/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
* Includes a Form with javascript
* @param {Object} formId
* @param {Object} initialHeight
* @param {Object} iframeCode
*/
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
this.formId = formId;
this.initialHeight = initialHeight;
this.iframeCode = iframeCode;
this.frame = null;
this.timeInterval= 200;
this.appendTo = appendTo || false;
// initialize function for object
this.init = function(){
this.createFrame();
this.addFrameContent(this.iframeCode);
};
// Create the frame
this.createFrame = function(){
var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\">";
if(this.appendTo === false){
document.write(htmlCode);
}else{
var tmp = document.createElement('div');
tmp.innerHTML = htmlCode;
var a = this.appendTo;
document.getElementById(a).appendChild(tmp.firstChild);
}
// also get the frame for future use.
this.frame = document.getElementById(this.formId);
// set the time on the on load event of the frame
this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
};
// add event function for different browsers
this.addEvent = function( obj, type, fn ) {
if ( obj.attachEvent ) {
obj["e"+type+fn] = fn;
obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
obj.attachEvent( "on"+type, obj[type+fn] );
}
else{
obj.addEventListener( type, fn, false );
}
};
this.addFrameContent = function (string){
string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"><'+'div id="recaptcha_div"><'+'/div>'+
'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
' }<'+'/script>');
string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
frameDocument.document.open();
frameDocument.document.write(string);
setTimeout( function(){
frameDocument.document.close();
try{
if('JotFormFrameLoaded' in window){
JotFormFrameLoaded();
}
}catch(e){}
},200);
};
this.setTimer = function(){
var self = this;
this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
};
this.changeHeight = function (){
var actualHeight = this.getBodyHeight();
var currentHeight = this.getViewPortHeight();
if(actualHeight === undefined){
this.frame.style.height = "100%";
if(!this.frame.style.minHeight){
this.frame.style.minHeight = "300px";
}
}else if (Math.abs(actualHeight - currentHeight) > 18){
this.frame.style.height = (actualHeight)+"px";
}
this.setTimer();
};
this.bindMethod = function(method, scope) {
return function() {
method.apply(scope,arguments);
};
};
this.getBodyHeight = function (){
var height;
var scrollHeight;
var offsetHeight;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.document.height){
height = this.frame.contentWindow.document.height;
//Emre: to prevent "iframe height" problem (61059)
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
} else if (this.frame.contentWindow.document.body){
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
if (scrollHeight && offsetHeight){
height = Math.max(scrollHeight, offsetHeight);
}
}
}catch(e){ }
return height;
};
this.getViewPortHeight = function(){
var height = 0;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.window.innerHeight)
{
height = this.frame.contentWindow.window.innerHeight - 18;
}
else if ((this.frame.contentWindow.document.documentElement) &&
(this.frame.contentWindow.document.documentElement.clientHeight))
{
height = this.frame.contentWindow.document.documentElement.clientHeight;
}
else if ((this.frame.contentWindow.document.body) &&
(this.frame.contentWindow.document.body.clientHeight))
{
height = this.frame.contentWindow.document.body.clientHeight;
}
}catch(e){ }
return height;
};
this.init();
}
FrameBuilder.get = [];
var i93151037480 = new FrameBuilder("93151037480", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2435\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:5px;\n }\n .form-label-right{\n width:150px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:#FFFFFF;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:0px;\n width:690px;\n background:#FFFFFF;\n color:#394F5F !important;\n font-family:Verdana;\n font-size:10px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2435\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n JotForm.setCalendar(\"30\");\n JotForm.description('input_119', '20');\n JotForm.setCalendar(\"47\");\n JotForm.setCalendar(\"49\");\n });\n\n clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" enctype=\"multipart\/form-data\" name=\"form_93151037480\" id=\"93151037480\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"93151037480\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_8\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_8\" class=\"form-header\">\n Thank you for taking your time to complete the Youth Leadership Spokane Application\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <div id=\"cid_10\" class=\"form-input-wide\">\n <div id=\"text_10\" class=\"form-html\">\n <p class=\"MsoNormal\"><span style=\"font-size: small;\"><span style=\"line-height: 115%; font-family: \" Calibri \",\"sans-serif \";\">The Online Application process should take between 20-30 minutes to complete. We suggest that you complete the essay questions and have a photo ready to upload prior to beginning the online process. Please do not use the back and forward browser button as this may invalidate your form submission. If you have difficulty during the submission process, do not hesitate to contact the Leadership Spokane Office at (509) 321-3645 or\n <a href=\"mailto:Leadership@leadershipspokane.org\"><span style=\"color: windowtext;\">Leadership@leadershipspokane.org<\/span><\/a>\n for additional assistance. Please note that your online application is not complete until all of the forms noted below have been submitted to our office. <\/span><span style=\"font-size: x-small;\">** Completed applications are due by June 30th. <\/span><\/span><span style=\"font-size: x-small;\"><span style=\"line-height: 115%;\"><\/span><\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_11\" class=\"form-input-wide\">\n <div class=\"form-pagebreak\">\n <div class=\"form-pagebreak-back-container form-label-left\">\n <button type=\"button\" class=\"form-pagebreak-back\" id=\"form-pagebreak-back_11\">\n Back\n <\/button>\n <\/div>\n <div class=\"form-pagebreak-next-container\">\n <button type=\"button\" class=\"form-pagebreak-next\" id=\"form-pagebreak-next_11\">\n Next\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <\/ul>\n <ul class=\"form-section\" style=\"display:none;\">\n <li class=\"form-line\" id=\"id_14\">\n <label class=\"form-label-left\" id=\"label_14\" for=\"input_14\">\n Enter your Full name to continue<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_14\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Alphabetic]\" id=\"input_14\" name=\"q14_enterYour\" size=\"40\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_30\">\n <label class=\"form-label-left\" id=\"label_30\" for=\"input_30\"> Date <\/label>\n <div id=\"cid_30\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_30\" name=\"q30_date[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_30\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_30\" name=\"q30_date[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_30\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_30\" name=\"q30_date[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_30\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_30\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_30\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_30\" name=\"q30_date[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"13\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_30\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_30\" name=\"q30_date[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"26\" \/>\n <label class=\"form-sub-label\" for=\"min_30\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_30\" name=\"q30_date[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_30\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_30_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_30_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li id=\"cid_16\" class=\"form-input-wide\">\n <div class=\"form-pagebreak\">\n <div class=\"form-pagebreak-back-container form-label-left\">\n <button type=\"button\" class=\"form-pagebreak-back\" id=\"form-pagebreak-back_16\">\n Back\n <\/button>\n <\/div>\n <div class=\"form-pagebreak-next-container\">\n <button type=\"button\" class=\"form-pagebreak-next\" id=\"form-pagebreak-next_16\">\n Next\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <\/ul>\n <ul class=\"form-section\" style=\"display:none;\">\n <li id=\"cid_21\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_21\" class=\"form-header\">\n Youth Leadership Spokane Application\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_22\">\n <div id=\"cid_22\" class=\"form-input-wide\">\n <div id=\"text_22\" class=\"form-html\">\n Please complete each section fully. Incomplete applications will not be considered.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_20\">\n <label class=\"form-label-left\" id=\"label_20\" for=\"input_20\">\n Full Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_20\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_20\" name=\"q20_fullName\" size=\"50\" maxlength=\"150\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_23\">\n <label class=\"form-label-left\" id=\"label_23\" for=\"input_23\">\n Preferred Name<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_preferredName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_119\">\n <label class=\"form-label-left\" id=\"label_119\" for=\"input_119\">\n Date of Birth<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_119\" class=\"form-input\"><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q119_dateOf[month]\" id=\"input_119_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_119_month\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q119_dateOf[day]\" id=\"input_119_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_119_day\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q119_dateOf[year]\" id=\"input_119_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_119_year\" id=\"sublabel_year\"> Year <\/label><\/span>\n <\/div>\n <\/li>\n <li id=\"cid_126\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_126\" class=\"form-header\">\n Contact Information\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_26\">\n <label class=\"form-label-left\" id=\"label_26\" for=\"input_26\">\n Home Phone<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_26\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_26\" name=\"q26_homePhone\" size=\"13\" maxlength=\"13\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_25\">\n <label class=\"form-label-left\" id=\"label_25\" for=\"input_25\"> Cell Phone <\/label>\n <div id=\"cid_25\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[Numeric]\" id=\"input_25\" name=\"q25_cellPhone\" size=\"13\" maxlength=\"13\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_27\">\n <label class=\"form-label-left\" id=\"label_27\" for=\"input_27\">\n Email<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_27\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Email]\" id=\"input_27\" name=\"q27_email\" size=\"40\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_32\">\n <label class=\"form-label-left\" id=\"label_32\" for=\"input_32\">\n Home Street Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_32\" class=\"form-input\">\n <textarea id=\"input_32\" class=\"form-textarea validate[required]\" name=\"q32_homeStreet\" cols=\"40\" rows=\"3\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_124\">\n <label class=\"form-label-left\" id=\"label_124\" for=\"input_124\">\n City<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_124\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Alphabetic]\" id=\"input_124\" name=\"q124_city\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_125\">\n <label class=\"form-label-left\" id=\"label_125\" for=\"input_125\">\n State<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_125\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_125\" name=\"q125_state\">\n <option> <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <option value=\"Alabama\"> Alabama <\/option>\n <option value=\"Alaska\"> Alaska <\/option>\n <option value=\"Arizona\"> Arizona <\/option>\n <option value=\"Arkansas\"> Arkansas <\/option>\n <option value=\"California\"> California <\/option>\n <option value=\"Colorado\"> Colorado <\/option>\n <option value=\"Connecticut\"> Connecticut <\/option>\n <option value=\"District of Columbia\"> District of Columbia <\/option>\n <option value=\"Delaware\"> Delaware <\/option>\n <option value=\"Florida\"> Florida <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Hawaii\"> Hawaii <\/option>\n <option value=\"Idaho\"> Idaho <\/option>\n <option value=\"Illinois\"> Illinois <\/option>\n <option value=\"Indiana\"> Indiana <\/option>\n <option value=\"Iowa\"> Iowa <\/option>\n <option value=\"Kansas\"> Kansas <\/option>\n <option value=\"Kentucky\"> Kentucky <\/option>\n <option value=\"Louisiana\"> Louisiana <\/option>\n <option value=\"Maine\"> Maine <\/option>\n <option value=\"Maryland\"> Maryland <\/option>\n <option value=\"Massachusetts\"> Massachusetts <\/option>\n <option value=\"Michigan\"> Michigan <\/option>\n <option value=\"Minnesota\"> Minnesota <\/option>\n <option value=\"Mississippi\"> Mississippi <\/option>\n <option value=\"Missouri\"> Missouri <\/option>\n <option value=\"Montana\"> Montana <\/option>\n <option value=\"Nebraska\"> Nebraska <\/option>\n <option value=\"Nevada\"> Nevada <\/option>\n <option value=\"New Hampshire\"> New Hampshire <\/option>\n <option value=\"New Jersey\"> New Jersey <\/option>\n <option value=\"New Mexico\"> New Mexico <\/option>\n <option value=\"New York\"> New York <\/option>\n <option value=\"North Carolina\"> North Carolina <\/option>\n <option value=\"North Dakota\"> North Dakota <\/option>\n <option value=\"Ohio\"> Ohio <\/option>\n <option value=\"Oklahoma\"> Oklahoma <\/option>\n <option value=\"Oregon\"> Oregon <\/option>\n <option value=\"Pennsylvania\"> Pennsylvania <\/option>\n <option value=\"Rhode Island\"> Rhode Island <\/option>\n <option value=\"South Carolina\"> South Carolina <\/option>\n <option value=\"South Dakota\"> South Dakota <\/option>\n <option value=\"Tennessee\"> Tennessee <\/option>\n <option value=\"Texas\"> Texas <\/option>\n <option value=\"Utah\"> Utah <\/option>\n <option value=\"Vermont\"> Vermont <\/option>\n <option value=\"Virginia\"> Virginia <\/option>\n <option value=\"Washington\"> Washington <\/option>\n <option value=\"West Virginia\"> West Virginia <\/option>\n <option value=\"Wisconsin\"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <option value=\"Alberta\"> Alberta <\/option>\n <option value=\"British Columbia\"> British Columbia <\/option>\n <option value=\"Manitoba\"> Manitoba <\/option>\n <option value=\"New Brunswick\"> New Brunswick <\/option>\n <option value=\"Newfoundland\"> Newfoundland <\/option>\n <option value=\"Northwest Territories\"> Northwest Territories <\/option>\n <option value=\"Nova Scotia\"> Nova Scotia <\/option>\n <option value=\"Nunavut\"> Nunavut <\/option>\n <option value=\"Ontario\"> Ontario <\/option>\n <option value=\"Prince Edward Island\"> Prince Edward Island <\/option>\n <option value=\"Quebec\"> Quebec <\/option>\n <option value=\"Saskatchewan\"> Saskatchewan <\/option>\n <option value=\"Yukon\"> Yukon <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_123\">\n <label class=\"form-label-left\" id=\"label_123\" for=\"input_123\">\n Zip Code<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_123\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required, Numeric]\" id=\"input_123\" name=\"q123_zipCode\" size=\"5\" maxlength=\"5\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_127\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_127\" class=\"form-header\">\n About You\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_36\">\n <label class=\"form-label-left\" id=\"label_36\" for=\"input_36\">\n What accommodations do you need to participate fully in the program? (Enter NA for Not Applicable)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_36\" class=\"form-input\">\n <textarea id=\"input_36\" class=\"form-textarea validate[required]\" name=\"q36_whatAccommodations\" cols=\"50\" rows=\"5\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_37\">\n <label class=\"form-label-left\" id=\"label_37\" for=\"input_37\">\n Do you have dietary restrictions?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_37\" 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_37_0\" name=\"q37_doYou\" value=\"Yes\" \/>\n <label for=\"input_37_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_37_1\" name=\"q37_doYou\" value=\"No\" \/>\n <label for=\"input_37_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_38\">\n <label class=\"form-label-left\" id=\"label_38\" for=\"input_38\"> If Yes, please Specify. <\/label>\n <div id=\"cid_38\" class=\"form-input\">\n <textarea id=\"input_38\" class=\"form-textarea\" name=\"q38_ifYes\" cols=\"40\" rows=\"3\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_121\">\n <label class=\"form-label-left\" id=\"label_121\" for=\"input_121\">\n How did you find out about Youth Leadership Spokane?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_121\" 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_121_0\" name=\"q121_howDid[]\" value=\"Friend\" \/>\n <label for=\"input_121_0\"> Friend <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_121_1\" name=\"q121_howDid[]\" value=\"Website\" \/>\n <label for=\"input_121_1\"> Website <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_121_2\" name=\"q121_howDid[]\" value=\"Mentoring Program\" \/>\n <label for=\"input_121_2\"> Mentoring Program <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_121_3\" name=\"q121_howDid[]\" value=\"Family Member\" \/>\n <label for=\"input_121_3\"> Family Member <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_121_4\" name=\"q121_howDid[]\" value=\"YLS Alumni\" \/>\n <label for=\"input_121_4\"> YLS Alumni <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_121_5\" name=\"q121_howDid[]\" value=\"Other\" \/>\n <label for=\"input_121_5\"> Other <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_122\">\n <label class=\"form-label-left\" id=\"label_122\" for=\"input_122\"> If other, please specify <\/label>\n <div id=\"cid_122\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_122\" name=\"q122_ifOther\" size=\"40\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_175\">\n <div id=\"cid_175\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_167\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_167\" class=\"form-header\">\n COMMUNITY ASSESSMENT\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_169\">\n <label class=\"form-label-left\" id=\"label_169\" for=\"input_169\">\n Do you believe that youth should be responsible in helping to solve community issues?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_169\" 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_169_0\" name=\"q169_doYou169[]\" value=\"Yes\" \/>\n <label for=\"input_169_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_169_1\" name=\"q169_doYou169[]\" value=\"No\" \/>\n <label for=\"input_169_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_170\">\n <label class=\"form-label-left\" id=\"label_170\" for=\"input_170\">\n Why or why not?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_170\" class=\"form-input\">\n <textarea id=\"input_170\" class=\"form-textarea validate[required]\" name=\"q170_whyOr\" cols=\"50\" rows=\"8\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_171\">\n <div id=\"cid_171\" class=\"form-input-wide\">\n <div id=\"text_171\" class=\"form-html\">\n What do you see as the three most important issues facing the community? Explain.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_172\">\n <label class=\"form-label-left\" id=\"label_172\" for=\"input_172\">\n Issue 1<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_172\" class=\"form-input\">\n <textarea id=\"input_172\" class=\"form-textarea validate[required]\" name=\"q172_issue1\" cols=\"45\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_174\">\n <label class=\"form-label-left\" id=\"label_174\" for=\"input_174\">\n Issue 2<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_174\" class=\"form-input\">\n <textarea id=\"input_174\" class=\"form-textarea validate[required]\" name=\"q174_issue2\" cols=\"45\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_173\">\n <label class=\"form-label-left\" id=\"label_173\" for=\"input_173\">\n Issue 3<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_173\" class=\"form-input\">\n <textarea id=\"input_173\" class=\"form-textarea validate[required]\" name=\"q173_issue3\" cols=\"45\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_177\">\n <div id=\"cid_177\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_40\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_40\" class=\"form-header\">\n EDUCATION\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_120\">\n <label class=\"form-label-left\" id=\"label_120\" for=\"input_120\">\n Year in School<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_120\" 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_120_0\" name=\"q120_yearIn\" value=\"Sophomore\" \/>\n <label for=\"input_120_0\"> Sophomore <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_120_1\" name=\"q120_yearIn\" value=\"Junior\" \/>\n <label for=\"input_120_1\"> Junior <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_120_2\" name=\"q120_yearIn\" value=\"Senior\" \/>\n <label for=\"input_120_2\"> Senior <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_120_3\" name=\"q120_yearIn\" value=\"Not in High School\" \/>\n <label for=\"input_120_3\"> Not in High School <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_51\">\n <div id=\"cid_51\" class=\"form-input-wide\">\n <div id=\"text_51\" class=\"form-html\">\n Please enter the name of your current high school.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_45\">\n <label class=\"form-label-left\" id=\"label_45\" for=\"input_45\">\n School Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_45\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_45\" name=\"q45_schoolName\" size=\"50\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_47\">\n <label class=\"form-label-left\" id=\"label_47\" for=\"input_47\"> Date From <\/label>\n <div id=\"cid_47\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_47\" name=\"q47_dateFrom[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_47\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_47\" name=\"q47_dateFrom[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_47\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_47\" name=\"q47_dateFrom[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_47\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_47\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_47\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_47\" name=\"q47_dateFrom[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"13\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_47\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_47\" name=\"q47_dateFrom[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"26\" \/>\n <label class=\"form-sub-label\" for=\"min_47\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_47\" name=\"q47_dateFrom[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_47\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_47_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_47_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_49\">\n <label class=\"form-label-left\" id=\"label_49\" for=\"input_49\"> Date To <\/label>\n <div id=\"cid_49\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_49\" name=\"q49_dateTo[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_49\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_49\" name=\"q49_dateTo[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_49\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_49\" name=\"q49_dateTo[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_49\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_49\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_49\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_49\" name=\"q49_dateTo[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"13\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_49\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_49\" name=\"q49_dateTo[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"26\" \/>\n <label class=\"form-sub-label\" for=\"min_49\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_49\" name=\"q49_dateTo[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_49\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_49_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_49_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_129\">\n <label class=\"form-label-left\" id=\"label_129\" for=\"input_129\">\n Name of Counselor<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_129\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_129\" name=\"q129_nameOf\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_176\">\n <div id=\"cid_176\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_81\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_81\" class=\"form-header\">\n ORGANIZATIONS AND ACTIVITIES\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_80\">\n <div id=\"cid_80\" class=\"form-input-wide\">\n <div id=\"text_80\" class=\"form-html\">\n This section will allow us to know you more. Please list in order of importance to you, up to four school, volunteer, religious, community, athletic or other activities or organizations in which you have participated during the last four years. Lack of previous participation WILL NOT exclude students from the selection process.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_130\">\n <label class=\"form-label-left\" id=\"label_130\" for=\"input_130\"> Organization 1 <\/label>\n <div id=\"cid_130\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_130\" name=\"q130_organization1\" size=\"45\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_132\">\n <label class=\"form-label-left\" id=\"label_132\" for=\"input_132\"> Explain your involvement <\/label>\n <div id=\"cid_132\" class=\"form-input\">\n <textarea id=\"input_132\" class=\"form-textarea\" name=\"q132_explainYour\" cols=\"40\" rows=\"4\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_131\">\n <label class=\"form-label-left\" id=\"label_131\" for=\"input_131\"> Organization 2 <\/label>\n <div id=\"cid_131\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_131\" name=\"q131_organization2\" size=\"45\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_133\">\n <label class=\"form-label-left\" id=\"label_133\" for=\"input_133\"> Explain your involvement <\/label>\n <div id=\"cid_133\" class=\"form-input\">\n <textarea id=\"input_133\" class=\"form-textarea\" name=\"q133_explainYour133\" cols=\"40\" rows=\"4\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_134\">\n <label class=\"form-label-left\" id=\"label_134\" for=\"input_134\"> Organization 3 <\/label>\n <div id=\"cid_134\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_134\" name=\"q134_organization3\" size=\"45\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_135\">\n <label class=\"form-label-left\" id=\"label_135\" for=\"input_135\"> Explain your involvement <\/label>\n <div id=\"cid_135\" class=\"form-input\">\n <textarea id=\"input_135\" class=\"form-textarea\" name=\"q135_explainYour135\" cols=\"40\" rows=\"4\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_136\">\n <label class=\"form-label-left\" id=\"label_136\" for=\"input_136\"> Organization 4 <\/label>\n <div id=\"cid_136\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_136\" name=\"q136_organization4\" size=\"45\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_137\">\n <label class=\"form-label-left\" id=\"label_137\" for=\"input_137\"> Explain your involvement <\/label>\n <div id=\"cid_137\" class=\"form-input\">\n <textarea id=\"input_137\" class=\"form-textarea\" name=\"q137_explainYour137\" cols=\"40\" rows=\"4\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_178\">\n <div id=\"cid_178\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_145\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_145\" class=\"form-header\">\n EMPLOYMENT\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_143\">\n <label class=\"form-label-left\" id=\"label_143\" for=\"input_143\">\n Do you currently have a part-time job?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_143\" 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_143_0\" name=\"q143_doYou143[]\" value=\"Yes\" \/>\n <label for=\"input_143_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_143_1\" name=\"q143_doYou143[]\" value=\"No\" \/>\n <label for=\"input_143_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_147\">\n <label class=\"form-label-left\" id=\"label_147\" for=\"input_147\"> If yes, how many hours per week? <\/label>\n <div id=\"cid_147\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[Numeric]\" id=\"input_147\" name=\"q147_ifYes147\" size=\"2\" maxlength=\"2\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_146\">\n <label class=\"form-label-left\" id=\"label_146\" for=\"input_146\">\n If selected for Youth Leadership Spokane, would participation interfere with your job?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_146\" 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_146_0\" name=\"q146_ifSelected[]\" value=\"Yes\" \/>\n <label for=\"input_146_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_146_1\" name=\"q146_ifSelected[]\" value=\"No\" \/>\n <label for=\"input_146_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_146_2\" name=\"q146_ifSelected[]\" value=\"I do not have a Job\" \/>\n <label for=\"input_146_2\"> I do not have a Job <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_144\">\n <div id=\"cid_144\" class=\"form-input-wide\">\n <div id=\"text_144\" class=\"form-html\">\n List any job experiences you\u2019ve had, paid or volunteer, and briefly tell us what your responsibility was.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_159\">\n <label class=\"form-label-left\" id=\"label_159\" for=\"input_159\"> Employment 1 <\/label>\n <div id=\"cid_159\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_159\" name=\"q159_employment1\" size=\"40\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_165\">\n <label class=\"form-label-left\" id=\"label_165\" for=\"input_165\"> Responsibilities <\/label>\n <div id=\"cid_165\" class=\"form-input\">\n <textarea id=\"input_165\" class=\"form-textarea\" name=\"q165_responsibilities\" cols=\"35\" rows=\"3\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_162\">\n <label class=\"form-label-left\" id=\"label_162\" for=\"input_162\"> Employment 2 <\/label>\n <div id=\"cid_162\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_162\" name=\"q162_employment2\" size=\"40\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_164\">\n <label class=\"form-label-left\" id=\"label_164\" for=\"input_164\"> Responsibilities <\/label>\n <div id=\"cid_164\" class=\"form-input\">\n <textarea id=\"input_164\" class=\"form-textarea\" name=\"q164_responsibilities164\" cols=\"35\" rows=\"3\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_161\">\n <label class=\"form-label-left\" id=\"label_161\" for=\"input_161\"> Employment 3 <\/label>\n <div id=\"cid_161\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_161\" name=\"q161_employment3\" size=\"40\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_166\">\n <label class=\"form-label-left\" id=\"label_166\" for=\"input_166\"> Responsibilities <\/label>\n <div id=\"cid_166\" class=\"form-input\">\n <textarea id=\"input_166\" class=\"form-textarea\" name=\"q166_responsibilities166\" cols=\"35\" rows=\"3\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_179\">\n <div id=\"cid_179\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_150\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_150\" class=\"form-header\">\n TIME COMMITMENT\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_149\">\n <div id=\"cid_149\" class=\"form-input-wide\">\n <div id=\"text_149\" class=\"form-html\">\n If you participate in other outside activities such as sports or clubs, please list them below and identify the general time commitment you expect during the school year.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_151\">\n <label class=\"form-label-left\" id=\"label_151\" for=\"input_151\"> Activity 1 <\/label>\n <div id=\"cid_151\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_151\" name=\"q151_activity1\" size=\"35\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_152\">\n <label class=\"form-label-left\" id=\"label_152\" for=\"input_152\"> Time Commitment per Week (e.g. 2 Hours) <\/label>\n <div id=\"cid_152\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_152\" name=\"q152_timeCommitment152\" size=\"2\" maxlength=\"2\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_153\">\n <label class=\"form-label-left\" id=\"label_153\" for=\"input_153\"> Activity 2 <\/label>\n <div id=\"cid_153\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_153\" name=\"q153_activity2\" size=\"35\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_154\">\n <label class=\"form-label-left\" id=\"label_154\" for=\"input_154\"> Time Commitment per Week (e.g. 2 Hours) <\/label>\n <div id=\"cid_154\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_154\" name=\"q154_timeCommitment154\" size=\"2\" maxlength=\"2\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_158\">\n <label class=\"form-label-left\" id=\"label_158\" for=\"input_158\"> Activity 3 <\/label>\n <div id=\"cid_158\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_158\" name=\"q158_activity3\" size=\"35\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_157\">\n <label class=\"form-label-left\" id=\"label_157\" for=\"input_157\"> Time Commitment per Week (e.g. 2 Hours) <\/label>\n <div id=\"cid_157\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_157\" name=\"q157_timeCommitment157\" size=\"2\" maxlength=\"2\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_156\">\n <label class=\"form-label-left\" id=\"label_156\" for=\"input_156\"> Activity 4 <\/label>\n <div id=\"cid_156\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_156\" name=\"q156_activity4\" size=\"35\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_155\">\n <label class=\"form-label-left\" id=\"label_155\" for=\"input_155\"> Time Commitment per Week (e.g. 2 Hours) <\/label>\n <div id=\"cid_155\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_155\" name=\"q155_timeCommitment155\" size=\"2\" maxlength=\"2\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_180\">\n <div id=\"cid_180\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_86\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_86\" class=\"form-header\">\n ESSAY QUESTIONS\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_84\">\n <div id=\"cid_84\" class=\"form-input-wide\">\n <div id=\"text_84\" class=\"form-html\">\n In the next page, you will have the opportunity to upload your essays and a photograph of yourself. Please note that the essays must be saved in word processor format, or .pdf formats.\n <\/div>\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 Below are the list of Essay Questions you must include in your essay. Please answer them to the best of your ability. Limit your essays to no more than two pages total.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_88\">\n <div id=\"cid_88\" class=\"form-input-wide\">\n <div id=\"text_88\" class=\"form-html\">\n 1. Describe the one thing about yourself that you feel most proud about. Explain why.\n <\/div>\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 2. What types of activities and or issues interest you?\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_90\">\n <div id=\"cid_90\" class=\"form-input-wide\">\n <div id=\"text_90\" class=\"form-html\">\n 3. Which one person do you look up to the most and why?\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_138\">\n <div id=\"cid_138\" class=\"form-input-wide\">\n <div id=\"text_138\" class=\"form-html\">\n 4. What do you hope to gain if selected to participate in Youth Leadership Spokane?\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_181\">\n <div id=\"cid_181\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\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 Attach your Essay<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_93\" class=\"form-input\">\n <input class=\"form-upload validate[required]\" type=\"file\" id=\"input_93\" name=\"q93_attachYour\" file-accept=\"doc, pdf, docx\" file-maxsize=\"7000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_141\">\n <label class=\"form-label-left\" id=\"label_141\" for=\"input_141\">\n Attach a photo of Yourself<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_141\" class=\"form-input\">\n <input class=\"form-upload validate[required]\" type=\"file\" id=\"input_141\" name=\"q141_attachA\" file-accept=\"jpg, jpeg, gif, png\" file-maxsize=\"5000\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_182\">\n <div id=\"cid_182\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_94\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_94\" class=\"form-header\">\n Scholarship\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_140\">\n <div id=\"cid_140\" class=\"form-input-wide\">\n <div id=\"text_140\" class=\"form-html\">\n Scholarships are an important part of the YLS program. We know that there are students who just can\u2019t afford the program but who would benefit from it and bring a lot to the experience of the rest of the class. If this is your situation, please do not hesitate to ask for a scholarship. It\u2019s a completely confidential process. No one accepted into the program will be denied participation for financial reasons.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_139\">\n <label class=\"form-label-left\" id=\"label_139\" for=\"input_139\">\n Will you be requesting Scholarship assistance?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_139\" 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_139_0\" name=\"q139_willYou\" value=\"Yes\" \/>\n <label for=\"input_139_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_139_1\" name=\"q139_willYou\" value=\"No\" \/>\n <label for=\"input_139_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_99\">\n <div id=\"cid_99\" class=\"form-input-wide\">\n <div id=\"text_99\" class=\"form-html\">\n If requesting Scholarship, Please complete this section. Otherwise, skip to the next page.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_100\">\n <label class=\"form-label-left\" id=\"label_100\" for=\"input_100\"> Why are you requesting Scholarship? <\/label>\n <div id=\"cid_100\" class=\"form-input\">\n <textarea id=\"input_100\" class=\"form-textarea\" name=\"q100_whyAre\" cols=\"45\" rows=\"5\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_183\">\n <div id=\"cid_183\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <a href=\"http:\/\/www.leadershipspokane.org\" target=\"_blank\"><img alt=\"\" class=\"form-image\" border=\"0\" src=\"http:\/\/www.leadershipspokane.org\/images\/LSLOGO.jpg\" height=\"93\" width=\"250\" \/><\/a>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_117\">\n <div id=\"cid_117\" class=\"form-input-wide\">\n <div id=\"text_117\" class=\"form-html\">\n You are almost done.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_118\">\n <label class=\"form-label-left\" id=\"label_118\" for=\"input_118\">\n By clicking the submit button below, I affirm that the information entered in my Leadership Spokane application is true to the best of my knowledge. I understand that my application is not complete until I submit the additional forms located at www. www.leadershipspokane.org\/apply-now\/application-forms.<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_118\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_118_0\" name=\"q118_byClicking118[]\" value=\"I Agree\" \/>\n <label for=\"input_118_0\"> I Agree <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_1\">\n <div id=\"cid_1\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_1\" type=\"submit\" class=\"form-submit-button\">\n Submit\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=\"93151037480\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"93151037480-93151037480\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");