"input_85\" class=\"form-textarea\" name=\"q85_whatIs85\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_83\">\n <label class=\"form-label-left\" id=\"label_83\" for=\"input_83\"> What percentage of your time are you currently spending on this project, and how much do you anticipate spending over the next couple of years? <\/label>\n <div id=\"cid_83\" class=\"form-input\">\n <textarea id=\"input_83\" class=\"form-textarea\" name=\"q83_whatPercentage83\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_93\">\n <label class=\"form-label-left\" id=\"label_93\" for=\"input_93\"> What is the source of your passion and domain expertise? <\/label>\n <div id=\"cid_93\" class=\"form-input\">\n <textarea id=\"input_93\" class=\"form-textarea\" name=\"q93_whatIs93\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_79\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_79\" class=\"form-header\">\n Team Member No. 4\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_82\">\n <label class=\"form-label-left\" id=\"label_82\" for=\"input_82\"> Full Name <\/label>\n <div id=\"cid_82\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_82\" name=\"q82_fullName82\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_87\">\n <label class=\"form-label-left\" id=\"label_87\" for=\"input_87\"> What is your current role in developing the business and what do you expect your role to be going forward? <\/label>\n <div id=\"cid_87\" class=\"form-input\">\n <textarea id=\"input_87\" class=\"form-textarea\" name=\"q87_whatIs87\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_88\">\n <label class=\"form-label-left\" id=\"label_88\" for=\"input_88\"> What percentage of your time are you currently spending on this project, and how much do you anticipate spending over the next couple of years? <\/label>\n <div id=\"cid_88\" class=\"form-input\">\n <textarea id=\"input_88\" class=\"form-textarea\" name=\"q88_whatPercentage88\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_94\">\n <label class=\"form-label-left\" id=\"label_94\" for=\"input_94\"> What is the source of your passion and domain expertise? <\/label>\n <div id=\"cid_94\" class=\"form-input\">\n <textarea id=\"input_94\" class=\"form-textarea\" name=\"q94_whatIs94\" cols=\"40\" rows=\"10\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_47\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_47\" class=\"form-header\">\n Upload Section (If Applicable)\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_48\">\n <div id=\"cid_48\" class=\"form-input-wide\">\n <div id=\"text_48\" class=\"form-html\">\n If you have completed a business plan, budget, or executive summary you may upload a copy here for us to review. If you would like to upload a video pitch for your company, you may also upload it here.\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_58\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_58\" class=\"form-header\">\n Team\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_53\">\n <label class=\"form-label-left\" id=\"label_53\" for=\"input_53\">\n Resume of Primary Contact (MS Word or PDF)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_53\" class=\"form-input\">\n <input class=\"form-upload validate[required]\" type=\"file\" id=\"input_53\" name=\"q53_resumeOf\" file-accept=\"doc, pdf\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_54\">\n <label class=\"form-label-left\" id=\"label_54\" for=\"input_54\"> Resume of Second Team Member (MS Word or PDF) <\/label>\n <div id=\"cid_54\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_54\" name=\"q54_resumeOf54\" file-accept=\"doc, pdf\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_55\">\n <label class=\"form-label-left\" id=\"label_55\" for=\"input_55\"> Resume of Third Team Member (MS Word or PDF) <\/label>\n <div id=\"cid_55\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_55\" name=\"q55_resumeOf55\" file-accept=\"doc, pdf\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_56\">\n <label class=\"form-label-left\" id=\"label_56\" for=\"input_56\"> Resume of Fourth Team Member (MS Word or PDF) <\/label>\n <div id=\"cid_56\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_56\" name=\"q56_resumeOf56\" file-accept=\"doc, pdf\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_57\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_57\" class=\"form-header\">\n Company\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_49\">\n <label class=\"form-label-left\" id=\"label_49\" for=\"input_49\"> Business Plan (MS Word or PDF) <\/label>\n <div id=\"cid_49\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_49\" name=\"q49_businessPlan\" file-accept=\"doc, pdf\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_50\">\n <label class=\"form-label-left\" id=\"label_50\" for=\"input_50\"> Budget (MS Excel or PDF) <\/label>\n <div id=\"cid_50\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_50\" name=\"q50_budgetms\" file-accept=\"xls, pdf\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_51\">\n <label class=\"form-label-left\" id=\"label_51\" for=\"input_51\"> Executive Summary (MS Word or PDF) <\/label>\n <div id=\"cid_51\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_51\" name=\"q51_executiveSummary\" file-accept=\"doc, pdf\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_52\">\n <label class=\"form-label-left\" id=\"label_52\" for=\"input_52\"> Video <\/label>\n <div id=\"cid_52\" class=\"form-input\">\n <input class=\"form-upload\" type=\"file\" id=\"input_52\" name=\"q52_video52\" file-accept=\"wmv\" file-maxsize=\"999999999999\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_117\">\n <label class=\"form-label-left\" id=\"label_117\" for=\"input_117\"> Click to edit <\/label>\n <div id=\"cid_117\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_117\" name=\"q117_clickTo\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_116\">\n <div id=\"cid_116\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_116\" type=\"submit\" class=\"form-submit-button\">\n Submit Your Application\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <li style=\"display:none\">\n Should be Empty:\n <input type=\"text\" name=\"website\" value=\"\" \/>\n <\/li>\n <\/ul>\n <\/div>\n <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"10484728869\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"10484728869-10484728869\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");