/*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"+"rame>";
        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"></scr'+'ipt><'+'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 i2145509229 = new FrameBuilder("2145509229", false, "", "<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>Form<\/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:265px !important;\n    }\n    .form-label-left{\n        width:265px !important;\n    }\n    .form-line{\n        padding:10px;\n    }\n    .form-label-right{\n        width:265px !important;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:#000000;\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:0px;\n        width:690px;\n        background:#000000;\n        color:#808080 !important;\n        font-family:Verdana;\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      $('input_14').hint('ex: myname@example.com');\n      JotForm.highlightInputs = false;\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\" name=\"form_2145509229\" id=\"2145509229\" accept-charset=\"utf-8\">\n  <input type=\"hidden\" name=\"formID\" value=\"2145509229\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section\">\n      <li id=\"cid_1\" class=\"form-input-wide\">\n        <div class=\"form-header-group\">\n          <h2 id=\"header_1\" class=\"form-header\">\n            Application for Admission\n          <\/h2>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_58\">\n        <div id=\"cid_58\" class=\"form-input-wide\">\n          <div id=\"text_58\" class=\"form-html\">\n            <p><span style=\"color: purple; font-size: small;\"><strong><span style=\"font-family: arial,helvetica,sans-serif; font-size: large; color: #c0c0c0;\">General Information<\/span>\n                  <br \/>\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_29\">\n        <label class=\"form-label-right\" id=\"label_29\" for=\"input_29\">\n          Full Name<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_29\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q29_fullName29[first]\" id=\"first_29\" \/>\n            <label class=\"form-sub-label\" for=\"first_29\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q29_fullName29[middle]\" id=\"middle_29\" \/>\n            <label class=\"form-sub-label\" for=\"middle_29\" id=\"sublabel_middle\"> Middle Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q29_fullName29[last]\" id=\"last_29\" \/>\n            <label class=\"form-sub-label\" for=\"last_29\" id=\"sublabel_last\"> Last Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"4\" name=\"q29_fullName29[suffix]\" id=\"suf_29\" \/>\n            <label class=\"form-sub-label\" for=\"suf_29\" id=\"sublabel_suffix\"> Suffix <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_3\">\n        <label class=\"form-label-right\" id=\"label_3\" for=\"input_3\"> Preferred First Name <\/label>\n        <div id=\"cid_3\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_3\" name=\"q3_preferredFirst\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_5\">\n        <label class=\"form-label-right\" id=\"label_5\" for=\"input_5\"> *Preferred Last Name(s) Used (optional) <\/label>\n        <div id=\"cid_5\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_5\" name=\"q5_preferredLast5\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_59\">\n        <div id=\"cid_59\" class=\"form-input-wide\">\n          <div id=\"text_59\" class=\"form-html\">\n            <p><span style=\"color: #888888; font-size: xx-small;\"><span style=\"font-size: x-small;\">*<\/span>\n                Requested for identification purposes only. Failure to disclose this information may affect your identification in the admissions process.<\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_8\">\n        <label class=\"form-label-right\" id=\"label_8\" for=\"input_8\">\n          Date of Birth<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_8\" class=\"form-input\"><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q8_dateOf8[month]\" id=\"input_8_month\">\n              <option>  <\/option>\n              <option value=\"January\"> January <\/option>\n              <option value=\"February\"> February <\/option>\n              <option value=\"March\"> March <\/option>\n              <option value=\"April\"> April <\/option>\n              <option value=\"May\"> May <\/option>\n              <option value=\"June\"> June <\/option>\n              <option value=\"July\"> July <\/option>\n              <option value=\"August\"> August <\/option>\n              <option value=\"September\"> September <\/option>\n              <option value=\"October\"> October <\/option>\n              <option value=\"November\"> November <\/option>\n              <option value=\"December\"> December <\/option>\n            <\/select>\n            <label class=\"form-sub-label\" for=\"input_8_month\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q8_dateOf8[day]\" id=\"input_8_day\">\n              <option>  <\/option>\n              <option value=\"1\"> 1 <\/option>\n              <option value=\"2\"> 2 <\/option>\n              <option value=\"3\"> 3 <\/option>\n              <option value=\"4\"> 4 <\/option>\n              <option value=\"5\"> 5 <\/option>\n              <option value=\"6\"> 6 <\/option>\n              <option value=\"7\"> 7 <\/option>\n              <option value=\"8\"> 8 <\/option>\n              <option value=\"9\"> 9 <\/option>\n              <option value=\"10\"> 10 <\/option>\n              <option value=\"11\"> 11 <\/option>\n              <option value=\"12\"> 12 <\/option>\n              <option value=\"13\"> 13 <\/option>\n              <option value=\"14\"> 14 <\/option>\n              <option value=\"15\"> 15 <\/option>\n              <option value=\"16\"> 16 <\/option>\n              <option value=\"17\"> 17 <\/option>\n              <option value=\"18\"> 18 <\/option>\n              <option value=\"19\"> 19 <\/option>\n              <option value=\"20\"> 20 <\/option>\n              <option value=\"21\"> 21 <\/option>\n              <option value=\"22\"> 22 <\/option>\n              <option value=\"23\"> 23 <\/option>\n              <option value=\"24\"> 24 <\/option>\n              <option value=\"25\"> 25 <\/option>\n              <option value=\"26\"> 26 <\/option>\n              <option value=\"27\"> 27 <\/option>\n              <option value=\"28\"> 28 <\/option>\n              <option value=\"29\"> 29 <\/option>\n              <option value=\"30\"> 30 <\/option>\n              <option value=\"31\"> 31 <\/option>\n            <\/select>\n            <label class=\"form-sub-label\" for=\"input_8_day\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q8_dateOf8[year]\" id=\"input_8_year\">\n              <option>  <\/option>\n              <option value=\"2016\"> 2016 <\/option>\n              <option value=\"2015\"> 2015 <\/option>\n              <option value=\"2014\"> 2014 <\/option>\n              <option value=\"2013\"> 2013 <\/option>\n              <option value=\"2012\"> 2012 <\/option>\n              <option value=\"2011\"> 2011 <\/option>\n              <option value=\"2010\"> 2010 <\/option>\n              <option value=\"2009\"> 2009 <\/option>\n              <option value=\"2008\"> 2008 <\/option>\n              <option value=\"2007\"> 2007 <\/option>\n              <option value=\"2006\"> 2006 <\/option>\n              <option value=\"2005\"> 2005 <\/option>\n              <option value=\"2004\"> 2004 <\/option>\n              <option value=\"2003\"> 2003 <\/option>\n              <option value=\"2002\"> 2002 <\/option>\n              <option value=\"2001\"> 2001 <\/option>\n              <option value=\"2000\"> 2000 <\/option>\n              <option value=\"1999\"> 1999 <\/option>\n              <option value=\"1998\"> 1998 <\/option>\n              <option value=\"1997\"> 1997 <\/option>\n              <option value=\"1996\"> 1996 <\/option>\n              <option value=\"1995\"> 1995 <\/option>\n              <option value=\"1994\"> 1994 <\/option>\n              <option value=\"1993\"> 1993 <\/option>\n              <option value=\"1992\"> 1992 <\/option>\n              <option value=\"1991\"> 1991 <\/option>\n              <option value=\"1990\"> 1990 <\/option>\n              <option value=\"1989\"> 1989 <\/option>\n              <option value=\"1988\"> 1988 <\/option>\n              <option value=\"1987\"> 1987 <\/option>\n              <option value=\"1986\"> 1986 <\/option>\n              <option value=\"1985\"> 1985 <\/option>\n              <option value=\"1984\"> 1984 <\/option>\n              <option value=\"1983\"> 1983 <\/option>\n              <option value=\"1982\"> 1982 <\/option>\n              <option value=\"1981\"> 1981 <\/option>\n              <option value=\"1980\"> 1980 <\/option>\n              <option value=\"1979\"> 1979 <\/option>\n              <option value=\"1978\"> 1978 <\/option>\n              <option value=\"1977\"> 1977 <\/option>\n              <option value=\"1976\"> 1976 <\/option>\n              <option value=\"1975\"> 1975 <\/option>\n              <option value=\"1974\"> 1974 <\/option>\n              <option value=\"1973\"> 1973 <\/option>\n              <option value=\"1972\"> 1972 <\/option>\n              <option value=\"1971\"> 1971 <\/option>\n              <option value=\"1970\"> 1970 <\/option>\n              <option value=\"1969\"> 1969 <\/option>\n              <option value=\"1968\"> 1968 <\/option>\n              <option value=\"1967\"> 1967 <\/option>\n              <option value=\"1966\"> 1966 <\/option>\n              <option value=\"1965\"> 1965 <\/option>\n              <option value=\"1964\"> 1964 <\/option>\n              <option value=\"1963\"> 1963 <\/option>\n              <option value=\"1962\"> 1962 <\/option>\n              <option value=\"1961\"> 1961 <\/option>\n              <option value=\"1960\"> 1960 <\/option>\n              <option value=\"1959\"> 1959 <\/option>\n              <option value=\"1958\"> 1958 <\/option>\n              <option value=\"1957\"> 1957 <\/option>\n              <option value=\"1956\"> 1956 <\/option>\n              <option value=\"1955\"> 1955 <\/option>\n              <option value=\"1954\"> 1954 <\/option>\n              <option value=\"1953\"> 1953 <\/option>\n              <option value=\"1952\"> 1952 <\/option>\n              <option value=\"1951\"> 1951 <\/option>\n              <option value=\"1950\"> 1950 <\/option>\n              <option value=\"1949\"> 1949 <\/option>\n              <option value=\"1948\"> 1948 <\/option>\n              <option value=\"1947\"> 1947 <\/option>\n              <option value=\"1946\"> 1946 <\/option>\n              <option value=\"1945\"> 1945 <\/option>\n              <option value=\"1944\"> 1944 <\/option>\n              <option value=\"1943\"> 1943 <\/option>\n              <option value=\"1942\"> 1942 <\/option>\n              <option value=\"1941\"> 1941 <\/option>\n              <option value=\"1940\"> 1940 <\/option>\n              <option value=\"1939\"> 1939 <\/option>\n              <option value=\"1938\"> 1938 <\/option>\n              <option value=\"1937\"> 1937 <\/option>\n              <option value=\"1936\"> 1936 <\/option>\n              <option value=\"1935\"> 1935 <\/option>\n              <option value=\"1934\"> 1934 <\/option>\n              <option value=\"1933\"> 1933 <\/option>\n              <option value=\"1932\"> 1932 <\/option>\n              <option value=\"1931\"> 1931 <\/option>\n              <option value=\"1930\"> 1930 <\/option>\n              <option value=\"1929\"> 1929 <\/option>\n              <option value=\"1928\"> 1928 <\/option>\n              <option value=\"1927\"> 1927 <\/option>\n              <option value=\"1926\"> 1926 <\/option>\n              <option value=\"1925\"> 1925 <\/option>\n              <option value=\"1924\"> 1924 <\/option>\n              <option value=\"1923\"> 1923 <\/option>\n              <option value=\"1922\"> 1922 <\/option>\n              <option value=\"1921\"> 1921 <\/option>\n              <option value=\"1920\"> 1920 <\/option>\n            <\/select>\n            <label class=\"form-sub-label\" for=\"input_8_year\" id=\"sublabel_year\"> Year <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_7\">\n        <label class=\"form-label-right\" id=\"label_7\" for=\"input_7\">\n          Social Security<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_7\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_7\" name=\"q7_socialSecurity7\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_10\">\n        <label class=\"form-label-right\" id=\"label_10\" for=\"input_10\">\n          Permanent Home Address<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_10\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q10_permanentHome[addr_line1]\" id=\"input_10_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_10_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q10_permanentHome[addr_line2]\" id=\"input_10_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_10_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q10_permanentHome[city]\" id=\"input_10_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_10_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q10_permanentHome[state]\" id=\"input_10_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_10_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q10_permanentHome[postal]\" id=\"input_10_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_10_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q10_permanentHome[country]\" id=\"input_10_country\">\n                    <option selected> Please Select <\/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                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_10_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_12\">\n        <label class=\"form-label-right\" id=\"label_12\" for=\"input_12\">\n          Phone Number<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_12\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q12_phoneNumber12[area]\" id=\"input_12_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_12_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q12_phoneNumber12[phone]\" id=\"input_12_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_12_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_11\">\n        <label class=\"form-label-right\" id=\"label_11\" for=\"input_11\"> Fax Number <\/label>\n        <div id=\"cid_11\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q11_faxNumber[area]\" id=\"input_11_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_11_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q11_faxNumber[phone]\" id=\"input_11_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_11_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_14\">\n        <label class=\"form-label-right\" id=\"label_14\" for=\"input_14\">\n          E-mail<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_14\" class=\"form-input\">\n          <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_14\" name=\"q14_email\" size=\"30\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_13\">\n        <label class=\"form-label-right\" id=\"label_13\" for=\"input_13\"> Mailing Address (if different than above) <\/label>\n        <div id=\"cid_13\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q13_mailingAddress13[addr_line1]\" id=\"input_13_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_13_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q13_mailingAddress13[addr_line2]\" id=\"input_13_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_13_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q13_mailingAddress13[city]\" id=\"input_13_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_13_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q13_mailingAddress13[state]\" id=\"input_13_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_13_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q13_mailingAddress13[postal]\" id=\"input_13_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_13_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q13_mailingAddress13[country]\" id=\"input_13_country\">\n                    <option selected> Please Select <\/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                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_13_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_61\">\n        <div id=\"cid_61\" class=\"form-input-wide\">\n          <div id=\"text_61\" class=\"form-html\">\n            <p><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: medium;\"><strong>\n                  Other Information\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_67\">\n        <label class=\"form-label-right\" id=\"label_67\" for=\"input_67\">\n          Gender<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_67\" class=\"form-input\">\n          <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_67\" name=\"q67_gender67\">\n            <option>  <\/option>\n            <option value=\"Male\"> Male <\/option>\n            <option value=\"Female\"> Female <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_15\">\n        <label class=\"form-label-right\" id=\"label_15\" for=\"input_15\">\n          Veteran Status<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_15\" class=\"form-input\">\n          <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_15\" name=\"q15_veteranStatus15\">\n            <option>  <\/option>\n            <option value=\"Veteran\"> Veteran <\/option>\n            <option value=\"Non-Veteran\"> Non-Veteran <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_17\">\n        <label class=\"form-label-right\" id=\"label_17\" for=\"input_17\"> *Ethnic Origin (optional) <\/label>\n        <div id=\"cid_17\" class=\"form-input\">\n          <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_17\" name=\"q17_ethnicOrigin17\">\n            <option>  <\/option>\n            <option value=\"Native American \/ Alaskan Native\"> Native American \/ Alaskan Native <\/option>\n            <option value=\"Hispanic\"> Hispanic <\/option>\n            <option value=\"Asian \/ Pacific Islander\"> Asian \/ Pacific Islander <\/option>\n            <option value=\"White \/ Non-Hispanic\"> White \/ Non-Hispanic <\/option>\n            <option value=\"African American\"> African American <\/option>\n            <option value=\"Other\"> Other <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line form-line-column\" id=\"id_63\">\n        <div id=\"cid_63\" class=\"form-input-wide\">\n          <div id=\"text_63\" class=\"form-html\">\n            <p><span style=\"color: #888888; font-size: xx-small;\"><span style=\"color: #666666;\"><span style=\"font-size: x-small;\">*<\/span>\n                  This information is optional: provided on a voluntary basis only. It is for informational or reporting purposes as required of educational institutions by federal or state law.<\/span><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_110\">\n        <label class=\"form-label-right\" id=\"label_110\" for=\"input_110\">\n          Were you born in the United States?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_110\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_110_0\" name=\"q110_wereYou\" value=\"Yes\" \/>\n              <label for=\"input_110_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_110_1\" name=\"q110_wereYou\" value=\"No\" \/>\n              <label for=\"input_110_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_9\">\n        <label class=\"form-label-right\" id=\"label_9\" for=\"input_9\"> If not, what is your country of birth? <\/label>\n        <div id=\"cid_9\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_9\" name=\"q9_ifNot\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_19\">\n        <label class=\"form-label-right\" id=\"label_19\" for=\"input_19\"> What is your country of origin? <\/label>\n        <div id=\"cid_19\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_19\" name=\"q19_whatIs\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_75\">\n        <label class=\"form-label-right\" id=\"label_75\" for=\"input_75\">\n          Are you a citizen of the United States?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_75\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_75_0\" name=\"q75_areYou\" value=\"Yes\" \/>\n              <label for=\"input_75_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_75_1\" name=\"q75_areYou\" value=\"No\" \/>\n              <label for=\"input_75_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_76\">\n        <label class=\"form-label-right\" id=\"label_76\" for=\"input_76\">\n          Are you a permanent resident of the US?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_76\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_76_0\" name=\"q76_areYou76\" value=\"Yes\" \/>\n              <label for=\"input_76_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_76_1\" name=\"q76_areYou76\" value=\"No\" \/>\n              <label for=\"input_76_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_22\">\n        <label class=\"form-label-right\" id=\"label_22\" for=\"input_22\"> Please indicate resident alien number <\/label>\n        <div id=\"cid_22\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_22\" name=\"q22_pleaseIndicate22\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_23\">\n        <label class=\"form-label-right\" id=\"label_23\" for=\"input_23\">\n          What is your primary language?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_23\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_23\" name=\"q23_whatIs23\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_30\">\n        <label class=\"form-label-right\" id=\"label_30\" for=\"input_30\"> TOEFL score (international students) <\/label>\n        <div id=\"cid_30\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_30\" name=\"q30_toeflScore\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_24\">\n        <label class=\"form-label-right\" id=\"label_24\" for=\"input_24\">\n          Campus applying to<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_24\" 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_24_0\" name=\"q24_campusApplying24[]\" value=\"Tucson\" \/>\n              <label for=\"input_24_0\"> Tucson <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_1\" name=\"q24_campusApplying24[]\" value=\"Albuquerque\" \/>\n              <label for=\"input_24_1\"> Albuquerque <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_26\">\n        <label class=\"form-label-right\" id=\"label_26\" for=\"input_26\">\n          Applying for<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_26\" class=\"form-input\">\n          <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_26\" name=\"q26_applyingFor26\">\n            <option>  <\/option>\n            <option value=\"Bachelor of Arts Degree\"> Bachelor of Arts Degree <\/option>\n            <option value=\"Transfer Student\"> Transfer Student <\/option>\n            <option value=\"Second Bachelor Degree\"> Second Bachelor Degree <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_68\">\n        <label class=\"form-label-right\" id=\"label_68\" for=\"input_68\">\n          Intended Major<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_68\" class=\"form-input\">\n          <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_68\" name=\"q68_intendedMajor68\">\n            <option>  <\/option>\n            <option value=\"Animation\"> Animation <\/option>\n            <option value=\"Graphic Design\"> Graphic Design <\/option>\n            <option value=\"Interior Design\"> Interior Design <\/option>\n            <option value=\"Illustration\"> Illustration <\/option>\n            <option value=\"Fine Arts\"> Fine Arts <\/option>\n            <option value=\"Photography\"> Photography <\/option>\n            <option value=\"Advertising and Marketing\"> Advertising and Marketing <\/option>\n            <option value=\"Landscape Architecture\"> Landscape Architecture <\/option>\n            <option value=\"Undecided\"> Undecided <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_69\">\n        <label class=\"form-label-right\" id=\"label_69\" for=\"input_69\">\n          Do you plan to apply for financial aid?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_69\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_69_0\" name=\"q69_doYou69\" value=\"Yes\" \/>\n              <label for=\"input_69_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_69_1\" name=\"q69_doYou69\" value=\"No\" \/>\n              <label for=\"input_69_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_70\">\n        <label class=\"form-label-right\" id=\"label_70\" for=\"input_70\">\n          Have you applied to Southwest University of Visual Arts before?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_70\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_70_0\" name=\"q70_haveYou70\" value=\"Yes\" \/>\n              <label for=\"input_70_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_70_1\" name=\"q70_haveYou70\" value=\"No\" \/>\n              <label for=\"input_70_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_32\">\n        <label class=\"form-label-right\" id=\"label_32\" for=\"input_32\"> If yes, when? <\/label>\n        <div id=\"cid_32\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_32\" name=\"q32_ifYes\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_72\">\n        <label class=\"form-label-right\" id=\"label_72\" for=\"input_72\">\n          Have you attended Southwest University of Visual Arts?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_72\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_72_0\" name=\"q72_haveYou\" value=\"Yes\" \/>\n              <label for=\"input_72_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_72_1\" name=\"q72_haveYou\" value=\"No\" \/>\n              <label for=\"input_72_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_34\">\n        <label class=\"form-label-right\" id=\"label_34\" for=\"input_34\"> If yes, when? <\/label>\n        <div id=\"cid_34\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_34\" name=\"q34_ifYes34\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_64\">\n        <div id=\"cid_64\" class=\"form-input-wide\">\n          <div id=\"text_64\" class=\"form-html\">\n            <p><span style=\"color: purple; font-size: small;\"><strong>\n                <\/strong><\/span><span style=\"font-size: x-small;\"><strong>\n                <\/strong><span style=\"font-family: arial,helvetica,sans-serif; color: #888888;\"><strong><span style=\"font-size: large;\">Previous Education<\/span>\n                    <br \/><span style=\"font-size: small;\">Education History<\/span>\n                  <\/strong><\/span><\/span>\n            <\/p>\n            <p><span style=\"font-size: x-small;\"><strong><span style=\"font-family: arial,helvetica,sans-serif; font-size: small; color: #888888;\">(list the most recently attended high school or G.E.D. information)<\/span>\n                  <br \/>\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_35\">\n        <label class=\"form-label-right\" id=\"label_35\" for=\"input_35\">\n          Name of High School<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_35\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_35\" name=\"q35_nameOf35\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_36\">\n        <label class=\"form-label-right\" id=\"label_36\" for=\"input_36\">\n          City\/State or Country<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_36\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_36\" name=\"q36_citystateOr36\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_37\">\n        <label class=\"form-label-right\" id=\"label_37\" for=\"input_37\">\n          Date of Graduation<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_37\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_37\" name=\"q37_dateOf37\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_73\">\n        <label class=\"form-label-right\" id=\"label_73\" for=\"input_73\">\n          Have you received a GED?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_73\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_73_0\" name=\"q73_haveYou73\" value=\"Yes\" \/>\n              <label for=\"input_73_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_73_1\" name=\"q73_haveYou73\" value=\"No\" \/>\n              <label for=\"input_73_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_74\">\n        <label class=\"form-label-right\" id=\"label_74\" for=\"input_74\">\n          Have you attended a pre-college program?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_74\" class=\"form-input\">\n          <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_74_0\" name=\"q74_haveYou74\" value=\"Yes\" \/>\n              <label for=\"input_74_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_74_1\" name=\"q74_haveYou74\" value=\"No\" \/>\n              <label for=\"input_74_1\"> No <\/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-right\" id=\"label_41\" for=\"input_41\"> Name of Pre-College Program <\/label>\n        <div id=\"cid_41\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_41\" name=\"q41_nameOf\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_42\">\n        <label class=\"form-label-right\" id=\"label_42\" for=\"input_42\"> Dates Attended <\/label>\n        <div id=\"cid_42\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_42\" name=\"q42_datesAttended42\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_65\">\n        <div id=\"cid_65\" class=\"form-input-wide\">\n          <div id=\"text_65\" class=\"form-html\">\n            <p><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: medium;\"><strong>\n                  List All Colleges Attended\n                <\/strong><\/span><span style=\"font-size: x-small;\"><strong>\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_43\">\n        <label class=\"form-label-right\" id=\"label_43\" for=\"input_43\"> First College Attended Name <\/label>\n        <div id=\"cid_43\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_43\" name=\"q43_firstCollege43\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_49\">\n        <label class=\"form-label-right\" id=\"label_49\" for=\"input_49\"> City\/State or Country <\/label>\n        <div id=\"cid_49\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_49\" name=\"q49_citystateOr\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_45\">\n        <label class=\"form-label-right\" id=\"label_45\" for=\"input_45\"> Major <\/label>\n        <div id=\"cid_45\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_45\" name=\"q45_major45\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_51\">\n        <label class=\"form-label-right\" id=\"label_51\" for=\"input_51\"> Degree Awarded <\/label>\n        <div id=\"cid_51\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_51\" name=\"q51_degreeAwarded51\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_47\">\n        <label class=\"form-label-right\" id=\"label_47\" for=\"input_47\"> Dates Attended <\/label>\n        <div id=\"cid_47\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_47\" name=\"q47_datesAttended\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_48\">\n        <label class=\"form-label-right\" id=\"label_48\" for=\"input_48\"> Second College Attended Name <\/label>\n        <div id=\"cid_48\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_48\" name=\"q48_secondCollege\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_54\">\n        <label class=\"form-label-right\" id=\"label_54\" for=\"input_54\"> City\/State or Country <\/label>\n        <div id=\"cid_54\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_54\" name=\"q54_citystateOr54\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_55\">\n        <label class=\"form-label-right\" id=\"label_55\" for=\"input_55\"> Major <\/label>\n        <div id=\"cid_55\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_55\" name=\"q55_major\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_56\">\n        <label class=\"form-label-right\" id=\"label_56\" for=\"input_56\"> Degree Awarded <\/label>\n        <div id=\"cid_56\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_56\" name=\"q56_degreeAwarded\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_57\">\n        <label class=\"form-label-right\" id=\"label_57\" for=\"input_57\"> Dates Attended <\/label>\n        <div id=\"cid_57\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_57\" name=\"q57_datesAttended57\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_53\">\n        <label class=\"form-label-right\" id=\"label_53\" for=\"input_53\"> Third College Attended Name <\/label>\n        <div id=\"cid_53\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_53\" name=\"q53_thirdCollege53\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_44\">\n        <label class=\"form-label-right\" id=\"label_44\" for=\"input_44\"> City\/State or Country <\/label>\n        <div id=\"cid_44\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_44\" name=\"q44_citystateOr44\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_50\">\n        <label class=\"form-label-right\" id=\"label_50\" for=\"input_50\"> Major <\/label>\n        <div id=\"cid_50\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_50\" name=\"q50_major50\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_46\">\n        <label class=\"form-label-right\" id=\"label_46\" for=\"input_46\"> Degree Awarded <\/label>\n        <div id=\"cid_46\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_46\" name=\"q46_degreeAwarded46\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_52\">\n        <label class=\"form-label-right\" id=\"label_52\" for=\"input_52\"> Dates Attended <\/label>\n        <div id=\"cid_52\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_52\" name=\"q52_datesAttended52\" size=\"20\" \/>\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            <p><span style=\"color: purple; font-size: small;\"><strong><span style=\"color: #888888; font-size: large; font-family: arial,helvetica,sans-serif;\">Parent\/Guardian Information<\/span>\n                  <br \/>\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_77\">\n        <label class=\"form-label-right\" id=\"label_77\" for=\"input_77\"> Choose one <\/label>\n        <div id=\"cid_77\" class=\"form-input\">\n          <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_77\" name=\"q77_chooseOne\">\n            <option>  <\/option>\n            <option value=\"Mother\"> Mother <\/option>\n            <option value=\"Father\"> Father <\/option>\n            <option value=\"Guardian\"> Guardian <\/option>\n            <option value=\"Spouse\"> Spouse <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_78\">\n        <label class=\"form-label-right\" id=\"label_78\" for=\"input_78\"> Full Name <\/label>\n        <div id=\"cid_78\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q78_fullName78[first]\" id=\"first_78\" \/>\n            <label class=\"form-sub-label\" for=\"first_78\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q78_fullName78[middle]\" id=\"middle_78\" \/>\n            <label class=\"form-sub-label\" for=\"middle_78\" id=\"sublabel_middle\"> Middle Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q78_fullName78[last]\" id=\"last_78\" \/>\n            <label class=\"form-sub-label\" for=\"last_78\" id=\"sublabel_last\"> Last Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"4\" name=\"q78_fullName78[suffix]\" id=\"suf_78\" \/>\n            <label class=\"form-sub-label\" for=\"suf_78\" id=\"sublabel_suffix\"> Suffix <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_79\">\n        <label class=\"form-label-right\" id=\"label_79\" for=\"input_79\"> Occupation <\/label>\n        <div id=\"cid_79\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_79\" name=\"q79_occupation79\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_80\">\n        <label class=\"form-label-right\" id=\"label_80\" for=\"input_80\"> Address <\/label>\n        <div id=\"cid_80\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q80_address80[addr_line1]\" id=\"input_80_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_80_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q80_address80[addr_line2]\" id=\"input_80_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_80_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q80_address80[city]\" id=\"input_80_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_80_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q80_address80[state]\" id=\"input_80_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_80_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q80_address80[postal]\" id=\"input_80_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_80_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q80_address80[country]\" id=\"input_80_country\">\n                    <option selected> Please Select <\/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                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_80_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_81\">\n        <label class=\"form-label-right\" id=\"label_81\" for=\"input_81\"> Phone Number <\/label>\n        <div id=\"cid_81\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q81_phoneNumber81[area]\" id=\"input_81_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_81_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q81_phoneNumber81[phone]\" id=\"input_81_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_81_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_87\">\n        <div id=\"cid_87\" class=\"form-input-wide\">\n          <div id=\"text_87\" class=\"form-html\">\n            <p><span style=\"font-size: medium; font-family: arial,helvetica,sans-serif;\"><strong>\n                  Emergency Contact\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_83\">\n        <label class=\"form-label-right\" id=\"label_83\" for=\"input_83\"> Full Name <\/label>\n        <div id=\"cid_83\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q83_fullName83[first]\" id=\"first_83\" \/>\n            <label class=\"form-sub-label\" for=\"first_83\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q83_fullName83[last]\" id=\"last_83\" \/>\n            <label class=\"form-sub-label\" for=\"last_83\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_84\">\n        <label class=\"form-label-right\" id=\"label_84\" for=\"input_84\"> Relationship <\/label>\n        <div id=\"cid_84\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_84\" name=\"q84_relationship\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_85\">\n        <label class=\"form-label-right\" id=\"label_85\" for=\"input_85\"> Address <\/label>\n        <div id=\"cid_85\" class=\"form-input\">\n          <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q85_address85[addr_line1]\" id=\"input_85_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_85_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q85_address85[addr_line2]\" id=\"input_85_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_85_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-city\" type=\"text\" name=\"q85_address85[city]\" id=\"input_85_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_85_city\" id=\"sublabel_city\"> City <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-state\" type=\"text\" name=\"q85_address85[state]\" id=\"input_85_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_85_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-postal\" type=\"text\" name=\"q85_address85[postal]\" id=\"input_85_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_85_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n              <\/td>\n              <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown form-address-country\" name=\"q85_address85[country]\" id=\"input_85_country\">\n                    <option selected> Please Select <\/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                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_85_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_86\">\n        <label class=\"form-label-right\" id=\"label_86\" for=\"input_86\"> Phone Number <\/label>\n        <div id=\"cid_86\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q86_phoneNumber86[area]\" id=\"input_86_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_86_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q86_phoneNumber86[phone]\" id=\"input_86_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_86_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_82\">\n        <div id=\"cid_82\" class=\"form-input-wide\">\n          <div id=\"text_82\" class=\"form-html\">\n            <p><span style=\"color: purple; font-size: small;\"><strong><span style=\"font-size: large; font-family: arial,helvetica,sans-serif; color: #888888;\">Interest<\/span>\n                  <br \/>\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_109\">\n        <label class=\"form-label-right\" id=\"label_109\" for=\"input_109\">\n          How did you hear about us?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_109\" class=\"form-input\">\n          <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_109\" name=\"q109_howDid\">\n            <option>  <\/option>\n            <option value=\"Admissions Counselor\"> Admissions Counselor <\/option>\n            <option value=\"School Presentation\"> School Presentation <\/option>\n            <option value=\"Our Students or Faculty\"> Our Students or Faculty <\/option>\n            <option value=\"Teacher \/ Counselor\"> Teacher \/ Counselor <\/option>\n            <option value=\"Alumnus\"> Alumnus <\/option>\n            <option value=\"Reputation\"> Reputation <\/option>\n            <option value=\"Internet\"> Internet <\/option>\n            <option value=\"Advertising\"> Advertising <\/option>\n            <option value=\"Other\"> Other <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_108\">\n        <div id=\"cid_108\" class=\"form-input-wide\">\n          <div id=\"text_108\" class=\"form-html\">\n            <p><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: small;\">List other colleges you are applying to: (optional)<\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_90\">\n        <label class=\"form-label-right\" id=\"label_90\" for=\"input_90\"> College 1 <\/label>\n        <div id=\"cid_90\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_90\" name=\"q90_college190\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_91\">\n        <label class=\"form-label-right\" id=\"label_91\" for=\"input_91\"> College 2 <\/label>\n        <div id=\"cid_91\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox\" id=\"input_91\" name=\"q91_college291\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_92\">\n        <label class=\"form-label-right\" id=\"label_92\" for=\"input_92\"> Southwest University of Visual Arts is my <\/label>\n        <div id=\"cid_92\" class=\"form-input\">\n          <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_92\" name=\"q92_theArt92\">\n            <option>  <\/option>\n            <option value=\"First Choice\"> First Choice <\/option>\n            <option value=\"Second Choice\"> Second Choice <\/option>\n            <option value=\"Third Choice\"> Third Choice <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_89\">\n        <div id=\"cid_89\" class=\"form-input-wide\">\n          <div id=\"text_89\" class=\"form-html\">\n            <p><span style=\"font-size: large; font-family: arial,helvetica,sans-serif;\"><strong>\n                  Essay\n                <\/strong><\/span><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: small;\"><br \/>\n                Your essay is evaluated on writing style, content, organization, grammar, vocabulary, punctuation, and spelling.\n                <br \/>\n                <br \/>\n                Please choose\n                <strong>\n                  ONE\n                <\/strong>\n                of the following topics and submit a 5 - 7 paragraph essay.<\/span>\n              <br \/>\n              <br \/><span style=\"color: #000000; font-size: xx-small;\"><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: small;\"><strong>\n                    Option 1:\n                  <\/strong>\n                  Walt Disney said, \"All our dreams can come true - if we have the courage to pursue them.\" Describe one of your dreams and the steps you will take to make it a reality.<\/span>\n                <br \/>\n                <br \/><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: small;\"><strong>\n                    Option 2:\n                  <\/strong>\n                  \"Success doesn't come to you...you go to it.\" (Marva Collins) Explain what this quote means to you and how it applies toward achieving your current goals.<\/span>\n                <br \/>\n                <br \/><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: small;\"><strong>\n                    Option 3:\n                  <\/strong>\n                  Explain how you became interested in the field you intend to study; describe what excites you about this field and how you believe Southwest University of Visual Arts will assist you in achieving your goals.<\/span>\n                <br \/>\n                <br \/><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: small;\">*If your essay does not fit in the form below, please send it to us in an email as a word document at<\/span><span style=\"font-family: arial,helvetica,sans-serif; font-size: small;\"><a href=\"mailto:inquire@suva.edu\" target=\"_parent\">inquire@suva.edu<\/a><\/span><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_93\">\n        <label class=\"form-label-left\" id=\"label_93\" for=\"input_93\">\n          Essay<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_93\" class=\"form-input\">\n          <textarea id=\"input_93\" class=\"form-textarea validate[required]\" name=\"q93_essay93\" cols=\"75\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_94\">\n        <div id=\"cid_94\" class=\"form-input-wide\">\n          <div id=\"text_94\" class=\"form-html\">\n            <p><span style=\"color: #888888; font-size: large; font-family: arial,helvetica,sans-serif;\"><strong>\n                  Personal Statements\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_95\">\n        <label class=\"form-label-right\" id=\"label_95\" for=\"input_95\">\n          My Educational Goals are<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_95\" class=\"form-input\">\n          <textarea id=\"input_95\" class=\"form-textarea validate[required]\" name=\"q95_myEducational95\" cols=\"40\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_97\">\n        <label class=\"form-label-right\" id=\"label_97\" for=\"input_97\">\n          Why I plan to pursue my goals at Southwest University of Visual Arts<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_97\" class=\"form-input\">\n          <textarea id=\"input_97\" class=\"form-textarea validate[required]\" name=\"q97_whyI\" cols=\"40\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_96\">\n        <label class=\"form-label-right\" id=\"label_96\" for=\"input_96\">\n          I am transferring to Southwest University of Visual Arts because<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_96\" class=\"form-input\">\n          <textarea id=\"input_96\" class=\"form-textarea validate[required]\" name=\"q96_iAm96\" cols=\"40\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_98\">\n        <div id=\"cid_98\" class=\"form-input-wide\">\n          <div id=\"text_98\" class=\"form-html\">\n            <p><span style=\"color: #888888; font-size: small; font-family: arial,helvetica,sans-serif;\">The following section may be answered in one or two words. There are no right or wrong answers.<\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_99\">\n        <label class=\"form-label-right\" id=\"label_99\" for=\"input_99\">\n          Strengths you use to achieve your goals<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_99\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_99\" name=\"q99_strengthsYou99\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_100\">\n        <label class=\"form-label-right\" id=\"label_100\" for=\"input_100\">\n          Areas you may want to work on<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_100\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_100\" name=\"q100_areasYou100\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_102\">\n        <label class=\"form-label-right\" id=\"label_102\" for=\"input_102\">\n          Other than the courses in your major, what are you most interested in learning at Southwest University of Visual Arts?<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_102\" class=\"form-input\">\n          <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_102\" name=\"q102_otherThan102\" size=\"20\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_104\">\n        <label class=\"form-label-right\" id=\"label_104\" for=\"input_104\"> Optional: You may use this space to provide additional information you believe is relevant to you as an applicant, but is not contained elsewhere in your application. <\/label>\n        <div id=\"cid_104\" class=\"form-input\">\n          <textarea id=\"input_104\" class=\"form-textarea\" name=\"q104_optionalYou\" cols=\"40\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_105\">\n        <div id=\"cid_105\" class=\"form-input-wide\">\n          <div id=\"text_105\" class=\"form-html\">\n            <table border=\"0\" cellspacing=\"1\" cellpadding=\"2\" width=\"100%\">\n              <tbody>\n                <tr>\n                  <td><span style=\"color: #888888; font-size: large; font-family: arial,helvetica,sans-serif;\"><strong>\n                        Authorization\n                      <\/strong><\/span>\n                  <\/td>\n                <\/tr>\n                <tr>\n                  <td><span style=\"color: #888888; font-family: arial,helvetica,sans-serif; font-size: small;\">I understand that I am required to submit the following items\n                      <br \/>\n                      to the Admissions Department before my application will be processed:<\/span>\n                  <\/td>\n                <\/tr>\n                <tr>\n                  <td><span style=\"color: #888888; font-size: small; font-family: arial,helvetica,sans-serif;\"><strong>\n                        &bull; Transcripts\n                        <br \/>\n                        &bull; ACT\/SAT Test Score\n                        <br \/>\n                        &bull; TOEFL Score (international students only)\n                        <br \/>\n                        &bull; Artwork\n                        <br \/>\n                        &bull; Recommendations\n                        <br \/>\n                        &bull; Application Fee Payment\n                      <\/strong><\/span>\n                  <\/td>\n                <\/tr>\n              <\/tbody>\n            <\/table>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_106\">\n        <label class=\"form-label-right\" id=\"label_106\" for=\"input_106\">\n          I Understand<span class=\"form-required\">*<\/span>\n        <\/label>\n        <div id=\"cid_106\" 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_106_0\" name=\"q106_iUnderstand[]\" value=\"Yes, I understand\" \/>\n              <label for=\"input_106_0\"> Yes, I understand <\/label><\/span><span class=\"clearfix\"><\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_107\">\n        <div id=\"cid_107\" class=\"form-input-wide\">\n          <div id=\"text_107\" class=\"form-html\">\n            <p><span style=\"font-family: arial,helvetica,sans-serif; font-size: small; color: #888888;\">By electronic submission of this application, I affirm that the information on this application is true, accurate and complete. The essay and artwork submitted with this application represent my work.\n                <br \/>\n                <br \/>\n                Southwest University of Visual Arts admits students of any race, color, age and national or ethnic origin to all rights, privileges and activities generally accord or made available to students at the school. Southwest University of Visual Arts does not discriminate on the basis of race, color, age, sex, religion, physical handicap, sexual orientation, national or ethnic origin in administration of its educational policies, scholarship and loan programs and other school-administered programs.\n                <br \/>\n                <br \/>\n                Fees and charges are subject to change at any time. Please call the Admissions Office in Tucson at 1-800-825-8753 or (520) 325-0123 or in Albuquerque at (505) 254-7575 to verify current charges.\n                <br \/>\n                <br \/>\n                I understand that, if admitted, I will inform myself of the rules and regulations of Southwest University of Visual Arts and will conduct myself in accordance with the provisions as stated in The Southwest University of Visual Arts Catalog.<\/span>\n              <br \/>\n              <br \/><span style=\"color: #888888; font-size: large; font-family: arial,helvetica,sans-serif;\"><strong>\n                  Congratulations! You are now ready to submit the application online.\n                <\/strong><\/span>\n            <\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\">\n          <div style=\"text-align:right\" class=\"form-buttons-wrapper\">\n            <button id=\"input_2\" type=\"submit\" class=\"form-submit-button\">\n              Submit 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=\"2145509229\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"2145509229-2145509229\";\n  <\/script>\n<\/form><\/body>\n<\/html>\n");