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document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("            <h2 class=\"fsSectionHeading\">PERSONAL INFORMATION</h2>"+"\n");
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document.write("                                                    "+"\n");
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document.write("                                                    "+"\n");
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document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
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document.write("                        "+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                                                                "+"\n");
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document.write("                "+"\n");
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document.write("                                                   "+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
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document.write("                                                    "+"\n");
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document.write("                                                    "+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("            "+"\n");
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document.write("                        "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                    <label id=\"label10631718\" class=\"fsLabel\" for=\"field10631718\">Country                                            </label>"+"\n");
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document.write("                                                   "+"\n");
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document.write("        <option value=\"ALB\" >Albania</option>"+"\n");
document.write("        <option value=\"DZA\" >Algeria</option>"+"\n");
document.write("        <option value=\"ASM\" >American Samoa</option>"+"\n");
document.write("        <option value=\"AND\" >Andorra</option>"+"\n");
document.write("        <option value=\"AGO\" >Angola</option>"+"\n");
document.write("        <option value=\"AIA\" >Anguilla</option>"+"\n");
document.write("        <option value=\"ATA\" >Antarctica</option>"+"\n");
document.write("        <option value=\"ATG\" >Antigua and Barbuda</option>"+"\n");
document.write("        <option value=\"ARG\" >Argentina</option>"+"\n");
document.write("        <option value=\"ARM\" >Armenia</option>"+"\n");
document.write("        <option value=\"ABW\" >Aruba</option>"+"\n");
document.write("        <option value=\"AUS\" >Australia</option>"+"\n");
document.write("        <option value=\"AUT\" >Austria</option>"+"\n");
document.write("        <option value=\"AZE\" >Azerbaijan</option>"+"\n");
document.write("        <option value=\"BHS\" >Bahamas</option>"+"\n");
document.write("        <option value=\"BHR\" >Bahrain</option>"+"\n");
document.write("        <option value=\"BGD\" >Bangladesh</option>"+"\n");
document.write("        <option value=\"BRB\" >Barbados</option>"+"\n");
document.write("        <option value=\"BLR\" >Belarus</option>"+"\n");
document.write("        <option value=\"BEL\" >Belgium</option>"+"\n");
document.write("        <option value=\"BLZ\" >Belize</option>"+"\n");
document.write("        <option value=\"BEN\" >Benin</option>"+"\n");
document.write("        <option value=\"BMU\" >Bermuda</option>"+"\n");
document.write("        <option value=\"BTN\" >Bhutan</option>"+"\n");
document.write("        <option value=\"BOL\" >Bolivia</option>"+"\n");
document.write("        <option value=\"BIH\" >Bosnia and Herzegovina</option>"+"\n");
document.write("        <option value=\"BWA\" >Botswana</option>"+"\n");
document.write("        <option value=\"BVT\" >Bouvet Island</option>"+"\n");
document.write("        <option value=\"BRA\" >Brazil</option>"+"\n");
document.write("        <option value=\"IOT\" >British Indian Ocean Territory</option>"+"\n");
document.write("        <option value=\"BRN\" >Brunei Darussalam</option>"+"\n");
document.write("        <option value=\"BGR\" >Bulgaria</option>"+"\n");
document.write("        <option value=\"BFA\" >Burkina Faso</option>"+"\n");
document.write("        <option value=\"BDI\" >Burundi</option>"+"\n");
document.write("        <option value=\"BYS\" >Cambodia</option>"+"\n");
document.write("        <option value=\"KHM\" >Cameroon</option>"+"\n");
document.write("        <option value=\"CMR\" >Canada</option>"+"\n");
document.write("        <option value=\"CAN\" >Cape Verde</option>"+"\n");
document.write("        <option value=\"CPV\" >Cayman Islands</option>"+"\n");
document.write("        <option value=\"CYM\" >Central African Republic</option>"+"\n");
document.write("        <option value=\"CAF\" >Chad</option>"+"\n");
document.write("        <option value=\"TCD\" >Chile</option>"+"\n");
document.write("        <option value=\"CHL\" >China</option>"+"\n");
document.write("        <option value=\"CHN\" >Christmas Island</option>"+"\n");
document.write("        <option value=\"CXR\" >Cocos (Keeling) Islands</option>"+"\n");
document.write("        <option value=\"CCK\" >Colombia</option>"+"\n");
document.write("        <option value=\"COL\" >Comoros</option>"+"\n");
document.write("        <option value=\"COM\" >Congo</option>"+"\n");
document.write("        <option value=\"COG\" >Congo, The Democratic Republic of the</option>"+"\n");
document.write("        <option value=\"COK\" >Cook Islands</option>"+"\n");
document.write("        <option value=\"CRI\" >Costa Rica</option>"+"\n");
document.write("        <option value=\"CIV\" >C</option>"+"\n");
document.write("        <option value=\"HRV\" >Croatia</option>"+"\n");
document.write("        <option value=\"CUB\" >Cuba</option>"+"\n");
document.write("        <option value=\"CR\" >Cyprus</option>"+"\n");
document.write("        <option value=\"CYP\" >Czech Republic</option>"+"\n");
document.write("        <option value=\"CZE\" >Denmark</option>"+"\n");
document.write("        <option value=\"CZ\" >Djibouti</option>"+"\n");
document.write("        <option value=\"DNK\" >Dominica</option>"+"\n");
document.write("        <option value=\"DJI\" >Dominican Republic</option>"+"\n");
document.write("        <option value=\"DMA\" >Ecuador</option>"+"\n");
document.write("        <option value=\"DOM\" >Egypt</option>"+"\n");
document.write("        <option value=\"TMP\" >El Salvador</option>"+"\n");
document.write("        <option value=\"ECU\" >Equatorial Guinea</option>"+"\n");
document.write("        <option value=\"EGY\" >Eritrea</option>"+"\n");
document.write("        <option value=\"SLV\" >Estonia</option>"+"\n");
document.write("        <option value=\"GNQ\" >Ethiopia</option>"+"\n");
document.write("        <option value=\"EST\" >Falkland Islands (Malvinas)</option>"+"\n");
document.write("        <option value=\"ETH\" >Faroe Islands</option>"+"\n");
document.write("        <option value=\"FLK\" >Fiji</option>"+"\n");
document.write("        <option value=\"FRO\" >Finland</option>"+"\n");
document.write("        <option value=\"FJI\" >France</option>"+"\n");
document.write("        <option value=\"FIN\" >French Guiana</option>"+"\n");
document.write("        <option value=\"FRA\" >French Polynesia</option>"+"\n");
document.write("        <option value=\"FXX\" >French Southern Territories</option>"+"\n");
document.write("        <option value=\"GUF\" >Gabon</option>"+"\n");
document.write("        <option value=\"PYF\" >Gambia</option>"+"\n");
document.write("        <option value=\"ATF\" >Georgia</option>"+"\n");
document.write("        <option value=\"GAB\" >Germany</option>"+"\n");
document.write("        <option value=\"GMB\" >Ghana</option>"+"\n");
document.write("        <option value=\"GEO\" >Gibraltar</option>"+"\n");
document.write("        <option value=\"DEU\" >Greece</option>"+"\n");
document.write("        <option value=\"GHA\" >Greenland</option>"+"\n");
document.write("        <option value=\"GIB\" >Grenada</option>"+"\n");
document.write("        <option value=\"GRC\" >Guadeloupe</option>"+"\n");
document.write("        <option value=\"GRL\" >Guam</option>"+"\n");
document.write("        <option value=\"GRD\" >Guatemala</option>"+"\n");
document.write("        <option value=\"GLP\" >Guernsey</option>"+"\n");
document.write("        <option value=\"GUM\" >Guinea</option>"+"\n");
document.write("        <option value=\"GTM\" >Guinea-bissau</option>"+"\n");
document.write("        <option value=\"GIN\" >Guyana</option>"+"\n");
document.write("        <option value=\"GNB\" >Haiti</option>"+"\n");
document.write("        <option value=\"GUY\" >Heard Island and Mcdonald Islands</option>"+"\n");
document.write("        <option value=\"HTI\" >Holy See (Vatican City State)</option>"+"\n");
document.write("        <option value=\"HMD\" >Honduras</option>"+"\n");
document.write("        <option value=\"HND\" >Hong Kong</option>"+"\n");
document.write("        <option value=\"HKG\" >Hungary</option>"+"\n");
document.write("        <option value=\"HUN\" >Iceland</option>"+"\n");
document.write("        <option value=\"ISL\" >India</option>"+"\n");
document.write("        <option value=\"IND\" >Indonesia</option>"+"\n");
document.write("        <option value=\"IDN\" >Iran, Islamic Republic of</option>"+"\n");
document.write("        <option value=\"IRN\" >Iraq</option>"+"\n");
document.write("        <option value=\"IRQ\" >Ireland</option>"+"\n");
document.write("        <option value=\"IRL\" >Isle of Man</option>"+"\n");
document.write("        <option value=\"ISR\" >Israel</option>"+"\n");
document.write("        <option value=\"ITA\" >Italy</option>"+"\n");
document.write("        <option value=\"JAM\" >Jamaica</option>"+"\n");
document.write("        <option value=\"JPN\" >Japan</option>"+"\n");
document.write("        <option value=\"JOR\" >Jersey</option>"+"\n");
document.write("        <option value=\"KAZ\" >Jordan</option>"+"\n");
document.write("        <option value=\"KEN\" >Kazakhstan</option>"+"\n");
document.write("        <option value=\"KIR\" >Kenya</option>"+"\n");
document.write("        <option value=\"PRK\" >Kiribati</option>"+"\n");
document.write("        <option value=\"KOR\" >Korea, Democratic People&#039;s Republic of</option>"+"\n");
document.write("        <option value=\"KWT\" >Korea, Republic of</option>"+"\n");
document.write("        <option value=\"KGZ\" >Kuwait</option>"+"\n");
document.write("        <option value=\"LAO\" >Kyrgyzstan</option>"+"\n");
document.write("        <option value=\"LVA\" >Lao People&#039;s Democratic Republic</option>"+"\n");
document.write("        <option value=\"LBN\" >Latvia</option>"+"\n");
document.write("        <option value=\"LSO\" >Lebanon</option>"+"\n");
document.write("        <option value=\"LBR\" >Lesotho</option>"+"\n");
document.write("        <option value=\"LBY\" >Liberia</option>"+"\n");
document.write("        <option value=\"LIE\" >Libyan Arab Jamahiriya</option>"+"\n");
document.write("        <option value=\"LTU\" >Liechtenstein</option>"+"\n");
document.write("        <option value=\"LUX\" >Lithuania</option>"+"\n");
document.write("        <option value=\"MAC\" >Luxembourg</option>"+"\n");
document.write("        <option value=\"MKD\" >Macao</option>"+"\n");
document.write("        <option value=\"MDG\" >Macedonia, The Former Yugoslav Republic of</option>"+"\n");
document.write("        <option value=\"MWI\" >Madagascar</option>"+"\n");
document.write("        <option value=\"MYS\" >Malawi</option>"+"\n");
document.write("        <option value=\"MDV\" >Malaysia</option>"+"\n");
document.write("        <option value=\"MLI\" >Maldives</option>"+"\n");
document.write("        <option value=\"MLT\" >Mali</option>"+"\n");
document.write("        <option value=\"MHL\" >Malta</option>"+"\n");
document.write("        <option value=\"MTQ\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"MRT\" >Martinique</option>"+"\n");
document.write("        <option value=\"MUS\" >Mauritania</option>"+"\n");
document.write("        <option value=\"MYT\" >Mauritius</option>"+"\n");
document.write("        <option value=\"MEX\" >Mayotte</option>"+"\n");
document.write("        <option value=\"FSM\" >Mexico</option>"+"\n");
document.write("        <option value=\"MDA\" >Micronesia, Federated States of</option>"+"\n");
document.write("        <option value=\"MCO\" >Moldova, Republic of</option>"+"\n");
document.write("        <option value=\"MNG\" >Monaco</option>"+"\n");
document.write("        <option value=\"MSR\" >Mongolia</option>"+"\n");
document.write("        <option value=\"MAR\" >Montenegro</option>"+"\n");
document.write("        <option value=\"MOZ\" >Montserrat</option>"+"\n");
document.write("        <option value=\"MMR\" >Morocco</option>"+"\n");
document.write("        <option value=\"NAM\" >Mozambique</option>"+"\n");
document.write("        <option value=\"NRU\" >Myanmar</option>"+"\n");
document.write("        <option value=\"NPL\" >Namibia</option>"+"\n");
document.write("        <option value=\"ANT\" >Nauru</option>"+"\n");
document.write("        <option value=\"NLD\" >Nepal</option>"+"\n");
document.write("        <option value=\"NTZ\" >Netherlands</option>"+"\n");
document.write("        <option value=\"NCL\" >Netherlands Antilles</option>"+"\n");
document.write("        <option value=\"NZL\" >New Caledonia</option>"+"\n");
document.write("        <option value=\"NIC\" >New Zealand</option>"+"\n");
document.write("        <option value=\"NER\" >Nicaragua</option>"+"\n");
document.write("        <option value=\"NGA\" >Niger</option>"+"\n");
document.write("        <option value=\"NIU\" >Nigeria</option>"+"\n");
document.write("        <option value=\"NFK\" >Niue</option>"+"\n");
document.write("        <option value=\"MNP\" >Norfolk Island</option>"+"\n");
document.write("        <option value=\"NOR\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"OMN\" >Norway</option>"+"\n");
document.write("        <option value=\"PAK\" >Oman</option>"+"\n");
document.write("        <option value=\"PLW\" >Pakistan</option>"+"\n");
document.write("        <option value=\"PAN\" >Palau</option>"+"\n");
document.write("        <option value=\"PNG\" >Palestinian Territory</option>"+"\n");
document.write("        <option value=\"PRY\" >Panama</option>"+"\n");
document.write("        <option value=\"PER\" >Papua New Guinea</option>"+"\n");
document.write("        <option value=\"PHL\" >Paraguay</option>"+"\n");
document.write("        <option value=\"PCN\" >Peru</option>"+"\n");
document.write("        <option value=\"POL\" >Philippines</option>"+"\n");
document.write("        <option value=\"PRT\" >Pitcairn</option>"+"\n");
document.write("        <option value=\"PRI\" >Poland</option>"+"\n");
document.write("        <option value=\"QAT\" >Portugal</option>"+"\n");
document.write("        <option value=\"REU\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"ROM\" >Qatar</option>"+"\n");
document.write("        <option value=\"RUS\" >Reunion</option>"+"\n");
document.write("        <option value=\"RWA\" >Romania</option>"+"\n");
document.write("        <option value=\"KNA\" >Russian Federation</option>"+"\n");
document.write("        <option value=\"LCA\" >Rwanda</option>"+"\n");
document.write("        <option value=\"VCT\" >Saint Barth</option>"+"\n");
document.write("        <option value=\"WSM\" >Saint Helena</option>"+"\n");
document.write("        <option value=\"SMR\" >Saint Kitts and Nevis</option>"+"\n");
document.write("        <option value=\"STP\" >Saint Lucia</option>"+"\n");
document.write("        <option value=\"SAU\" >Saint Martin</option>"+"\n");
document.write("        <option value=\"SEN\" >Saint Pierre and Miquelon</option>"+"\n");
document.write("        <option value=\"SYC\" >Saint Vincent and the Grenadines</option>"+"\n");
document.write("        <option value=\"SLE\" >Samoa</option>"+"\n");
document.write("        <option value=\"SGP\" >San Marino</option>"+"\n");
document.write("        <option value=\"SVK\" >Sao Tome and Principe</option>"+"\n");
document.write("        <option value=\"SVN\" >Saudi Arabia</option>"+"\n");
document.write("        <option value=\"SLB\" >Senegal</option>"+"\n");
document.write("        <option value=\"SOM\" >Serbia</option>"+"\n");
document.write("        <option value=\"ZAF\" >Seychelles</option>"+"\n");
document.write("        <option value=\"ESP\" >Sierra Leone</option>"+"\n");
document.write("        <option value=\"LKA\" >Singapore</option>"+"\n");
document.write("        <option value=\"SHN\" >Slovakia</option>"+"\n");
document.write("        <option value=\"ST\" >Slovenia</option>"+"\n");
document.write("        <option value=\"SPM\" >Solomon Islands</option>"+"\n");
document.write("        <option value=\"SDN\" >Somalia</option>"+"\n");
document.write("        <option value=\"SUR\" >South Africa</option>"+"\n");
document.write("        <option value=\"SJM\" >South Georgia and the South Sandwich Islands</option>"+"\n");
document.write("        <option value=\"SWZ\" >Spain</option>"+"\n");
document.write("        <option value=\"SWE\" >Sri Lanka</option>"+"\n");
document.write("        <option value=\"CHE\" >Sudan</option>"+"\n");
document.write("        <option value=\"SYR\" >Suriname</option>"+"\n");
document.write("        <option value=\"TWN\" >Svalbard and Jan Mayen</option>"+"\n");
document.write("        <option value=\"TJK\" >Swaziland</option>"+"\n");
document.write("        <option value=\"TZA\" >Sweden</option>"+"\n");
document.write("        <option value=\"THA\" >Switzerland</option>"+"\n");
document.write("        <option value=\"TIB\" >Syrian Arab Republic</option>"+"\n");
document.write("        <option value=\"TGO\" >Taiwan, Province of China</option>"+"\n");
document.write("        <option value=\"TKL\" >Tajikistan</option>"+"\n");
document.write("        <option value=\"TON\" >Tanzania, United Republic of</option>"+"\n");
document.write("        <option value=\"TTO\" >Thailand</option>"+"\n");
document.write("        <option value=\"TUN\" >Timor-leste</option>"+"\n");
document.write("        <option value=\"TUR\" >Togo</option>"+"\n");
document.write("        <option value=\"TKM\" >Tokelau</option>"+"\n");
document.write("        <option value=\"TCA\" >Tonga</option>"+"\n");
document.write("        <option value=\"TUV\" >Trinidad and Tobago</option>"+"\n");
document.write("        <option value=\"UMI\" >Tunisia</option>"+"\n");
document.write("        <option value=\"UGA\" >Turkey</option>"+"\n");
document.write("        <option value=\"UKR\" >Turkmenistan</option>"+"\n");
document.write("        <option value=\"ARE\" >Turks and Caicos Islands</option>"+"\n");
document.write("        <option value=\"GBR\" >Tuvalu</option>"+"\n");
document.write("        <option value=\"URY\" >Uganda</option>"+"\n");
document.write("        <option value=\"SUN\" >Ukraine</option>"+"\n");
document.write("        <option value=\"UZB\" >United Arab Emirates</option>"+"\n");
document.write("        <option value=\"VUT\" >United Kingdom</option>"+"\n");
document.write("        <option value=\"VAT\" >United States Minor Outlying Islands</option>"+"\n");
document.write("        <option value=\"VEN\" >Uruguay</option>"+"\n");
document.write("        <option value=\"VNM\" >Uzbekistan</option>"+"\n");
document.write("        <option value=\"VGB\" >Vanuatu</option>"+"\n");
document.write("        <option value=\"VIR\" >Venezuela</option>"+"\n");
document.write("        <option value=\"WLF\" >Vietnam</option>"+"\n");
document.write("        <option value=\"ESH\" >Virgin Islands, British</option>"+"\n");
document.write("        <option value=\"YEM\" >Virgin Islands, U.S.</option>"+"\n");
document.write("        <option value=\"YUG\" >Wallis and Futuna</option>"+"\n");
document.write("        <option value=\"ZAR\" >Western Sahara</option>"+"\n");
document.write("        <option value=\"ZMB\" >Yemen</option>"+"\n");
document.write("        <option value=\"ZWE\" >Zambia</option>"+"\n");
document.write("        <option value=\"Zambia\" >Zimbabwe</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-8\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492193\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10492193\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Gender</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10492193_1\"><input type=\"radio\" id=\"field10492193_1\" name=\"field10492193\" value=\"M\"  class=\"fsField  horizontal\"   />Male</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10492193_2\"><input type=\"radio\" id=\"field10492193_2\" name=\"field10492193\" value=\"F\"  class=\"fsField  horizontal\"   />Female</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-9\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492199\" aria-describedby=\"fsSupporting10492199\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492199\" class=\"fsLabel\" for=\"field10492199\">Social security number - will be encrypted for privacy                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10492199\" name=\"field10492199\" size=\"50\"  maxlength=\"9\"  value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10492199\" class=\"fsSupporting\">"+"\n");
document.write("                                enter with no dashes or hyphens (ex: 000000000)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-10\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492200\" aria-describedby=\"fsSupporting10492200\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492200\" class=\"fsLabel fsRequiredLabel\" for=\"field10492200\">Date of birth<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10492200\" name=\"field10492200\" size=\"8\" required maxlength=\"8\"  value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\"  />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10492200\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-11\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492196\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492196\" class=\"fsLabel fsRequiredLabel\" for=\"field10492196\">Email<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"email\" id=\"field10492196\" name=\"field10492196\" size=\"50\" required=\"required\"    value=\"\"  class=\"fsField fsFormatEmail fsRequired\" aria-required=\"true\"  />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-12\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10492211\" aria-describedby=\"fsSupporting10492211\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10492211\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>xxHave you ever been convicted of a crime OR been the recipient of any disciplinary action by an institution of higher education? (Mark yes if any criminal or disciplinary actions are pending as well).</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field10492211_1\"><input type=\"radio\" id=\"field10492211_1\" name=\"field10492211\" value=\"Y\"  class=\"fsField  vertical\"   />Yes</label>"+"\n");
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document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field10492211_2\"><input type=\"radio\" id=\"field10492211_2\" name=\"field10492211\" value=\"N\"  class=\"fsField  vertical\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10492211\" class=\"fsSupporting\">"+"\n");
document.write("                                replaced by the 2 questions below in Feb 2013 to separate out the crime and disciplinary actions"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                <div id=\"fsRow1031780-13\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
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document.write("                        "+"\n");
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document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell18885249\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label18885249\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Have you ever been convicted of a crime? Mark \"yes\" if any criminal actions are pending as well.<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field18885249_1\"><input type=\"radio\" id=\"field18885249_1\" name=\"field18885249\" value=\"Y\"  class=\"fsField fsRequired vertical\" aria-required=\"true\"  />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field18885249_2\"><input type=\"radio\" id=\"field18885249_2\" name=\"field18885249\" value=\"N\"  class=\"fsField fsRequired vertical\" aria-required=\"true\"  />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                            			</div></fieldset>"+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-14\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell18885267\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label18885267\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Have you been the recipient of any disciplinary action by an institution of higher learning? Mark “yes” if any disciplinary actions are pending as well.<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
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document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field18885267_2\"><input type=\"radio\" id=\"field18885267_2\" name=\"field18885267\" value=\"N\"  class=\"fsField fsRequired vertical\" aria-required=\"true\"  />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col\" id=\"fsSection10593574\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Permanent Address</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-16\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593575\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593575\" class=\"fsLabel fsRequiredLabel\" for=\"field10593575\">Address 1<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10593575\" name=\"field10593575\" size=\"50\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\"  />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-17\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593576\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593576\" class=\"fsLabel\" for=\"field10593576\">Address 2                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10593576\" name=\"field10593576\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-18\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593577\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593577\" class=\"fsLabel fsRequiredLabel\" for=\"field10593577\">City<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10593577\" name=\"field10593577\" size=\"50\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\"  />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-19\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell10704116\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10704116\" class=\"fsLabel fsRequiredLabel\" for=\"field10704116\">State<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10704116\" name=\"field10704116\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"\" >--</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >Washington, D.C.</option>"+"\n");
document.write("        <option value=\"WI\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WY\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"Wyoming\" >Wyoming</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-20\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593579\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593579\" class=\"fsLabel\" for=\"field10593579\">Zip Code/Postal Code                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10593579\" name=\"field10593579\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-21\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell14387920\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label14387920\" class=\"fsLabel\" for=\"field14387920\">Do you have a local (Vermont) address that is different than the address above?                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field14387920\" name=\"field14387920\" size=\"1\"   class=\"fsField \"  >"+"\n");
document.write("        <option value=\"\" selected=\"selected\">&nbsp;</option>"+"\n");
document.write("        <option value=\"Yes\" >Yes</option>"+"\n");
document.write("        <option value=\"No\" >No</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col\" id=\"fsSection10593569\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Local Address</h2>"+"\n");
document.write("        "+"\n");
document.write("            <div class=\"fsSectionText\"><div style=\"color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: #ffffff; margin: 8px;\">"+"\n");
document.write("<p>(if different from above)</p>"+"\n");
document.write("</div></div>"+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-23\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                    <label id=\"label10593559\" class=\"fsLabel\" for=\"field10593559\">Address 1                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("            "+"\n");
document.write("                            "+"\n");
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document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-24\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593560\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593560\" class=\"fsLabel\" for=\"field10593560\">Address 2                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10593560\" name=\"field10593560\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-25\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593561\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593561\" class=\"fsLabel\" for=\"field10593561\">City                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10593561\" name=\"field10593561\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-26\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593563\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593563\" class=\"fsLabel\" for=\"field10593563\">State                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10593563\" name=\"field10593563\" size=\"1\"   class=\"fsField \"  >"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" selected=\"selected\">Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >Washington, D.C.</option>"+"\n");
document.write("        <option value=\"WI\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WY\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"Wyoming\" >Wyoming</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-27\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593564\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593564\" class=\"fsLabel\" for=\"field10593564\">Zip Code/Postal Code                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10593564\" name=\"field10593564\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-28\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10593565\" aria-describedby=\"fsSupporting10593565\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593565\" class=\"fsLabel\" for=\"field10593565\">Country_local_address                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10593565\" name=\"field10593565\" size=\"1\"   class=\"fsField \"  >"+"\n");
document.write("        <option value=\"--\" >United States</option>"+"\n");
document.write("        <option value=\"AFG\" >Afghanistan</option>"+"\n");
document.write("        <option value=\"ALB\" >Albania</option>"+"\n");
document.write("        <option value=\"DZA\" >Algeria</option>"+"\n");
document.write("        <option value=\"ASM\" >American Samoa</option>"+"\n");
document.write("        <option value=\"AND\" >Andorra</option>"+"\n");
document.write("        <option value=\"AGO\" >Angola</option>"+"\n");
document.write("        <option value=\"AIA\" >Anguilla</option>"+"\n");
document.write("        <option value=\"ATA\" >Antarctica</option>"+"\n");
document.write("        <option value=\"ATG\" >Antigua and Barbuda</option>"+"\n");
document.write("        <option value=\"ARG\" >Argentina</option>"+"\n");
document.write("        <option value=\"ARM\" >Armenia</option>"+"\n");
document.write("        <option value=\"ABW\" >Aruba</option>"+"\n");
document.write("        <option value=\"AUS\" >Australia</option>"+"\n");
document.write("        <option value=\"AUT\" >Austria</option>"+"\n");
document.write("        <option value=\"AZE\" >Azerbaijan</option>"+"\n");
document.write("        <option value=\"BHS\" >Bahamas</option>"+"\n");
document.write("        <option value=\"BHR\" >Bahrain</option>"+"\n");
document.write("        <option value=\"BGD\" >Bangladesh</option>"+"\n");
document.write("        <option value=\"BRB\" >Barbados</option>"+"\n");
document.write("        <option value=\"BLR\" >Belarus</option>"+"\n");
document.write("        <option value=\"BEL\" >Belgium</option>"+"\n");
document.write("        <option value=\"BLZ\" >Belize</option>"+"\n");
document.write("        <option value=\"BEN\" >Benin</option>"+"\n");
document.write("        <option value=\"BMU\" >Bermuda</option>"+"\n");
document.write("        <option value=\"BTN\" >Bhutan</option>"+"\n");
document.write("        <option value=\"BOL\" >Bolivia</option>"+"\n");
document.write("        <option value=\"BIH\" >Bosnia and Herzegovina</option>"+"\n");
document.write("        <option value=\"BWA\" >Botswana</option>"+"\n");
document.write("        <option value=\"BVT\" >Bouvet Island</option>"+"\n");
document.write("        <option value=\"BRA\" >Brazil</option>"+"\n");
document.write("        <option value=\"IOT\" >British Indian Ocean Territory</option>"+"\n");
document.write("        <option value=\"BRN\" >Brunei Darussalam</option>"+"\n");
document.write("        <option value=\"BGR\" >Bulgaria</option>"+"\n");
document.write("        <option value=\"BFA\" >Burkina Faso</option>"+"\n");
document.write("        <option value=\"BDI\" >Burundi</option>"+"\n");
document.write("        <option value=\"BYS\" >Cambodia</option>"+"\n");
document.write("        <option value=\"KHM\" >Cameroon</option>"+"\n");
document.write("        <option value=\"CMR\" >Canada</option>"+"\n");
document.write("        <option value=\"CAN\" >Cape Verde</option>"+"\n");
document.write("        <option value=\"CPV\" >Cayman Islands</option>"+"\n");
document.write("        <option value=\"CYM\" >Central African Republic</option>"+"\n");
document.write("        <option value=\"CAF\" >Chad</option>"+"\n");
document.write("        <option value=\"TCD\" >Chile</option>"+"\n");
document.write("        <option value=\"CHL\" >China</option>"+"\n");
document.write("        <option value=\"CHN\" >Christmas Island</option>"+"\n");
document.write("        <option value=\"CXR\" >Cocos (Keeling) Islands</option>"+"\n");
document.write("        <option value=\"CCK\" >Colombia</option>"+"\n");
document.write("        <option value=\"COL\" >Comoros</option>"+"\n");
document.write("        <option value=\"COM\" >Congo</option>"+"\n");
document.write("        <option value=\"COG\" >Congo, The Democratic Republic of the</option>"+"\n");
document.write("        <option value=\"COK\" >Cook Islands</option>"+"\n");
document.write("        <option value=\"CRI\" >Costa Rica</option>"+"\n");
document.write("        <option value=\"CIV\" >C</option>"+"\n");
document.write("        <option value=\"HRV\" >Croatia</option>"+"\n");
document.write("        <option value=\"CUB\" >Cuba</option>"+"\n");
document.write("        <option value=\"CR\" >Cyprus</option>"+"\n");
document.write("        <option value=\"CYP\" >Czech Republic</option>"+"\n");
document.write("        <option value=\"CZE\" >Denmark</option>"+"\n");
document.write("        <option value=\"CZ\" >Djibouti</option>"+"\n");
document.write("        <option value=\"DNK\" >Dominica</option>"+"\n");
document.write("        <option value=\"DJI\" >Dominican Republic</option>"+"\n");
document.write("        <option value=\"DMA\" >Ecuador</option>"+"\n");
document.write("        <option value=\"DOM\" >Egypt</option>"+"\n");
document.write("        <option value=\"TMP\" >El Salvador</option>"+"\n");
document.write("        <option value=\"ECU\" >Equatorial Guinea</option>"+"\n");
document.write("        <option value=\"EGY\" >Eritrea</option>"+"\n");
document.write("        <option value=\"SLV\" >Estonia</option>"+"\n");
document.write("        <option value=\"GNQ\" >Ethiopia</option>"+"\n");
document.write("        <option value=\"EST\" >Falkland Islands (Malvinas)</option>"+"\n");
document.write("        <option value=\"ETH\" >Faroe Islands</option>"+"\n");
document.write("        <option value=\"FLK\" >Fiji</option>"+"\n");
document.write("        <option value=\"FRO\" >Finland</option>"+"\n");
document.write("        <option value=\"FJI\" >France</option>"+"\n");
document.write("        <option value=\"FIN\" >French Guiana</option>"+"\n");
document.write("        <option value=\"FRA\" >French Polynesia</option>"+"\n");
document.write("        <option value=\"FXX\" >French Southern Territories</option>"+"\n");
document.write("        <option value=\"GUF\" >Gabon</option>"+"\n");
document.write("        <option value=\"PYF\" >Gambia</option>"+"\n");
document.write("        <option value=\"ATF\" >Georgia</option>"+"\n");
document.write("        <option value=\"GAB\" >Germany</option>"+"\n");
document.write("        <option value=\"GMB\" >Ghana</option>"+"\n");
document.write("        <option value=\"GEO\" >Gibraltar</option>"+"\n");
document.write("        <option value=\"DEU\" >Greece</option>"+"\n");
document.write("        <option value=\"GHA\" >Greenland</option>"+"\n");
document.write("        <option value=\"GIB\" >Grenada</option>"+"\n");
document.write("        <option value=\"GRC\" >Guadeloupe</option>"+"\n");
document.write("        <option value=\"GRL\" >Guam</option>"+"\n");
document.write("        <option value=\"GRD\" >Guatemala</option>"+"\n");
document.write("        <option value=\"GLP\" >Guernsey</option>"+"\n");
document.write("        <option value=\"GUM\" >Guinea</option>"+"\n");
document.write("        <option value=\"GTM\" >Guinea-bissau</option>"+"\n");
document.write("        <option value=\"GIN\" >Guyana</option>"+"\n");
document.write("        <option value=\"GNB\" >Haiti</option>"+"\n");
document.write("        <option value=\"GUY\" >Heard Island and Mcdonald Islands</option>"+"\n");
document.write("        <option value=\"HTI\" >Holy See (Vatican City State)</option>"+"\n");
document.write("        <option value=\"HMD\" >Honduras</option>"+"\n");
document.write("        <option value=\"HND\" >Hong Kong</option>"+"\n");
document.write("        <option value=\"HKG\" >Hungary</option>"+"\n");
document.write("        <option value=\"HUN\" >Iceland</option>"+"\n");
document.write("        <option value=\"ISL\" >India</option>"+"\n");
document.write("        <option value=\"IND\" >Indonesia</option>"+"\n");
document.write("        <option value=\"IDN\" >Iran, Islamic Republic of</option>"+"\n");
document.write("        <option value=\"IRN\" >Iraq</option>"+"\n");
document.write("        <option value=\"IRQ\" >Ireland</option>"+"\n");
document.write("        <option value=\"IRL\" >Isle of Man</option>"+"\n");
document.write("        <option value=\"ISR\" >Israel</option>"+"\n");
document.write("        <option value=\"ITA\" >Italy</option>"+"\n");
document.write("        <option value=\"JAM\" >Jamaica</option>"+"\n");
document.write("        <option value=\"JPN\" >Japan</option>"+"\n");
document.write("        <option value=\"JOR\" >Jersey</option>"+"\n");
document.write("        <option value=\"KAZ\" >Jordan</option>"+"\n");
document.write("        <option value=\"KEN\" >Kazakhstan</option>"+"\n");
document.write("        <option value=\"KIR\" >Kenya</option>"+"\n");
document.write("        <option value=\"PRK\" >Kiribati</option>"+"\n");
document.write("        <option value=\"KOR\" >Korea, Democratic People&#039;s Republic of</option>"+"\n");
document.write("        <option value=\"KWT\" >Korea, Republic of</option>"+"\n");
document.write("        <option value=\"KGZ\" >Kuwait</option>"+"\n");
document.write("        <option value=\"LAO\" >Kyrgyzstan</option>"+"\n");
document.write("        <option value=\"LVA\" >Lao People&#039;s Democratic Republic</option>"+"\n");
document.write("        <option value=\"LBN\" >Latvia</option>"+"\n");
document.write("        <option value=\"LSO\" >Lebanon</option>"+"\n");
document.write("        <option value=\"LBR\" >Lesotho</option>"+"\n");
document.write("        <option value=\"LBY\" >Liberia</option>"+"\n");
document.write("        <option value=\"LIE\" >Libyan Arab Jamahiriya</option>"+"\n");
document.write("        <option value=\"LTU\" >Liechtenstein</option>"+"\n");
document.write("        <option value=\"LUX\" >Lithuania</option>"+"\n");
document.write("        <option value=\"MAC\" >Luxembourg</option>"+"\n");
document.write("        <option value=\"MKD\" >Macao</option>"+"\n");
document.write("        <option value=\"MDG\" >Macedonia, The Former Yugoslav Republic of</option>"+"\n");
document.write("        <option value=\"MWI\" >Madagascar</option>"+"\n");
document.write("        <option value=\"MYS\" >Malawi</option>"+"\n");
document.write("        <option value=\"MDV\" >Malaysia</option>"+"\n");
document.write("        <option value=\"MLI\" >Maldives</option>"+"\n");
document.write("        <option value=\"MLT\" >Mali</option>"+"\n");
document.write("        <option value=\"MHL\" >Malta</option>"+"\n");
document.write("        <option value=\"MTQ\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"MRT\" >Martinique</option>"+"\n");
document.write("        <option value=\"MUS\" >Mauritania</option>"+"\n");
document.write("        <option value=\"MYT\" >Mauritius</option>"+"\n");
document.write("        <option value=\"MEX\" >Mayotte</option>"+"\n");
document.write("        <option value=\"FSM\" >Mexico</option>"+"\n");
document.write("        <option value=\"MDA\" >Micronesia, Federated States of</option>"+"\n");
document.write("        <option value=\"MCO\" >Moldova, Republic of</option>"+"\n");
document.write("        <option value=\"MNG\" >Monaco</option>"+"\n");
document.write("        <option value=\"MSR\" >Mongolia</option>"+"\n");
document.write("        <option value=\"MAR\" >Montenegro</option>"+"\n");
document.write("        <option value=\"MOZ\" >Montserrat</option>"+"\n");
document.write("        <option value=\"MMR\" >Morocco</option>"+"\n");
document.write("        <option value=\"NAM\" >Mozambique</option>"+"\n");
document.write("        <option value=\"NRU\" >Myanmar</option>"+"\n");
document.write("        <option value=\"NPL\" >Namibia</option>"+"\n");
document.write("        <option value=\"ANT\" >Nauru</option>"+"\n");
document.write("        <option value=\"NLD\" >Nepal</option>"+"\n");
document.write("        <option value=\"NTZ\" >Netherlands</option>"+"\n");
document.write("        <option value=\"NCL\" >Netherlands Antilles</option>"+"\n");
document.write("        <option value=\"NZL\" >New Caledonia</option>"+"\n");
document.write("        <option value=\"NIC\" >New Zealand</option>"+"\n");
document.write("        <option value=\"NER\" >Nicaragua</option>"+"\n");
document.write("        <option value=\"NGA\" >Niger</option>"+"\n");
document.write("        <option value=\"NIU\" >Nigeria</option>"+"\n");
document.write("        <option value=\"NFK\" >Niue</option>"+"\n");
document.write("        <option value=\"MNP\" >Norfolk Island</option>"+"\n");
document.write("        <option value=\"NOR\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"OMN\" >Norway</option>"+"\n");
document.write("        <option value=\"PAK\" >Oman</option>"+"\n");
document.write("        <option value=\"PLW\" >Pakistan</option>"+"\n");
document.write("        <option value=\"PAN\" >Palau</option>"+"\n");
document.write("        <option value=\"PNG\" >Palestinian Territory</option>"+"\n");
document.write("        <option value=\"PRY\" >Panama</option>"+"\n");
document.write("        <option value=\"PER\" >Papua New Guinea</option>"+"\n");
document.write("        <option value=\"PHL\" >Paraguay</option>"+"\n");
document.write("        <option value=\"PCN\" >Peru</option>"+"\n");
document.write("        <option value=\"POL\" >Philippines</option>"+"\n");
document.write("        <option value=\"PRT\" >Pitcairn</option>"+"\n");
document.write("        <option value=\"PRI\" >Poland</option>"+"\n");
document.write("        <option value=\"QAT\" >Portugal</option>"+"\n");
document.write("        <option value=\"REU\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"ROM\" >Qatar</option>"+"\n");
document.write("        <option value=\"RUS\" >Reunion</option>"+"\n");
document.write("        <option value=\"RWA\" >Romania</option>"+"\n");
document.write("        <option value=\"KNA\" >Russian Federation</option>"+"\n");
document.write("        <option value=\"LCA\" >Rwanda</option>"+"\n");
document.write("        <option value=\"VCT\" >Saint Barth</option>"+"\n");
document.write("        <option value=\"WSM\" >Saint Helena</option>"+"\n");
document.write("        <option value=\"SMR\" >Saint Kitts and Nevis</option>"+"\n");
document.write("        <option value=\"STP\" >Saint Lucia</option>"+"\n");
document.write("        <option value=\"SAU\" >Saint Martin</option>"+"\n");
document.write("        <option value=\"SEN\" >Saint Pierre and Miquelon</option>"+"\n");
document.write("        <option value=\"SYC\" >Saint Vincent and the Grenadines</option>"+"\n");
document.write("        <option value=\"SLE\" >Samoa</option>"+"\n");
document.write("        <option value=\"SGP\" >San Marino</option>"+"\n");
document.write("        <option value=\"SVK\" >Sao Tome and Principe</option>"+"\n");
document.write("        <option value=\"SVN\" >Saudi Arabia</option>"+"\n");
document.write("        <option value=\"SLB\" >Senegal</option>"+"\n");
document.write("        <option value=\"SOM\" >Serbia</option>"+"\n");
document.write("        <option value=\"ZAF\" >Seychelles</option>"+"\n");
document.write("        <option value=\"ESP\" >Sierra Leone</option>"+"\n");
document.write("        <option value=\"LKA\" >Singapore</option>"+"\n");
document.write("        <option value=\"SHN\" >Slovakia</option>"+"\n");
document.write("        <option value=\"ST\" >Slovenia</option>"+"\n");
document.write("        <option value=\"SPM\" >Solomon Islands</option>"+"\n");
document.write("        <option value=\"SDN\" >Somalia</option>"+"\n");
document.write("        <option value=\"SUR\" >South Africa</option>"+"\n");
document.write("        <option value=\"SJM\" >South Georgia and the South Sandwich Islands</option>"+"\n");
document.write("        <option value=\"SWZ\" >Spain</option>"+"\n");
document.write("        <option value=\"SWE\" >Sri Lanka</option>"+"\n");
document.write("        <option value=\"CHE\" >Sudan</option>"+"\n");
document.write("        <option value=\"SYR\" >Suriname</option>"+"\n");
document.write("        <option value=\"TWN\" >Svalbard and Jan Mayen</option>"+"\n");
document.write("        <option value=\"TJK\" >Swaziland</option>"+"\n");
document.write("        <option value=\"TZA\" >Sweden</option>"+"\n");
document.write("        <option value=\"THA\" >Switzerland</option>"+"\n");
document.write("        <option value=\"TIB\" >Syrian Arab Republic</option>"+"\n");
document.write("        <option value=\"TGO\" >Taiwan, Province of China</option>"+"\n");
document.write("        <option value=\"TKL\" >Tajikistan</option>"+"\n");
document.write("        <option value=\"TON\" >Tanzania, United Republic of</option>"+"\n");
document.write("        <option value=\"TTO\" >Thailand</option>"+"\n");
document.write("        <option value=\"TUN\" >Timor-leste</option>"+"\n");
document.write("        <option value=\"TUR\" >Togo</option>"+"\n");
document.write("        <option value=\"TKM\" >Tokelau</option>"+"\n");
document.write("        <option value=\"TCA\" >Tonga</option>"+"\n");
document.write("        <option value=\"TUV\" >Trinidad and Tobago</option>"+"\n");
document.write("        <option value=\"UMI\" >Tunisia</option>"+"\n");
document.write("        <option value=\"UGA\" >Turkey</option>"+"\n");
document.write("        <option value=\"UKR\" >Turkmenistan</option>"+"\n");
document.write("        <option value=\"ARE\" >Turks and Caicos Islands</option>"+"\n");
document.write("        <option value=\"GBR\" >Tuvalu</option>"+"\n");
document.write("        <option value=\"USA\" >Uganda</option>"+"\n");
document.write("        <option value=\"URY\" >Ukraine</option>"+"\n");
document.write("        <option value=\"SUN\" >United Arab Emirates</option>"+"\n");
document.write("        <option value=\"UZB\" >United Kingdom</option>"+"\n");
document.write("        <option value=\"VUT\" >United States Minor Outlying Islands</option>"+"\n");
document.write("        <option value=\"VAT\" >Uruguay</option>"+"\n");
document.write("        <option value=\"VEN\" >Uzbekistan</option>"+"\n");
document.write("        <option value=\"VNM\" >Vanuatu</option>"+"\n");
document.write("        <option value=\"VGB\" >Venezuela</option>"+"\n");
document.write("        <option value=\"VIR\" >Vietnam</option>"+"\n");
document.write("        <option value=\"WLF\" >Virgin Islands, British</option>"+"\n");
document.write("        <option value=\"ESH\" >Virgin Islands, U.S.</option>"+"\n");
document.write("        <option value=\"YEM\" >Wallis and Futuna</option>"+"\n");
document.write("        <option value=\"YUG\" >Western Sahara</option>"+"\n");
document.write("        <option value=\"ZAR\" >Yemen</option>"+"\n");
document.write("        <option value=\"ZMB\" >Zambia</option>"+"\n");
document.write("        <option value=\"ZWE\" >Zimbabwe</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10593565\" class=\"fsSupporting\">"+"\n");
document.write("                                hidden 1/10/12 since it\'s not relevant to local addresses"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs2Col\" id=\"fsSection10593769\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Phone Numbers</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-30\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                    "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst  fsLabelVertical fsHidden fsSpan50 \" id=\"fsCell10593770\" aria-describedby=\"fsSupporting10593770\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593770\" class=\"fsLabel fsRequiredLabel\" for=\"field10593770\">Permanent Area Code<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("    <input type=\"number\" id=\"field10593770\" name=\"field10593770\" size=\"3\" required value=\"\"  class=\"fsField fsFormatNumber fsNumberMin-100 fsNumberMax-999   fsNumberDecimals-0 fsRequired\" min=\"100\" max=\"999\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10593770\" class=\"fsSupporting\">"+"\n");
document.write("                                enter 3 digits only, without parentheses"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("    "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell   fsLast fsLabelVertical fsHidden fsSpan50 \" id=\"fsCell10593771\" aria-describedby=\"fsSupporting10593771\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593771\" class=\"fsLabel fsRequiredLabel\" for=\"field10593771\">Permanent Exchange and number<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"tel\" id=\"field10593771\" name=\"field10593771\" size=\"20\" required   value=\"\"  class=\"fsField fsFormatPhoneXX fsRequired\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10593771\" class=\"fsSupporting\">"+"\n");
document.write("                                no spaces or hyphens, i.e.: XXXXXXX"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-31\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                    "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst  fsLabelVertical  fsSpan50 \" id=\"fsCell10593737\" aria-describedby=\"fsSupporting10593737\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593737\" class=\"fsLabel\" for=\"field10593737\">Local Area Code                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("    <input type=\"number\" id=\"field10593737\" name=\"field10593737\" size=\"3\"  value=\"\"  class=\"fsField fsFormatNumber fsNumberMin-100 fsNumberMax-999   fsNumberDecimals-0 \" min=\"100\" max=\"999\"   />"+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10593737\" class=\"fsSupporting\">"+"\n");
document.write("                                enter 3 digits only, without parentheses"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("    "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell   fsLast fsLabelVertical  fsSpan50 \" id=\"fsCell10492197\" aria-describedby=\"fsSupporting10492197\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492197\" class=\"fsLabel\" for=\"field10492197\">Local Exchange and number                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"tel\" id=\"field10492197\" name=\"field10492197\" size=\"20\"    value=\"\"  class=\"fsField fsFormatPhoneXX \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10492197\" class=\"fsSupporting\">"+"\n");
document.write("                                no spaces or hyphens, i.e.: XXXXXXX"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-32\" class=\"fsRow fsFieldRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                    "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst  fsLabelVertical  fsSpan50 \" id=\"fsCell10593775\" aria-describedby=\"fsSupporting10593775\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593775\" class=\"fsLabel\" for=\"field10593775\">Mobile Area Code                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("    <input type=\"number\" id=\"field10593775\" name=\"field10593775\" size=\"3\"  value=\"\"  class=\"fsField fsFormatNumber fsNumberMin-100 fsNumberMax-999   fsNumberDecimals-0 \" min=\"100\" max=\"999\"   />"+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10593775\" class=\"fsSupporting\">"+"\n");
document.write("                                enter 3 digits only, without parentheses"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("    "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell   fsLast fsLabelVertical  fsSpan50 \" id=\"fsCell10593776\" aria-describedby=\"fsSupporting10593776\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10593776\" class=\"fsLabel\" for=\"field10593776\">Mobile Exchange and number                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"tel\" id=\"field10593776\" name=\"field10593776\" size=\"20\"    value=\"\"  class=\"fsField fsFormatPhoneXX \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10593776\" class=\"fsSupporting\">"+"\n");
document.write("                                no spaces or hyphens, i.e.: XXXXXXX"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col\" id=\"fsSection10632125\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Race and Ethnicity</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-34\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593588\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10593588\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Are you Hispanic or Latino?</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10593588_1\"><input type=\"radio\" id=\"field10593588_1\" name=\"field10593588\" value=\"Y\"  class=\"fsField  horizontal\"   />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10593588_2\"><input type=\"radio\" id=\"field10593588_2\" name=\"field10593588\" value=\"N\"  class=\"fsField  horizontal\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-35\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10593589\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10593589\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>American Indian or Alaska Native</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10593589_1\"><input type=\"radio\" id=\"field10593589_1\" name=\"field10593589\" value=\"1\"  class=\"fsField  horizontal\"   />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10593589_2\"><input type=\"radio\" id=\"field10593589_2\" name=\"field10593589\" value=\"--\"  class=\"fsField  horizontal\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-36\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10640697\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10640697\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Asian</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640697_1\"><input type=\"radio\" id=\"field10640697_1\" name=\"field10640697\" value=\"2\"  class=\"fsField  horizontal\"   />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640697_2\"><input type=\"radio\" id=\"field10640697_2\" name=\"field10640697\" value=\"--\"  class=\"fsField  horizontal\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-37\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10640696\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10640696\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Black or African American</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640696_1\"><input type=\"radio\" id=\"field10640696_1\" name=\"field10640696\" value=\"3\"  class=\"fsField  horizontal\"   />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640696_2\"><input type=\"radio\" id=\"field10640696_2\" name=\"field10640696\" value=\"--\"  class=\"fsField  horizontal\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-38\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10640695\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10640695\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Native Hawaiian or Other Pacific Islander</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640695_1\"><input type=\"radio\" id=\"field10640695_1\" name=\"field10640695\" value=\"4\"  class=\"fsField  horizontal\"   />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640695_2\"><input type=\"radio\" id=\"field10640695_2\" name=\"field10640695\" value=\"--\"  class=\"fsField  horizontal\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-39\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10640694\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10640694\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>White</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640694_1\"><input type=\"radio\" id=\"field10640694_1\" name=\"field10640694\" value=\"5\"  class=\"fsField  horizontal\"   />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10640694_2\"><input type=\"radio\" id=\"field10640694_2\" name=\"field10640694\" value=\"--\"  class=\"fsField  horizontal\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col\" id=\"fsSection16825740\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Citizenship</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-41\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596556\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10596556\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Are you a US Citizen?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10596556_1\"><input type=\"radio\" id=\"field10596556_1\" name=\"field10596556\" value=\"Y\"  class=\"fsField fsRequired horizontal\" aria-required=\"true\"  />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10596556_2\"><input type=\"radio\" id=\"field10596556_2\" name=\"field10596556\" value=\"N\"  class=\"fsField fsRequired horizontal\" aria-required=\"true\"  />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection10513805\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">For Non-US citizens</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-43\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492203\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10492203\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Visa Status</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field10492203_1\"><input type=\"checkbox\" id=\"field10492203_1\" name=\"field10492203[]\" value=\"I currently hold a non-immigrant visa.\"  class=\"fsField  vertical\"  disabled=\"disabled\" />I currently hold a non-immigrant visa.</label>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("                "+"\n");
document.write("                            "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field10492203_2\"><input type=\"checkbox\" id=\"field10492203_2\" name=\"field10492203[]\" value=\"I will be applying for a student F-1 or J-1 visa.\"  class=\"fsField  vertical\"  disabled=\"disabled\" />I will be applying for a student F-1 or J-1 visa.</label>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("                "+"\n");
document.write("                            "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field10492203_3\"><input type=\"checkbox\" id=\"field10492203_3\" name=\"field10492203[]\" value=\"I have been granted permanent U.S. residency.\"  class=\"fsField  vertical\"  disabled=\"disabled\" />I have been granted permanent U.S. residency.</label>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-44\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell10492204\" aria-describedby=\"fsSupporting10492204\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492204\" class=\"fsLabel\" for=\"field10492204\">Please state Visa Type:                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10492204\" name=\"field10492204\" size=\"50\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10492204\" class=\"fsSupporting\">"+"\n");
document.write("                                ex. F-1; J-1; L-2; H-4; other"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-45\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell10492205\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492205\" class=\"fsLabel\" for=\"field10492205\">Alien registration number                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("    <input type=\"number\" id=\"field10492205\" name=\"field10492205\" size=\"50\"  value=\"\"  class=\"fsField fsFormatNumber     fsNumberDecimals-0 \"    disabled=\"disabled\" />"+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col\" id=\"fsSection13096180\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Vermont Residency</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-47\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell13096142\" aria-describedby=\"fsSupporting13096142\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label13096142\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Do you intend to register as a Vermont resident for tuition purposes?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field13096142_1\"><input type=\"radio\" id=\"field13096142_1\" name=\"field13096142\" value=\"RESS\"  class=\"fsField fsRequired horizontal\" aria-required=\"true\"  />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field13096142_2\"><input type=\"radio\" id=\"field13096142_2\" name=\"field13096142\" value=\"--\"  class=\"fsField fsRequired horizontal\" aria-required=\"true\"  />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting13096142\" class=\"fsSupporting\">"+"\n");
document.write("                                <a href=\"http://bit.ly/Wb014q\" target=\"_blank\">Learn more about UVM residency criteria</a>"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection12025777\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Vermont Residency Questionnaire</h2>"+"\n");
document.write("        "+"\n");
document.write("            <div class=\"fsSectionText\"><p>In order to be considered for in-state tuition, you must complete this section. The final decision on residency is made by the residency office. Regardless of your responses below, it is the student\'s responsibility to understand their final residency determination before they register. The residency office may request additional information before determining residency status. All Applications for In-State Status should be received no later than the last day of the Add/Drop period for the semester for which in-state status is sought. All applications received after the Add/Drop period will be considered for the following semester for which the student is enrolled.</p></div>"+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-49\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell12069053\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label12069053\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Were you born in Vermont?</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field12069053_1\"><input type=\"radio\" id=\"field12069053_1\" name=\"field12069053\" value=\"Yes\"  class=\"fsField  vertical\"   />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field12069053_2\"><input type=\"radio\" id=\"field12069053_2\" name=\"field12069053\" value=\"No\"  class=\"fsField  vertical\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-50\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell12025800\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label12025800\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>When did you first begin living in Vermont?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("    <!-- Used to pull in url for jquery -->"+"\n");
document.write("    <span style=\"display:none;\" id=\"fsCalendar12025800ImageUrl\">https://www.formstack.com/forms/images/2/calendar.png</span>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("    "+"\n");
document.write("    <input type=\"hidden\" id=\"field12025800Format\" name=\"field12025800Format\" value=\"MY\" />"+"\n");
document.write("    "+"\n");
document.write("                    <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field12025800M\">Month</label>"+"\n");
document.write("        <select id=\"field12025800M\" name=\"field12025800M\" class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\" >"+"\n");
document.write("                    <option value=\"\" selected=\"selected\"> </option>"+"\n");
document.write("                    <option value=\"Jan\" >Jan</option>"+"\n");
document.write("                    <option value=\"Feb\" >Feb</option>"+"\n");
document.write("                    <option value=\"Mar\" >Mar</option>"+"\n");
document.write("                    <option value=\"Apr\" >Apr</option>"+"\n");
document.write("                    <option value=\"May\" >May</option>"+"\n");
document.write("                    <option value=\"Jun\" >Jun</option>"+"\n");
document.write("                    <option value=\"Jul\" >Jul</option>"+"\n");
document.write("                    <option value=\"Aug\" >Aug</option>"+"\n");
document.write("                    <option value=\"Sep\" >Sep</option>"+"\n");
document.write("                    <option value=\"Oct\" >Oct</option>"+"\n");
document.write("                    <option value=\"Nov\" >Nov</option>"+"\n");
document.write("                    <option value=\"Dec\" >Dec</option>"+"\n");
document.write("                </select>"+"\n");
document.write("             <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field12025800Y\">Year</label>"+"\n");
document.write("        <select id=\"field12025800Y\" name=\"field12025800Y\" class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\"disabled=\"disabled\">"+"\n");
document.write("                    <option value=\"\" selected=\"selected\"> </option>"+"\n");
document.write("                    <option value=\"1913\" >1913</option>"+"\n");
document.write("                    <option value=\"1914\" >1914</option>"+"\n");
document.write("                    <option value=\"1915\" >1915</option>"+"\n");
document.write("                    <option value=\"1916\" >1916</option>"+"\n");
document.write("                    <option value=\"1917\" >1917</option>"+"\n");
document.write("                    <option value=\"1918\" >1918</option>"+"\n");
document.write("                    <option value=\"1919\" >1919</option>"+"\n");
document.write("                    <option value=\"1920\" >1920</option>"+"\n");
document.write("                    <option value=\"1921\" >1921</option>"+"\n");
document.write("                    <option value=\"1922\" >1922</option>"+"\n");
document.write("                    <option value=\"1923\" >1923</option>"+"\n");
document.write("                    <option value=\"1924\" >1924</option>"+"\n");
document.write("                    <option value=\"1925\" >1925</option>"+"\n");
document.write("                    <option value=\"1926\" >1926</option>"+"\n");
document.write("                    <option value=\"1927\" >1927</option>"+"\n");
document.write("                    <option value=\"1928\" >1928</option>"+"\n");
document.write("                    <option value=\"1929\" >1929</option>"+"\n");
document.write("                    <option value=\"1930\" >1930</option>"+"\n");
document.write("                    <option value=\"1931\" >1931</option>"+"\n");
document.write("                    <option value=\"1932\" >1932</option>"+"\n");
document.write("                    <option value=\"1933\" >1933</option>"+"\n");
document.write("                    <option value=\"1934\" >1934</option>"+"\n");
document.write("                    <option value=\"1935\" >1935</option>"+"\n");
document.write("                    <option value=\"1936\" >1936</option>"+"\n");
document.write("                    <option value=\"1937\" >1937</option>"+"\n");
document.write("                    <option value=\"1938\" >1938</option>"+"\n");
document.write("                    <option value=\"1939\" >1939</option>"+"\n");
document.write("                    <option value=\"1940\" >1940</option>"+"\n");
document.write("                    <option value=\"1941\" >1941</option>"+"\n");
document.write("                    <option value=\"1942\" >1942</option>"+"\n");
document.write("                    <option value=\"1943\" >1943</option>"+"\n");
document.write("                    <option value=\"1944\" >1944</option>"+"\n");
document.write("                    <option value=\"1945\" >1945</option>"+"\n");
document.write("                    <option value=\"1946\" >1946</option>"+"\n");
document.write("                    <option value=\"1947\" >1947</option>"+"\n");
document.write("                    <option value=\"1948\" >1948</option>"+"\n");
document.write("                    <option value=\"1949\" >1949</option>"+"\n");
document.write("                    <option value=\"1950\" >1950</option>"+"\n");
document.write("                    <option value=\"1951\" >1951</option>"+"\n");
document.write("                    <option value=\"1952\" >1952</option>"+"\n");
document.write("                    <option value=\"1953\" >1953</option>"+"\n");
document.write("                    <option value=\"1954\" >1954</option>"+"\n");
document.write("                    <option value=\"1955\" >1955</option>"+"\n");
document.write("                    <option value=\"1956\" >1956</option>"+"\n");
document.write("                    <option value=\"1957\" >1957</option>"+"\n");
document.write("                    <option value=\"1958\" >1958</option>"+"\n");
document.write("                    <option value=\"1959\" >1959</option>"+"\n");
document.write("                    <option value=\"1960\" >1960</option>"+"\n");
document.write("                    <option value=\"1961\" >1961</option>"+"\n");
document.write("                    <option value=\"1962\" >1962</option>"+"\n");
document.write("                    <option value=\"1963\" >1963</option>"+"\n");
document.write("                    <option value=\"1964\" >1964</option>"+"\n");
document.write("                    <option value=\"1965\" >1965</option>"+"\n");
document.write("                    <option value=\"1966\" >1966</option>"+"\n");
document.write("                    <option value=\"1967\" >1967</option>"+"\n");
document.write("                    <option value=\"1968\" >1968</option>"+"\n");
document.write("                    <option value=\"1969\" >1969</option>"+"\n");
document.write("                    <option value=\"1970\" >1970</option>"+"\n");
document.write("                    <option value=\"1971\" >1971</option>"+"\n");
document.write("                    <option value=\"1972\" >1972</option>"+"\n");
document.write("                    <option value=\"1973\" >1973</option>"+"\n");
document.write("                    <option value=\"1974\" >1974</option>"+"\n");
document.write("                    <option value=\"1975\" >1975</option>"+"\n");
document.write("                    <option value=\"1976\" >1976</option>"+"\n");
document.write("                    <option value=\"1977\" >1977</option>"+"\n");
document.write("                    <option value=\"1978\" >1978</option>"+"\n");
document.write("                    <option value=\"1979\" >1979</option>"+"\n");
document.write("                    <option value=\"1980\" >1980</option>"+"\n");
document.write("                    <option value=\"1981\" >1981</option>"+"\n");
document.write("                    <option value=\"1982\" >1982</option>"+"\n");
document.write("                    <option value=\"1983\" >1983</option>"+"\n");
document.write("                    <option value=\"1984\" >1984</option>"+"\n");
document.write("                    <option value=\"1985\" >1985</option>"+"\n");
document.write("                    <option value=\"1986\" >1986</option>"+"\n");
document.write("                    <option value=\"1987\" >1987</option>"+"\n");
document.write("                    <option value=\"1988\" >1988</option>"+"\n");
document.write("                    <option value=\"1989\" >1989</option>"+"\n");
document.write("                    <option value=\"1990\" >1990</option>"+"\n");
document.write("                    <option value=\"1991\" >1991</option>"+"\n");
document.write("                    <option value=\"1992\" >1992</option>"+"\n");
document.write("                    <option value=\"1993\" >1993</option>"+"\n");
document.write("                    <option value=\"1994\" >1994</option>"+"\n");
document.write("                    <option value=\"1995\" >1995</option>"+"\n");
document.write("                    <option value=\"1996\" >1996</option>"+"\n");
document.write("                    <option value=\"1997\" >1997</option>"+"\n");
document.write("                    <option value=\"1998\" >1998</option>"+"\n");
document.write("                    <option value=\"1999\" >1999</option>"+"\n");
document.write("                    <option value=\"2000\" >2000</option>"+"\n");
document.write("                    <option value=\"2001\" >2001</option>"+"\n");
document.write("                    <option value=\"2002\" >2002</option>"+"\n");
document.write("                    <option value=\"2003\" >2003</option>"+"\n");
document.write("                    <option value=\"2004\" >2004</option>"+"\n");
document.write("                    <option value=\"2005\" >2005</option>"+"\n");
document.write("                    <option value=\"2006\" >2006</option>"+"\n");
document.write("                    <option value=\"2007\" >2007</option>"+"\n");
document.write("                    <option value=\"2008\" >2008</option>"+"\n");
document.write("                    <option value=\"2009\" >2009</option>"+"\n");
document.write("                    <option value=\"2010\" >2010</option>"+"\n");
document.write("                    <option value=\"2011\" >2011</option>"+"\n");
document.write("                    <option value=\"2012\" >2012</option>"+"\n");
document.write("                    <option value=\"2013\" >2013</option>"+"\n");
document.write("                </select>"+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("        "+"\n");
document.write("    <input type=\"text\" id=\"fsCalendar12025800Link\" class=\"fsCalendarPickerLink\" style=\"display:none;\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("    "+"\n");
document.write("    <div id=\"fsCalendar12025800\" class=\"fsCalendar\" style=\" position:absolute\"></div>"+"\n");
document.write("        "+"\n");
document.write("    &nbsp;"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-51\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell19708708\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label19708708\" class=\"fsLabel\" for=\"field19708708\">  	Where is Your True, Fixed and Permanent Address                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <label for=\"field19708708-address\" class=\"hidden\">Address Line 1</label>"+"\n");
document.write("<input type=\"text\" id=\"field19708708-address\" name=\"field19708708-address\" size=\"50\"  value=\"\" class=\"fsField fsFieldAddress\"  disabled=\"disabled\" />"+"\n");
document.write("<label for=\"field19708708-address2\" class=\"hidden\">Address Line 2</label>"+"\n");
document.write("<input type=\"text\" id=\"field19708708-address2\" name=\"field19708708-address2\" size=\"50\" value=\"\" style=\"margin-top:5px;\" class=\"fsField fsFieldAddress2\" disabled=\"disabled\" />"+"\n");
document.write("<div class=\"fsSubFieldGroup\">"+"\n");
document.write("    <div class=\"fsSubField fsFieldCity\">"+"\n");
document.write("        <input type=\"text\" id=\"field19708708-city\" name=\"field19708708-city\" size=\"15\" value=\"\"  class=\"fsField fsFieldCity \"  disabled=\"disabled\" />"+"\n");
document.write("        <label class=\"fsSupporting\" for=\"field19708708-city\">City</label>"+"\n");
document.write("    </div>"+"\n");
document.write("    <div class=\"fsSubField fsFieldState\">"+"\n");
document.write("                    <select id=\"field19708708-state\" name=\"field19708708-state\"  class=\"fsField fsFieldState \"  disabled=\"disabled\">"+"\n");
document.write("                <option value=\"\">&nbsp;</option>"+"\n");
document.write("                                    <option value=\"AL\">Alabama</option>"+"\n");
document.write("                                    <option value=\"AK\">Alaska</option>"+"\n");
document.write("                                    <option value=\"AZ\">Arizona</option>"+"\n");
document.write("                                    <option value=\"AR\">Arkansas</option>"+"\n");
document.write("                                    <option value=\"CA\">California</option>"+"\n");
document.write("                                    <option value=\"CO\">Colorado</option>"+"\n");
document.write("                                    <option value=\"CT\">Connecticut</option>"+"\n");
document.write("                                    <option value=\"DE\">Delaware</option>"+"\n");
document.write("                                    <option value=\"DC\">District of Columbia</option>"+"\n");
document.write("                                    <option value=\"FL\">Florida</option>"+"\n");
document.write("                                    <option value=\"GA\">Georgia</option>"+"\n");
document.write("                                    <option value=\"HI\">Hawaii</option>"+"\n");
document.write("                                    <option value=\"ID\">Idaho</option>"+"\n");
document.write("                                    <option value=\"IL\">Illinois</option>"+"\n");
document.write("                                    <option value=\"IN\">Indiana</option>"+"\n");
document.write("                                    <option value=\"IA\">Iowa</option>"+"\n");
document.write("                                    <option value=\"KS\">Kansas</option>"+"\n");
document.write("                                    <option value=\"KY\">Kentucky</option>"+"\n");
document.write("                                    <option value=\"LA\">Louisiana</option>"+"\n");
document.write("                                    <option value=\"ME\">Maine</option>"+"\n");
document.write("                                    <option value=\"MD\">Maryland</option>"+"\n");
document.write("                                    <option value=\"MA\">Massachusetts</option>"+"\n");
document.write("                                    <option value=\"MI\">Michigan</option>"+"\n");
document.write("                                    <option value=\"MN\">Minnesota</option>"+"\n");
document.write("                                    <option value=\"MS\">Mississippi</option>"+"\n");
document.write("                                    <option value=\"MO\">Missouri</option>"+"\n");
document.write("                                    <option value=\"MT\">Montana</option>"+"\n");
document.write("                                    <option value=\"NE\">Nebraska</option>"+"\n");
document.write("                                    <option value=\"NV\">Nevada</option>"+"\n");
document.write("                                    <option value=\"NH\">New Hampshire</option>"+"\n");
document.write("                                    <option value=\"NJ\">New Jersey</option>"+"\n");
document.write("                                    <option value=\"NM\">New Mexico</option>"+"\n");
document.write("                                    <option value=\"NY\">New York</option>"+"\n");
document.write("                                    <option value=\"NC\">North Carolina</option>"+"\n");
document.write("                                    <option value=\"ND\">North Dakota</option>"+"\n");
document.write("                                    <option value=\"OH\">Ohio</option>"+"\n");
document.write("                                    <option value=\"OK\">Oklahoma</option>"+"\n");
document.write("                                    <option value=\"OR\">Oregon</option>"+"\n");
document.write("                                    <option value=\"PA\">Pennsylvania</option>"+"\n");
document.write("                                    <option value=\"RI\">Rhode Island</option>"+"\n");
document.write("                                    <option value=\"SC\">South Carolina</option>"+"\n");
document.write("                                    <option value=\"SD\">South Dakota</option>"+"\n");
document.write("                                    <option value=\"TN\">Tennessee</option>"+"\n");
document.write("                                    <option value=\"TX\">Texas</option>"+"\n");
document.write("                                    <option value=\"UT\">Utah</option>"+"\n");
document.write("                                    <option value=\"VT\">Vermont</option>"+"\n");
document.write("                                    <option value=\"VA\">Virginia</option>"+"\n");
document.write("                                    <option value=\"WA\">Washington</option>"+"\n");
document.write("                                    <option value=\"WV\">West Virginia</option>"+"\n");
document.write("                                    <option value=\"WI\">Wisconsin</option>"+"\n");
document.write("                                    <option value=\"WY\">Wyoming</option>"+"\n");
document.write("                            </select>"+"\n");
document.write("            <label class=\"fsSupporting\" for=\"field19708708-state\">State</label>"+"\n");
document.write("            </div>"+"\n");
document.write("    <div class=\"fsSubField fsFieldZip\">"+"\n");
document.write("                    <input type=\"text\" id=\"field19708708-zip\" name=\"field19708708-zip\" size=\"6\" value=\"\"  class=\"fsField fsFieldZip fsFormatZipUS \"  disabled=\"disabled\" />"+"\n");
document.write("            <label class=\"fsSupporting\" for=\"field19708708-zip\">Zip Code</label>"+"\n");
document.write("            </div>"+"\n");
document.write("    "+"\n");
document.write("</div>"+"\n");
document.write("<div class=\"clear\"></div>"+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-52\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell12025814\" aria-describedby=\"fsSupporting12025814\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label12025814\" class=\"fsLabel fsRequiredLabel\" for=\"field12025814\">How long have you resided at the address above?<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field12025814\" name=\"field12025814\" size=\"50\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting12025814\" class=\"fsSupporting\">"+"\n");
document.write("                                enter years and months (i.e. 10 years, 2 months)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-53\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell12025821\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label12025821\" class=\"fsLabel fsRequiredLabel\" for=\"field12025821\">Where is Your Parent/Guardian\'s True, Fixed and Permanent Address<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <label for=\"field12025821-address\" class=\"hidden\">Address Line 1<span class=\"fsRequiredMarker\">*</span></label>"+"\n");
document.write("<input type=\"text\" id=\"field12025821-address\" name=\"field12025821-address\" size=\"50\" required value=\"\" class=\"fsField fsFieldAddress fsRequired\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("<label for=\"field12025821-address2\" class=\"hidden\">Address Line 2</label>"+"\n");
document.write("<input type=\"text\" id=\"field12025821-address2\" name=\"field12025821-address2\" size=\"50\" value=\"\" style=\"margin-top:5px;\" class=\"fsField fsFieldAddress2\" disabled=\"disabled\" />"+"\n");
document.write("<div class=\"fsSubFieldGroup\">"+"\n");
document.write("    <div class=\"fsSubField fsFieldCity\">"+"\n");
document.write("        <input type=\"text\" id=\"field12025821-city\" name=\"field12025821-city\" size=\"15\" value=\"\" required class=\"fsField fsFieldCity fsRequired\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("        <label class=\"fsSupporting\" for=\"field12025821-city\">City</label>"+"\n");
document.write("    </div>"+"\n");
document.write("    <div class=\"fsSubField fsFieldState\">"+"\n");
document.write("                    <select id=\"field12025821-state\" name=\"field12025821-state\" required class=\"fsField fsFieldState fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("                <option value=\"\">&nbsp;</option>"+"\n");
document.write("                                    <option value=\"AL\">Alabama</option>"+"\n");
document.write("                                    <option value=\"AK\">Alaska</option>"+"\n");
document.write("                                    <option value=\"AZ\">Arizona</option>"+"\n");
document.write("                                    <option value=\"AR\">Arkansas</option>"+"\n");
document.write("                                    <option value=\"CA\">California</option>"+"\n");
document.write("                                    <option value=\"CO\">Colorado</option>"+"\n");
document.write("                                    <option value=\"CT\">Connecticut</option>"+"\n");
document.write("                                    <option value=\"DE\">Delaware</option>"+"\n");
document.write("                                    <option value=\"DC\">District of Columbia</option>"+"\n");
document.write("                                    <option value=\"FL\">Florida</option>"+"\n");
document.write("                                    <option value=\"GA\">Georgia</option>"+"\n");
document.write("                                    <option value=\"HI\">Hawaii</option>"+"\n");
document.write("                                    <option value=\"ID\">Idaho</option>"+"\n");
document.write("                                    <option value=\"IL\">Illinois</option>"+"\n");
document.write("                                    <option value=\"IN\">Indiana</option>"+"\n");
document.write("                                    <option value=\"IA\">Iowa</option>"+"\n");
document.write("                                    <option value=\"KS\">Kansas</option>"+"\n");
document.write("                                    <option value=\"KY\">Kentucky</option>"+"\n");
document.write("                                    <option value=\"LA\">Louisiana</option>"+"\n");
document.write("                                    <option value=\"ME\">Maine</option>"+"\n");
document.write("                                    <option value=\"MD\">Maryland</option>"+"\n");
document.write("                                    <option value=\"MA\">Massachusetts</option>"+"\n");
document.write("                                    <option value=\"MI\">Michigan</option>"+"\n");
document.write("                                    <option value=\"MN\">Minnesota</option>"+"\n");
document.write("                                    <option value=\"MS\">Mississippi</option>"+"\n");
document.write("                                    <option value=\"MO\">Missouri</option>"+"\n");
document.write("                                    <option value=\"MT\">Montana</option>"+"\n");
document.write("                                    <option value=\"NE\">Nebraska</option>"+"\n");
document.write("                                    <option value=\"NV\">Nevada</option>"+"\n");
document.write("                                    <option value=\"NH\">New Hampshire</option>"+"\n");
document.write("                                    <option value=\"NJ\">New Jersey</option>"+"\n");
document.write("                                    <option value=\"NM\">New Mexico</option>"+"\n");
document.write("                                    <option value=\"NY\">New York</option>"+"\n");
document.write("                                    <option value=\"NC\">North Carolina</option>"+"\n");
document.write("                                    <option value=\"ND\">North Dakota</option>"+"\n");
document.write("                                    <option value=\"OH\">Ohio</option>"+"\n");
document.write("                                    <option value=\"OK\">Oklahoma</option>"+"\n");
document.write("                                    <option value=\"OR\">Oregon</option>"+"\n");
document.write("                                    <option value=\"PA\">Pennsylvania</option>"+"\n");
document.write("                                    <option value=\"RI\">Rhode Island</option>"+"\n");
document.write("                                    <option value=\"SC\">South Carolina</option>"+"\n");
document.write("                                    <option value=\"SD\">South Dakota</option>"+"\n");
document.write("                                    <option value=\"TN\">Tennessee</option>"+"\n");
document.write("                                    <option value=\"TX\">Texas</option>"+"\n");
document.write("                                    <option value=\"UT\">Utah</option>"+"\n");
document.write("                                    <option value=\"VT\">Vermont</option>"+"\n");
document.write("                                    <option value=\"VA\">Virginia</option>"+"\n");
document.write("                                    <option value=\"WA\">Washington</option>"+"\n");
document.write("                                    <option value=\"WV\">West Virginia</option>"+"\n");
document.write("                                    <option value=\"WI\">Wisconsin</option>"+"\n");
document.write("                                    <option value=\"WY\">Wyoming</option>"+"\n");
document.write("                            </select>"+"\n");
document.write("            <label class=\"fsSupporting\" for=\"field12025821-state\">State</label>"+"\n");
document.write("            </div>"+"\n");
document.write("    <div class=\"fsSubField fsFieldZip\">"+"\n");
document.write("                    <input type=\"text\" id=\"field12025821-zip\" name=\"field12025821-zip\" size=\"6\" value=\"\" required class=\"fsField fsFieldZip fsFormatZipUS fsRequired\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("            <label class=\"fsSupporting\" for=\"field12025821-zip\">Zip Code</label>"+"\n");
document.write("            </div>"+"\n");
document.write("    "+"\n");
document.write("</div>"+"\n");
document.write("<div class=\"clear\"></div>"+"\n");
document.write("                "+"\n");
document.write("    <select id=\"field12025821-country\" name=\"field12025821-country\" style=\"margin-top:5px;\" required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\" >"+"\n");
document.write("        <option value=\"\">&nbsp;</option>"+"\n");
document.write("                    <option value=\"Afghanistan\">Afghanistan</option>"+"\n");
document.write("                    <option value=\"Aland Islands\">Aland Islands</option>"+"\n");
document.write("                    <option value=\"Albania\">Albania</option>"+"\n");
document.write("                    <option value=\"Algeria\">Algeria</option>"+"\n");
document.write("                    <option value=\"American Samoa\">American Samoa</option>"+"\n");
document.write("                    <option value=\"Andorra\">Andorra</option>"+"\n");
document.write("                    <option value=\"Angola\">Angola</option>"+"\n");
document.write("                    <option value=\"Anguilla\">Anguilla</option>"+"\n");
document.write("                    <option value=\"Antarctica\">Antarctica</option>"+"\n");
document.write("                    <option value=\"Antigua and Barbuda\">Antigua and Barbuda</option>"+"\n");
document.write("                    <option value=\"Argentina\">Argentina</option>"+"\n");
document.write("                    <option value=\"Armenia\">Armenia</option>"+"\n");
document.write("                    <option value=\"Aruba\">Aruba</option>"+"\n");
document.write("                    <option value=\"Australia\">Australia</option>"+"\n");
document.write("                    <option value=\"Austria\">Austria</option>"+"\n");
document.write("                    <option value=\"Azerbaijan\">Azerbaijan</option>"+"\n");
document.write("                    <option value=\"Bahamas\">Bahamas</option>"+"\n");
document.write("                    <option value=\"Bahrain\">Bahrain</option>"+"\n");
document.write("                    <option value=\"Bangladesh\">Bangladesh</option>"+"\n");
document.write("                    <option value=\"Barbados\">Barbados</option>"+"\n");
document.write("                    <option value=\"Belarus\">Belarus</option>"+"\n");
document.write("                    <option value=\"Belgium\">Belgium</option>"+"\n");
document.write("                    <option value=\"Belize\">Belize</option>"+"\n");
document.write("                    <option value=\"Benin\">Benin</option>"+"\n");
document.write("                    <option value=\"Bermuda\">Bermuda</option>"+"\n");
document.write("                    <option value=\"Bhutan\">Bhutan</option>"+"\n");
document.write("                    <option value=\"Bolivia, Plurinational State of\">Bolivia, Plurinational State of</option>"+"\n");
document.write("                    <option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option>"+"\n");
document.write("                    <option value=\"Botswana\">Botswana</option>"+"\n");
document.write("                    <option value=\"Bouvet Island\">Bouvet Island</option>"+"\n");
document.write("                    <option value=\"Brazil\">Brazil</option>"+"\n");
document.write("                    <option value=\"British Indian Ocean Territory\">British Indian Ocean Territory</option>"+"\n");
document.write("                    <option value=\"Brunei Darussalam\">Brunei Darussalam</option>"+"\n");
document.write("                    <option value=\"Bulgaria\">Bulgaria</option>"+"\n");
document.write("                    <option value=\"Burkina Faso\">Burkina Faso</option>"+"\n");
document.write("                    <option value=\"Burundi\">Burundi</option>"+"\n");
document.write("                    <option value=\"Cambodia\">Cambodia</option>"+"\n");
document.write("                    <option value=\"Cameroon\">Cameroon</option>"+"\n");
document.write("                    <option value=\"Canada\">Canada</option>"+"\n");
document.write("                    <option value=\"Cape Verde\">Cape Verde</option>"+"\n");
document.write("                    <option value=\"Cayman Islands\">Cayman Islands</option>"+"\n");
document.write("                    <option value=\"Central African Republic\">Central African Republic</option>"+"\n");
document.write("                    <option value=\"Chad\">Chad</option>"+"\n");
document.write("                    <option value=\"Chile\">Chile</option>"+"\n");
document.write("                    <option value=\"China\">China</option>"+"\n");
document.write("                    <option value=\"Christmas Island\">Christmas Island</option>"+"\n");
document.write("                    <option value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands</option>"+"\n");
document.write("                    <option value=\"Colombia\">Colombia</option>"+"\n");
document.write("                    <option value=\"Comoros\">Comoros</option>"+"\n");
document.write("                    <option value=\"Congo\">Congo</option>"+"\n");
document.write("                    <option value=\"Congo, The Democratic Republic of the\">Congo, The Democratic Republic of the</option>"+"\n");
document.write("                    <option value=\"Cook Islands\">Cook Islands</option>"+"\n");
document.write("                    <option value=\"Costa Rica\">Costa Rica</option>"+"\n");
document.write("                    <option value=\"Cote Divoire\">Cote Divoire</option>"+"\n");
document.write("                    <option value=\"Croatia\">Croatia</option>"+"\n");
document.write("                    <option value=\"Cuba\">Cuba</option>"+"\n");
document.write("                    <option value=\"Cyprus\">Cyprus</option>"+"\n");
document.write("                    <option value=\"Czech Republic\">Czech Republic</option>"+"\n");
document.write("                    <option value=\"Denmark\">Denmark</option>"+"\n");
document.write("                    <option value=\"Djibouti\">Djibouti</option>"+"\n");
document.write("                    <option value=\"Dominica\">Dominica</option>"+"\n");
document.write("                    <option value=\"Dominican Republic\">Dominican Republic</option>"+"\n");
document.write("                    <option value=\"Ecuador\">Ecuador</option>"+"\n");
document.write("                    <option value=\"Egypt\">Egypt</option>"+"\n");
document.write("                    <option value=\"El Salvador\">El Salvador</option>"+"\n");
document.write("                    <option value=\"Equatorial Guinea\">Equatorial Guinea</option>"+"\n");
document.write("                    <option value=\"Eritrea\">Eritrea</option>"+"\n");
document.write("                    <option value=\"Estonia\">Estonia</option>"+"\n");
document.write("                    <option value=\"Ethiopia\">Ethiopia</option>"+"\n");
document.write("                    <option value=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option>"+"\n");
document.write("                    <option value=\"Faroe Islands\">Faroe Islands</option>"+"\n");
document.write("                    <option value=\"Fiji\">Fiji</option>"+"\n");
document.write("                    <option value=\"Finland\">Finland</option>"+"\n");
document.write("                    <option value=\"France\">France</option>"+"\n");
document.write("                    <option value=\"French Guiana\">French Guiana</option>"+"\n");
document.write("                    <option value=\"French Polynesia\">French Polynesia</option>"+"\n");
document.write("                    <option value=\"French Southern Territories\">French Southern Territories</option>"+"\n");
document.write("                    <option value=\"Gabon\">Gabon</option>"+"\n");
document.write("                    <option value=\"Gambia\">Gambia</option>"+"\n");
document.write("                    <option value=\"Georgia\">Georgia</option>"+"\n");
document.write("                    <option value=\"Germany\">Germany</option>"+"\n");
document.write("                    <option value=\"Ghana\">Ghana</option>"+"\n");
document.write("                    <option value=\"Gibraltar\">Gibraltar</option>"+"\n");
document.write("                    <option value=\"Greece\">Greece</option>"+"\n");
document.write("                    <option value=\"Greenland\">Greenland</option>"+"\n");
document.write("                    <option value=\"Grenada\">Grenada</option>"+"\n");
document.write("                    <option value=\"Guadeloupe\">Guadeloupe</option>"+"\n");
document.write("                    <option value=\"Guam\">Guam</option>"+"\n");
document.write("                    <option value=\"Guatemala\">Guatemala</option>"+"\n");
document.write("                    <option value=\"Guernsey\">Guernsey</option>"+"\n");
document.write("                    <option value=\"Guinea\">Guinea</option>"+"\n");
document.write("                    <option value=\"Guinea-bissau\">Guinea-bissau</option>"+"\n");
document.write("                    <option value=\"Guyana\">Guyana</option>"+"\n");
document.write("                    <option value=\"Haiti\">Haiti</option>"+"\n");
document.write("                    <option value=\"Heard Island and Mcdonald Islands\">Heard Island and Mcdonald Islands</option>"+"\n");
document.write("                    <option value=\"Holy See (Vatican City State)\">Holy See (Vatican City State)</option>"+"\n");
document.write("                    <option value=\"Honduras\">Honduras</option>"+"\n");
document.write("                    <option value=\"Hong Kong\">Hong Kong</option>"+"\n");
document.write("                    <option value=\"Hungary\">Hungary</option>"+"\n");
document.write("                    <option value=\"Iceland\">Iceland</option>"+"\n");
document.write("                    <option value=\"India\">India</option>"+"\n");
document.write("                    <option value=\"Indonesia\">Indonesia</option>"+"\n");
document.write("                    <option value=\"Iran, Islamic Republic of\">Iran, Islamic Republic of</option>"+"\n");
document.write("                    <option value=\"Iraq\">Iraq</option>"+"\n");
document.write("                    <option value=\"Ireland\">Ireland</option>"+"\n");
document.write("                    <option value=\"Isle of Man\">Isle of Man</option>"+"\n");
document.write("                    <option value=\"Israel\">Israel</option>"+"\n");
document.write("                    <option value=\"Italy\">Italy</option>"+"\n");
document.write("                    <option value=\"Jamaica\">Jamaica</option>"+"\n");
document.write("                    <option value=\"Japan\">Japan</option>"+"\n");
document.write("                    <option value=\"Jersey\">Jersey</option>"+"\n");
document.write("                    <option value=\"Jordan\">Jordan</option>"+"\n");
document.write("                    <option value=\"Kazakhstan\">Kazakhstan</option>"+"\n");
document.write("                    <option value=\"Kenya\">Kenya</option>"+"\n");
document.write("                    <option value=\"Kiribati\">Kiribati</option>"+"\n");
document.write("                    <option value=\"Korea, Democratic People\\&#039;s Republic of\">Korea, Democratic People\\&#039;s Republic of</option>"+"\n");
document.write("                    <option value=\"Korea, Republic of\">Korea, Republic of</option>"+"\n");
document.write("                    <option value=\"Kuwait\">Kuwait</option>"+"\n");
document.write("                    <option value=\"Kyrgyzstan\">Kyrgyzstan</option>"+"\n");
document.write("                    <option value=\"Lao People\\&#039;s Democratic Republic\">Lao People\\&#039;s Democratic Republic</option>"+"\n");
document.write("                    <option value=\"Latvia\">Latvia</option>"+"\n");
document.write("                    <option value=\"Lebanon\">Lebanon</option>"+"\n");
document.write("                    <option value=\"Lesotho\">Lesotho</option>"+"\n");
document.write("                    <option value=\"Liberia\">Liberia</option>"+"\n");
document.write("                    <option value=\"Libyan Arab Jamahiriya\">Libyan Arab Jamahiriya</option>"+"\n");
document.write("                    <option value=\"Liechtenstein\">Liechtenstein</option>"+"\n");
document.write("                    <option value=\"Lithuania\">Lithuania</option>"+"\n");
document.write("                    <option value=\"Luxembourg\">Luxembourg</option>"+"\n");
document.write("                    <option value=\"Macao\">Macao</option>"+"\n");
document.write("                    <option value=\"Macedonia, The Former Yugoslav Republic of\">Macedonia, The Former Yugoslav Republic of</option>"+"\n");
document.write("                    <option value=\"Madagascar\">Madagascar</option>"+"\n");
document.write("                    <option value=\"Malawi\">Malawi</option>"+"\n");
document.write("                    <option value=\"Malaysia\">Malaysia</option>"+"\n");
document.write("                    <option value=\"Maldives\">Maldives</option>"+"\n");
document.write("                    <option value=\"Mali\">Mali</option>"+"\n");
document.write("                    <option value=\"Malta\">Malta</option>"+"\n");
document.write("                    <option value=\"Marshall Islands\">Marshall Islands</option>"+"\n");
document.write("                    <option value=\"Martinique\">Martinique</option>"+"\n");
document.write("                    <option value=\"Mauritania\">Mauritania</option>"+"\n");
document.write("                    <option value=\"Mauritius\">Mauritius</option>"+"\n");
document.write("                    <option value=\"Mayotte\">Mayotte</option>"+"\n");
document.write("                    <option value=\"Mexico\">Mexico</option>"+"\n");
document.write("                    <option value=\"Micronesia, Federated States of\">Micronesia, Federated States of</option>"+"\n");
document.write("                    <option value=\"Moldova, Republic of\">Moldova, Republic of</option>"+"\n");
document.write("                    <option value=\"Monaco\">Monaco</option>"+"\n");
document.write("                    <option value=\"Mongolia\">Mongolia</option>"+"\n");
document.write("                    <option value=\"Montenegro\">Montenegro</option>"+"\n");
document.write("                    <option value=\"Montserrat\">Montserrat</option>"+"\n");
document.write("                    <option value=\"Morocco\">Morocco</option>"+"\n");
document.write("                    <option value=\"Mozambique\">Mozambique</option>"+"\n");
document.write("                    <option value=\"Myanmar\">Myanmar</option>"+"\n");
document.write("                    <option value=\"Namibia\">Namibia</option>"+"\n");
document.write("                    <option value=\"Nauru\">Nauru</option>"+"\n");
document.write("                    <option value=\"Nepal\">Nepal</option>"+"\n");
document.write("                    <option value=\"Netherlands\">Netherlands</option>"+"\n");
document.write("                    <option value=\"Netherlands Antilles\">Netherlands Antilles</option>"+"\n");
document.write("                    <option value=\"New Caledonia\">New Caledonia</option>"+"\n");
document.write("                    <option value=\"New Zealand\">New Zealand</option>"+"\n");
document.write("                    <option value=\"Nicaragua\">Nicaragua</option>"+"\n");
document.write("                    <option value=\"Niger\">Niger</option>"+"\n");
document.write("                    <option value=\"Nigeria\">Nigeria</option>"+"\n");
document.write("                    <option value=\"Niue\">Niue</option>"+"\n");
document.write("                    <option value=\"Norfolk Island\">Norfolk Island</option>"+"\n");
document.write("                    <option value=\"Northern Mariana Islands\">Northern Mariana Islands</option>"+"\n");
document.write("                    <option value=\"Norway\">Norway</option>"+"\n");
document.write("                    <option value=\"Oman\">Oman</option>"+"\n");
document.write("                    <option value=\"Pakistan\">Pakistan</option>"+"\n");
document.write("                    <option value=\"Palau\">Palau</option>"+"\n");
document.write("                    <option value=\"Palestinian Territory\">Palestinian Territory</option>"+"\n");
document.write("                    <option value=\"Panama\">Panama</option>"+"\n");
document.write("                    <option value=\"Papua New Guinea\">Papua New Guinea</option>"+"\n");
document.write("                    <option value=\"Paraguay\">Paraguay</option>"+"\n");
document.write("                    <option value=\"Peru\">Peru</option>"+"\n");
document.write("                    <option value=\"Philippines\">Philippines</option>"+"\n");
document.write("                    <option value=\"Pitcairn\">Pitcairn</option>"+"\n");
document.write("                    <option value=\"Poland\">Poland</option>"+"\n");
document.write("                    <option value=\"Portugal\">Portugal</option>"+"\n");
document.write("                    <option value=\"Puerto Rico\">Puerto Rico</option>"+"\n");
document.write("                    <option value=\"Qatar\">Qatar</option>"+"\n");
document.write("                    <option value=\"Reunion\">Reunion</option>"+"\n");
document.write("                    <option value=\"Romania\">Romania</option>"+"\n");
document.write("                    <option value=\"Russian Federation\">Russian Federation</option>"+"\n");
document.write("                    <option value=\"Rwanda\">Rwanda</option>"+"\n");
document.write("                    <option value=\"Saint Barthelemy\">Saint Barthelemy</option>"+"\n");
document.write("                    <option value=\"Saint Helena\">Saint Helena</option>"+"\n");
document.write("                    <option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option>"+"\n");
document.write("                    <option value=\"Saint Lucia\">Saint Lucia</option>"+"\n");
document.write("                    <option value=\"Saint Martin\">Saint Martin</option>"+"\n");
document.write("                    <option value=\"Saint Pierre and Miquelon\">Saint Pierre and Miquelon</option>"+"\n");
document.write("                    <option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines</option>"+"\n");
document.write("                    <option value=\"Samoa\">Samoa</option>"+"\n");
document.write("                    <option value=\"San Marino\">San Marino</option>"+"\n");
document.write("                    <option value=\"Sao Tome and Principe\">Sao Tome and Principe</option>"+"\n");
document.write("                    <option value=\"Saudi Arabia\">Saudi Arabia</option>"+"\n");
document.write("                    <option value=\"Senegal\">Senegal</option>"+"\n");
document.write("                    <option value=\"Serbia\">Serbia</option>"+"\n");
document.write("                    <option value=\"Seychelles\">Seychelles</option>"+"\n");
document.write("                    <option value=\"Sierra Leone\">Sierra Leone</option>"+"\n");
document.write("                    <option value=\"Singapore\">Singapore</option>"+"\n");
document.write("                    <option value=\"Slovakia\">Slovakia</option>"+"\n");
document.write("                    <option value=\"Slovenia\">Slovenia</option>"+"\n");
document.write("                    <option value=\"Solomon Islands\">Solomon Islands</option>"+"\n");
document.write("                    <option value=\"Somalia\">Somalia</option>"+"\n");
document.write("                    <option value=\"South Africa\">South Africa</option>"+"\n");
document.write("                    <option value=\"South Georgia and the South Sandwich Islands\">South Georgia and the South Sandwich Islands</option>"+"\n");
document.write("                    <option value=\"Spain\">Spain</option>"+"\n");
document.write("                    <option value=\"Sri Lanka\">Sri Lanka</option>"+"\n");
document.write("                    <option value=\"Sudan\">Sudan</option>"+"\n");
document.write("                    <option value=\"Suriname\">Suriname</option>"+"\n");
document.write("                    <option value=\"Svalbard and Jan Mayen\">Svalbard and Jan Mayen</option>"+"\n");
document.write("                    <option value=\"Swaziland\">Swaziland</option>"+"\n");
document.write("                    <option value=\"Sweden\">Sweden</option>"+"\n");
document.write("                    <option value=\"Switzerland\">Switzerland</option>"+"\n");
document.write("                    <option value=\"Syrian Arab Republic\">Syrian Arab Republic</option>"+"\n");
document.write("                    <option value=\"Taiwan, Republic of China\">Taiwan, Republic of China</option>"+"\n");
document.write("                    <option value=\"Tajikistan\">Tajikistan</option>"+"\n");
document.write("                    <option value=\"Tanzania, United Republic of\">Tanzania, United Republic of</option>"+"\n");
document.write("                    <option value=\"Thailand\">Thailand</option>"+"\n");
document.write("                    <option value=\"Timor-leste\">Timor-leste</option>"+"\n");
document.write("                    <option value=\"Togo\">Togo</option>"+"\n");
document.write("                    <option value=\"Tokelau\">Tokelau</option>"+"\n");
document.write("                    <option value=\"Tonga\">Tonga</option>"+"\n");
document.write("                    <option value=\"Trinidad and Tobago\">Trinidad and Tobago</option>"+"\n");
document.write("                    <option value=\"Tunisia\">Tunisia</option>"+"\n");
document.write("                    <option value=\"Turkey\">Turkey</option>"+"\n");
document.write("                    <option value=\"Turkmenistan\">Turkmenistan</option>"+"\n");
document.write("                    <option value=\"Turks and Caicos Islands\">Turks and Caicos Islands</option>"+"\n");
document.write("                    <option value=\"Tuvalu\">Tuvalu</option>"+"\n");
document.write("                    <option value=\"Uganda\">Uganda</option>"+"\n");
document.write("                    <option value=\"Ukraine\">Ukraine</option>"+"\n");
document.write("                    <option value=\"United Arab Emirates\">United Arab Emirates</option>"+"\n");
document.write("                    <option value=\"United Kingdom\">United Kingdom</option>"+"\n");
document.write("                    <option value=\"United States\" selected=\"selected\">United States</option>"+"\n");
document.write("                    <option value=\"United States Minor Outlying Islands\">United States Minor Outlying Islands</option>"+"\n");
document.write("                    <option value=\"Uruguay\">Uruguay</option>"+"\n");
document.write("                    <option value=\"Uzbekistan\">Uzbekistan</option>"+"\n");
document.write("                    <option value=\"Vanuatu\">Vanuatu</option>"+"\n");
document.write("                    <option value=\"Venezuela\">Venezuela</option>"+"\n");
document.write("                    <option value=\"Vietnam\">Vietnam</option>"+"\n");
document.write("                    <option value=\"Virgin Islands, British\">Virgin Islands, British</option>"+"\n");
document.write("                    <option value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.</option>"+"\n");
document.write("                    <option value=\"Wallis and Futuna\">Wallis and Futuna</option>"+"\n");
document.write("                    <option value=\"Western Sahara\">Western Sahara</option>"+"\n");
document.write("                    <option value=\"Yemen\">Yemen</option>"+"\n");
document.write("                    <option value=\"Zambia\">Zambia</option>"+"\n");
document.write("                    <option value=\"Zimbabwe\">Zimbabwe</option>"+"\n");
document.write("                    <option value=\"Kosovo\">Kosovo</option>"+"\n");
document.write("            </select>"+"\n");
document.write("    <label class=\"fsSupporting\" for=\"field12025821-country\">Country</label>"+"\n");
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document.write("                                "+"\n");
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document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
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document.write("                        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell12025826\">"+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <p>For Vermont Residents Only: The information above does not change the residency status established at your last enrollment.&#160;For information on filing for in-state status, contact the Residency Office, Registrar\'s Office, 85 South Prospect St., (802) 656-8515.</p>"+"\n");
document.write("<p>Information is also available online under <a onclick=\"newwindow =window.open(this.href,\'windowTitle\',\'width=900,height=600,resizable=yes,scrollbars=yes,location=yes,left=50,top=50\'); if (window.focus) {newwindow.focus()} return false; \" href=\"http://www.uvm.edu/&#126;rgweb\">Policies &amp; Procedures on the Registar\'s webpage</a>.</p>"+"\n");
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document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
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document.write("            <div class=\"fsSection fs1Col\" id=\"fsSection17906779\">           "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                    <label id=\"label10492221\" class=\"fsLabel fsRequiredLabel\" for=\"field10492221\">Please indicate the term you intend to enroll:<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10492221\" name=\"field10492221\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" >"+"\n");
document.write("        <option value=\"201306\" >Summer 2013</option>"+"\n");
document.write("        <option value=\"201309\" >Fall 2013</option>"+"\n");
document.write("        <option value=\"201401\" >Spring 2014</option>"+"\n");
document.write("        <option value=\"201406\" >Summer 2014</option>"+"\n");
document.write("        <option value=\"201409\" >Fall 2014</option>"+"\n");
document.write("        <option value=\"New Option\" >Spring 2014</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("            "+"\n");
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document.write("                        "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
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document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection10492216\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">PROFESSIONAL CHOICE</h2>"+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-58\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <h3>Please check the profession(s) you are interested in pursuing.</h3>"+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
document.write("                            "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-59\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492217\">"+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Medicine</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10492217_1\"><input type=\"radio\" id=\"field10492217_1\" name=\"field10492217\" value=\"PBMD\"  class=\"fsField  horizontal\"  disabled=\"disabled\" />Yes</label>"+"\n");
document.write("                "+"\n");
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document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10492217_2\"><input type=\"radio\" id=\"field10492217_2\" name=\"field10492217\" value=\"--\" checked=\"checked\" class=\"fsField  horizontal\"  disabled=\"disabled\" />No</label>"+"\n");
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document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                            			</div></fieldset>"+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Dentistry</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10648930_1\"><input type=\"radio\" id=\"field10648930_1\" name=\"field10648930\" value=\"PBPD\"  class=\"fsField  horizontal\"  disabled=\"disabled\" />Yes</label>"+"\n");
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document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Veterinary Medicine</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10650052_1\"><input type=\"radio\" id=\"field10650052_1\" name=\"field10650052\" value=\"PBVM\"  class=\"fsField  horizontal\"  disabled=\"disabled\" />Yes</label>"+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Physician Assistant</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10650051_1\"><input type=\"radio\" id=\"field10650051_1\" name=\"field10650051\" value=\"PBPH\"  class=\"fsField  horizontal\"  disabled=\"disabled\" />Yes</label>"+"\n");
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document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10650051_2\"><input type=\"radio\" id=\"field10650051_2\" name=\"field10650051\" value=\"--\" checked=\"checked\" class=\"fsField  horizontal\"  disabled=\"disabled\" />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("            "+"\n");
document.write("                            "+"\n");
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document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Nurse Practitioner</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field10650050_1\"><input type=\"radio\" id=\"field10650050_1\" name=\"field10650050\" value=\"PBNP\"  class=\"fsField  horizontal\"  disabled=\"disabled\" />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
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document.write("                                                                    "+"\n");
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document.write("                                                    "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Physical Therapy</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
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document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("            <h2 class=\"fsSectionHeading\">SLPA Professional Growth</h2>"+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Do you have access to a school-based Speech-Language Pathologist who is certified by ASHA for supervision during this SLP-Assistant Program?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
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document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
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document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Are you intending to use these courses as preparation for a UVM MS in Communication Sciences? <span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Are you committed to service as a Speech-Language Pathology Assistant in the schools?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                            			</div></fieldset>"+"\n");
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document.write("            "+"\n");
document.write("                            "+"\n");
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document.write("                        "+"\n");
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document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
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document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Brain Research and Learning:  Reasons for Applying</h2>"+"\n");
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document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-70\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Please describe briefly your reasons for applying to this program<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
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document.write("        "+"\n");
document.write("        "+"\n");
document.write("                "+"\n");
document.write("                            "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15009506_2\"><input type=\"checkbox\" id=\"field15009506_2\" name=\"field15009506[]\" value=\"Using as part of a Master&#039;s Degree\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />Using as part of a Master&#039;s Degree</label>"+"\n");
document.write("        "+"\n");
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document.write("                "+"\n");
document.write("                            "+"\n");
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document.write("    "+"\n");
document.write("	<div class=\"clear\">"+"\n");
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document.write("	     aria-required=\"true\"	    /><label class=\"hidden\" for=\"field15009506_othervalue\">Other Value</label>"+"\n");
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document.write("                                Check all that apply"+"\n");
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document.write("                                                                            "+"\n");
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document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
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document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Pre-college Course Selection</h2>"+"\n");
document.write("        "+"\n");
document.write("            <div class=\"fsSectionText\"><p>Enter the courses that you would like to take below. You can look up the course information if needed.</p>"+"\n");
document.write("<ul>"+"\n");
document.write("<li><a href=\"http://learn.uvm.edu/high-school-2/spring-courses-for-high-school-students/\" target=\"_blank\">Spring courses for high school students</a></li>"+"\n");
document.write("<li><a href=\"http://learn.uvm.edu/high-school-2/summer-courses/\" target=\"_blank\">Summer courses for high school students</a></li>"+"\n");
document.write("<li><a href=\"http://learn.uvm.edu/high-school-2/fall-courses-for-high-school-students/\" target=\"_blank\">Fall courses for high school students</a></li>"+"\n");
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document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <h3>First Choice</h3>"+"\n");
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document.write("                                "+"\n");
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document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                                    <label id=\"label17203428\" class=\"fsLabel fsRequiredLabel\" for=\"field17203428\">First choice: Course Registration Number and Title<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("                "+"\n");
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document.write("                                EG:  90130 General Psychology"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17203515\" aria-describedby=\"fsSupporting17203515\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17203515\" class=\"fsLabel fsRequiredLabel\" for=\"field17203515\">Subject, Course Number, and Section Code  (first choice)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17203515\" name=\"field17203515\" size=\"35\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17203515\" class=\"fsSupporting\">"+"\n");
document.write("                                i.e. PSYC 001 B"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-75\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17203552\" aria-describedby=\"fsSupporting17203552\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17203552\" class=\"fsLabel fsRequiredLabel\" for=\"field17203552\">Days/hrs offered  (first choice)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17203552\" name=\"field17203552\" size=\"25\" required maxlength=\"50\"  value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17203552\" class=\"fsSupporting\">"+"\n");
document.write("                                i.e. MWF 10-11am"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-76\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17203665\">"+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <h3>Second Choice</h3>"+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-77\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17203494\" aria-describedby=\"fsSupporting17203494\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17203494\" class=\"fsLabel\" for=\"field17203494\">Second Choice: Course Registration Number and Course Title                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17203494\" name=\"field17203494\" size=\"50\"  maxlength=\"100\"  value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17203494\" class=\"fsSupporting\">"+"\n");
document.write("                                EG:  90130 General Psychology"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-78\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17203523\" aria-describedby=\"fsSupporting17203523\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17203523\" class=\"fsLabel\" for=\"field17203523\">Subject, Course Number, and Section Code  (second choice)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17203523\" name=\"field17203523\" size=\"35\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17203523\" class=\"fsSupporting\">"+"\n");
document.write("                                i.e.  PSYC 001 B"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-79\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17203559\" aria-describedby=\"fsSupporting17203559\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17203559\" class=\"fsLabel\" for=\"field17203559\">Days/hrs offered  (second choice)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17203559\" name=\"field17203559\" size=\"25\"  maxlength=\"50\"  value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17203559\" class=\"fsSupporting\">"+"\n");
document.write("                                i.e. MWF 10-11am"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-80\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17205460\">"+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <h3>Math Placement</h3>"+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-81\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17203944\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17203944\" class=\"fsLabel fsRequiredLabel\" for=\"field17203944\">Have you selected one or more math courses above?<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field17203944\" name=\"field17203944\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"Yes\" >Yes</option>"+"\n");
document.write("        <option value=\"No\" >No</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-82\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell17204060\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label17204060\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Have you taken a math course at UVM before?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field17204060_1\"><input type=\"radio\" id=\"field17204060_1\" name=\"field17204060\" value=\"Yes\"  class=\"fsField fsRequired horizontal\" aria-required=\"true\" disabled=\"disabled\" />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field17204060_2\"><input type=\"radio\" id=\"field17204060_2\" name=\"field17204060\" value=\"No\"  class=\"fsField fsRequired horizontal\" aria-required=\"true\" disabled=\"disabled\" />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-83\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell17204113\" aria-describedby=\"fsSupporting17204113\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label17204113\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Math Readiness acknowledgement<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("        <label class=\"fsOptionLabel horizontal\" for=\"field17204113_1\"><input type=\"checkbox\" id=\"field17204113_1\" name=\"field17204113[]\" value=\"I understand that if this is my first time taking a University level Math course  I must complete the Math Placement Test and call 656-2085 to discuss the results and be placed accordingly into the appropriate section for my level.\"  class=\"fsField fsRequired horizontal\" aria-required=\"true\" disabled=\"disabled\" />I understand that if this is my first time taking a University level Math course  I must complete the Math Placement Test and call 656-2085 to discuss the results and be placed accordingly into the appropriate section for my level.</label>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17204113\" class=\"fsSupporting\">"+"\n");
document.write("                                <p class=\'fsLabel\'>You will be sent a link to the test</p>"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection17521457\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Parent and/or Guidance Counselor Contact Information</h2>"+"\n");
document.write("        "+"\n");
document.write("            <div class=\"fsSectionText\"><p>We will be contacting your parents and/or guidance counselor regarding the course(s) that you select.</p></div>"+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-85\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17206118\" aria-describedby=\"fsSupporting17206118\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17206118\" class=\"fsLabel fsRequiredLabel\" for=\"field17206118\">Email Address of your High School Guidance Counselor<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"email\" id=\"field17206118\" name=\"field17206118\" size=\"50\" required=\"required\"    value=\"\"  class=\"fsField fsFormatEmail fsRequired\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17206118\" class=\"fsSupporting\">"+"\n");
document.write("                                We will contact this address requesting that he/she approve your course selection.  "+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-86\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17206153\" aria-describedby=\"fsSupporting17206153\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17206153\" class=\"fsLabel fsRequiredLabel\" for=\"field17206153\">Parent\'s Email Address<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"email\" id=\"field17206153\" name=\"field17206153\" size=\"50\" required=\"required\"    value=\"\"  class=\"fsField fsFormatEmail fsRequired\" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17206153\" class=\"fsSupporting\">"+"\n");
document.write("                                We will contact this address to approve the terms and conditions and course selection"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
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document.write("                                Include dates, duration, grade level, subject(s), school, town and state"+"\n");
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document.write("                                For  information about financial aid and paying for your education, UVM\'s Student  Financial Services Office can be reached at 802-656-5700 or via <a href=\"http://www.uvm.edu/sfs\" target=\"_blank\">uvm.edu/sfs</a>"+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-109\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
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document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Are you planning to initiate financial aid?</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15338833_1\"><input type=\"radio\" id=\"field15338833_1\" name=\"field15338833\" value=\"Yes\"  class=\"fsField  vertical\"   />Yes</label>"+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15338833_2\"><input type=\"radio\" id=\"field15338833_2\" name=\"field15338833\" value=\"No\"  class=\"fsField  vertical\"   />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell15338842\" aria-describedby=\"fsSupporting15338842\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label15338842\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>FAFSA<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
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document.write("                                A FAFSA can be downloaded at <a href=\"http://www.fafsa.gov\" target=\"_blank\">fafsa.gov</a>.  UVM\'s school code is 003696"+"\n");
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document.write("                                                                            "+"\n");
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document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Housing<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15338845_1\"><input type=\"radio\" id=\"field15338845_1\" name=\"field15338845\" value=\"UVM Housing\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />UVM Housing</label>"+"\n");
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document.write("            "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15338845_3\"><input type=\"radio\" id=\"field15338845_3\" name=\"field15338845\" value=\"I plan to participate in GAP Online\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />I plan to participate in GAP Online</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15338845_4\"><input type=\"radio\" id=\"field15338845_4\" name=\"field15338845\" value=\"Other\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />Other</label>"+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                            			</div></fieldset>"+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell15338854\" aria-describedby=\"fsSupporting15338854\">"+"\n");
document.write("                "+"\n");
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document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Add/Drop/Withrawal<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15338854_1\"><input type=\"radio\" id=\"field15338854_1\" name=\"field15338854\" value=\"I understand the add/drop/withdrawal policies as indicated in the link below\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />I understand the add/drop/withdrawal policies as indicated in the link below</label>"+"\n");
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document.write("                                                                                        <div id=\"fsSupporting15338854\" class=\"fsSupporting\">"+"\n");
document.write("                                <a href=\"http://www.uvm.edu/~summer/info/registration/add-drop/\" target=\"_blank\">Review add/drop/withdrawal policies</a>"+"\n");
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document.write("                                                                            "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Do you qualify for UVM tuition remission?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15962652_2\"><input type=\"radio\" id=\"field15962652_2\" name=\"field15962652\" value=\"No\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />No</label>"+"\n");
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document.write("                                You or one of your parents must be a current UVM employee to qualify."+"\n");
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document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
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document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Military Status</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                            			</div></fieldset>"+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
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document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Are you an ROTC student planning on enrolling in Military Studies courses?</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15652444_2\"><input type=\"radio\" id=\"field15652444_2\" name=\"field15652444\" value=\"No\"  class=\"fsField  vertical\"   />No</label>"+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
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document.write("                        "+"\n");
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document.write("                        "+"\n");
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document.write("                                                                "+"\n");
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document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Have you ever taken a course at UVM before?</span></legend>"+"\n");
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document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
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document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15652460_1\"><input type=\"radio\" id=\"field15652460_1\" name=\"field15652460\" value=\"Yes\"  class=\"fsField  vertical\"   />Yes</label>"+"\n");
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document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field15652460_2\"><input type=\"radio\" id=\"field15652460_2\" name=\"field15652460\" value=\"No\"  class=\"fsField  vertical\"   />No</label>"+"\n");
document.write("                "+"\n");
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document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("            "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
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document.write("                                "+"\n");
document.write("                        "+"\n");
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document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">High School</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-119\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17206160\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17206160\" class=\"fsLabel\" for=\"field17206160\">Grade                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field17206160\" name=\"field17206160\" size=\"1\"   class=\"fsField \"  disabled=\"disabled\">"+"\n");
document.write("        <option value=\"12th\" >12th</option>"+"\n");
document.write("        <option value=\"11th\" >11th</option>"+"\n");
document.write("        <option value=\"10th\" >10th</option>"+"\n");
document.write("        <option value=\"9th\" >9th</option>"+"\n");
document.write("        <option value=\"GED\" >GED</option>"+"\n");
document.write("        <option value=\"Graduated\" >Graduated</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-120\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17316595\" aria-describedby=\"fsSupporting17316595\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17316595\" class=\"fsLabel\" for=\"field17316595\">High School Graduation Year                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17316595\" name=\"field17316595\" size=\"4\"  maxlength=\"4\"  value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17316595\" class=\"fsSupporting\">"+"\n");
document.write("                                (anticipated or actual). Please enter with no dashes or hyphens (ex: YYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-121\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell16819469\" aria-describedby=\"fsSupporting16819469\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label16819469\" class=\"fsLabel fsRequiredLabel\" for=\"field16819469\">Primary High School (choose state or province)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field16819469\" name=\"field16819469\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"DC\" >District of Columbia</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WI\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"WY\" >Wyoming</option>"+"\n");
document.write("        <option value=\"ust\" >US TERRITORIES</option>"+"\n");
document.write("        <option value=\"AS\" >American Samoa</option>"+"\n");
document.write("        <option value=\"GU\" >Guam</option>"+"\n");
document.write("        <option value=\"MP\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"PR\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"VI\" >Virgin Islands</option>"+"\n");
document.write("        <option value=\"FM\" >Federated States of Micronesia</option>"+"\n");
document.write("        <option value=\"MH\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"PW\" >Palau</option>"+"\n");
document.write("        <option value=\"can\" >CANADIAN PROVINCES</option>"+"\n");
document.write("        <option value=\"ON\" >Ontario</option>"+"\n");
document.write("        <option value=\"QC\" >Quebec</option>"+"\n");
document.write("        <option value=\"NS\" >Nova Scotia</option>"+"\n");
document.write("        <option value=\"NB\" >New Brunswick</option>"+"\n");
document.write("        <option value=\"MB\" >Manitoba</option>"+"\n");
document.write("        <option value=\"BC\" >British Columbia</option>"+"\n");
document.write("        <option value=\"PE\" >Prince Edward Island</option>"+"\n");
document.write("        <option value=\"SK\" >Saskatchewan</option>"+"\n");
document.write("        <option value=\"AB\" >Alberta</option>"+"\n");
document.write("        <option value=\"NL\" >Newfoundland and Labrador</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting16819469\" class=\"fsSupporting\">"+"\n");
document.write("                                Please choose the location of the high school you intend to graduate from"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-122\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17694727\" aria-describedby=\"fsSupporting17694727\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17694727\" class=\"fsLabel\" for=\"field17694727\">Primary High School (select name)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17694727\" name=\"field17694727\" size=\"50\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17694727\" class=\"fsSupporting\">"+"\n");
document.write("                                Please select the high school that you have graduated from or intend to graduate from"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-123\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell17694724\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17694724\" class=\"fsLabel\" for=\"field17694724\">Primary High School 1 - hidden to users                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17694724\" name=\"field17694724\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-124\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell17710062\" aria-describedby=\"fsSupporting17710062\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label17710062\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>Secondary High School</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field17710062_1\"><input type=\"radio\" id=\"field17710062_1\" name=\"field17710062\" value=\"Yes\"  class=\"fsField  vertical\"  disabled=\"disabled\" />Yes</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field17710062_2\"><input type=\"radio\" id=\"field17710062_2\" name=\"field17710062\" value=\"No\"  class=\"fsField  vertical\"  disabled=\"disabled\" />No</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17710062\" class=\"fsSupporting\">"+"\n");
document.write("                                Is there another high school that you have attended in addition to the one listed above?"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-125\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell17710041\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17710041\" class=\"fsLabel\" for=\"field17710041\">Secondary High School  (choose state or province)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field17710041\" name=\"field17710041\" size=\"1\"   class=\"fsField \"  disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"DC\" >District of Columbia</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WI\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"WY\" >Wyoming</option>"+"\n");
document.write("        <option value=\"ust\" >US TERRITORIES</option>"+"\n");
document.write("        <option value=\"AS\" >American Samoa</option>"+"\n");
document.write("        <option value=\"GU\" >Guam</option>"+"\n");
document.write("        <option value=\"MP\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"PR\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"VI\" >Virgin Islands</option>"+"\n");
document.write("        <option value=\"FM\" >Federated States of Micronesia</option>"+"\n");
document.write("        <option value=\"MH\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"PW\" >Palau</option>"+"\n");
document.write("        <option value=\"can\" >CANADIAN PROVINCES</option>"+"\n");
document.write("        <option value=\"ON\" >Ontario</option>"+"\n");
document.write("        <option value=\"QC\" >Quebec</option>"+"\n");
document.write("        <option value=\"NS\" >Nova Scotia</option>"+"\n");
document.write("        <option value=\"NB\" >New Brunswick</option>"+"\n");
document.write("        <option value=\"MB\" >Manitoba</option>"+"\n");
document.write("        <option value=\"BC\" >British Columbia</option>"+"\n");
document.write("        <option value=\"PE\" >Prince Edward Island</option>"+"\n");
document.write("        <option value=\"SK\" >Saskatchewan</option>"+"\n");
document.write("        <option value=\"AB\" >Alberta</option>"+"\n");
document.write("        <option value=\"NL\" >Newfoundland and Labrador</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
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document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-126\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 \" id=\"fsCell17710047\" aria-describedby=\"fsSupporting17710047\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17710047\" class=\"fsLabel\" for=\"field17710047\">Secondary High School (select name)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17710047\" name=\"field17710047\" size=\"50\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17710047\" class=\"fsSupporting\">"+"\n");
document.write("                                Please select the high school that you have attended or are attending"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-127\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                    <label id=\"label16819471\" class=\"fsLabel\" for=\"field16819471\">Secondary High School 2 hidden to users                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field16819471\" name=\"field16819471\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection17727923\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">Colleges Attended</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-129\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell16818740\" aria-describedby=\"fsSupporting16818740\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label16818740\">"+"\n");
document.write("                        <legend class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>How many colleges have you attended where you have earned college credit?<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field16818740_1\"><input type=\"radio\" id=\"field16818740_1\" name=\"field16818740\" value=\"None\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />None</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field16818740_2\"><input type=\"radio\" id=\"field16818740_2\" name=\"field16818740\" value=\"1\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />1</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field16818740_3\"><input type=\"radio\" id=\"field16818740_3\" name=\"field16818740\" value=\"2\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />2</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field16818740_4\"><input type=\"radio\" id=\"field16818740_4\" name=\"field16818740\" value=\"3\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />3</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field16818740_5\"><input type=\"radio\" id=\"field16818740_5\" name=\"field16818740\" value=\"4\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />4</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field16818740_6\"><input type=\"radio\" id=\"field16818740_6\" name=\"field16818740\" value=\"5\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />5</label>"+"\n");
document.write("                "+"\n");
document.write("            "+"\n");
document.write("            "+"\n");
document.write("        "+"\n");
document.write("        <label class=\"fsOptionLabel vertical\" for=\"field16818740_7\"><input type=\"radio\" id=\"field16818740_7\" name=\"field16818740\" value=\"More than 5\"  class=\"fsField fsRequired vertical\" aria-required=\"true\" disabled=\"disabled\" />More than 5</label>"+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting16818740\" class=\"fsSupporting\">"+"\n");
document.write("                                transcripts are required for all college credit work"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection10492226\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">College Attended</h2>"+"\n");
document.write("        "+"\n");
document.write("            <div class=\"fsSectionText\"><h3>Complete for all undergraduate, graduate or professional schools attended.&#160; Schools not listed may be added to the \"Additional colleges or universities attended\" section below</h3>"+"\n");
document.write("<h3>Please submit official transcripts for all schools listed.</h3></div>"+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection16835328\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">College #1</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-132\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492230\" aria-describedby=\"fsSupporting10492230\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492230\" class=\"fsLabel fsRequiredLabel\" for=\"field10492230\">College 1 (choose state or province)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10492230\" name=\"field10492230\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"DC\" >District of Columbia</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WI\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"WY\" >Wyoming</option>"+"\n");
document.write("        <option value=\"ust\" >US TERRITORIES</option>"+"\n");
document.write("        <option value=\"AS\" >American Samoa</option>"+"\n");
document.write("        <option value=\"GU\" >Guam</option>"+"\n");
document.write("        <option value=\"MP\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"PR\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"VI\" >Virgin Islands</option>"+"\n");
document.write("        <option value=\"FM\" >Federated States of Micronesia</option>"+"\n");
document.write("        <option value=\"MH\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"PW\" >Palau</option>"+"\n");
document.write("        <option value=\"can\" >CANADIAN PROVINCES</option>"+"\n");
document.write("        <option value=\"ON\" >Ontario</option>"+"\n");
document.write("        <option value=\"QC\" >Quebec</option>"+"\n");
document.write("        <option value=\"NS\" >Nova Scotia</option>"+"\n");
document.write("        <option value=\"NB\" >New Brunswick</option>"+"\n");
document.write("        <option value=\"MB\" >Manitoba</option>"+"\n");
document.write("        <option value=\"BC\" >British Columbia</option>"+"\n");
document.write("        <option value=\"PE\" >Prince Edward Island</option>"+"\n");
document.write("        <option value=\"SK\" >Saskatchewan</option>"+"\n");
document.write("        <option value=\"AB\" >Alberta</option>"+"\n");
document.write("        <option value=\"NL\" >Newfoundland and Labrador</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10492230\" class=\"fsSupporting\">"+"\n");
document.write("                                 Select the US State, Province, or Territory in which your college or university is located"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-133\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10641876\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10641876\" class=\"fsLabel\" for=\"field10641876\">College 1 (select name of college or university)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10641876\" name=\"field10641876\" size=\"50\"    value=\"--\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-134\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10949366\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10949366\" class=\"fsLabel\" for=\"field10949366\">College 1- College Name  -- hidden to users                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10949366\" name=\"field10949366\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-135\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596577\" aria-describedby=\"fsSupporting10596577\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596577\" class=\"fsLabel fsRequiredLabel\" for=\"field10596577\">Start date of attendance (College #1)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596577\" name=\"field10596577\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596577\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-136\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596578\" aria-describedby=\"fsSupporting10596578\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596578\" class=\"fsLabel fsRequiredLabel\" for=\"field10596578\">End date of attendance (College #1):<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596578\" name=\"field10596578\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596578\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-137\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10492229\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10492229\" class=\"fsLabel fsRequiredLabel\" for=\"field10492229\">Degree received (College #1)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10492229\" name=\"field10492229\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"--\" >-please select-</option>"+"\n");
document.write("        <option value=\"ND\" >Non Degree</option>"+"\n");
document.write("        <option value=\"0\" >Undeclared Degree</option>"+"\n");
document.write("        <option value=\"AS\" >Associate in Science</option>"+"\n");
document.write("        <option value=\"ASHS\" >Associate in Health Science</option>"+"\n");
document.write("        <option value=\"ASPS\" >Associate in Prof Studies</option>"+"\n");
document.write("        <option value=\"T2YR\" >Transfer - 2 Yr Degree</option>"+"\n");
document.write("        <option value=\"BA\" >Bachelor of Arts</option>"+"\n");
document.write("        <option value=\"BAE\" >Bachelor of Arts in Engineering</option>"+"\n");
document.write("        <option value=\"BE\" >Bachelor of Engineering</option>"+"\n");
document.write("        <option value=\"BMUS\" >Bachelor of Music</option>"+"\n");
document.write("        <option value=\"BS\" >Bachelor of Science</option>"+"\n");
document.write("        <option value=\"BSAE\" >B.S. Art Education</option>"+"\n");
document.write("        <option value=\"BSBA\" >B.S. Business Administration</option>"+"\n");
document.write("        <option value=\"BSBE\" >B.S. Business Education</option>"+"\n");
document.write("        <option value=\"BSC\" >B.S. Chemistry</option>"+"\n");
document.write("        <option value=\"BSC&amp;E\" >B.S. Commerce &amp; Economics</option>"+"\n");
document.write("        <option value=\"BSCE\" >B.S. Civil Engineering</option>"+"\n");
document.write("        <option value=\"BSCS\" >B.S. Computer Science</option>"+"\n");
document.write("        <option value=\"BSE\" >B.S. Engineering</option>"+"\n");
document.write("        <option value=\"BSED\" >B.S. Education</option>"+"\n");
document.write("        <option value=\"BSEE\" >B.S. Electrical Engineering</option>"+"\n");
document.write("        <option value=\"BSEM\" >B.S. Engineering Management</option>"+"\n");
document.write("        <option value=\"BSEV\" >B.S.Environmental Engineering</option>"+"\n");
document.write("        <option value=\"BSG\" >B.S. Geology</option>"+"\n");
document.write("        <option value=\"BSHE\" >B.S. Home Economics</option>"+"\n");
document.write("        <option value=\"BSM\" >B.S. Mathematics</option>"+"\n");
document.write("        <option value=\"BSME\" >B.S. Mechanical Engineering</option>"+"\n");
document.write("        <option value=\"BSMM\" >B.S. Mfg &amp; Mgt Engineering</option>"+"\n");
document.write("        <option value=\"BSMS\" >B.S. Music Education</option>"+"\n");
document.write("        <option value=\"BSP\" >B.S. Physics</option>"+"\n");
document.write("        <option value=\"T4YR\" >Transfer - 4 Yr Degree</option>"+"\n");
document.write("        <option value=\"TBC\" >Trsfr Bachelor Commerce</option>"+"\n");
document.write("        <option value=\"DHC\" >Dental Hygiene Certificate</option>"+"\n");
document.write("        <option value=\"DPT\" >Doctor of Physical Therapy</option>"+"\n");
document.write("        <option value=\"EDD\" >Doctor of Education</option>"+"\n");
document.write("        <option value=\"FYR\" >Fifth-Year Certificate in Educ</option>"+"\n");
document.write("        <option value=\"MA\" >Master of Arts</option>"+"\n");
document.write("        <option value=\"MACC\" >Master of Accountancy</option>"+"\n");
document.write("        <option value=\"MAT\" >M.A. in Teaching</option>"+"\n");
document.write("        <option value=\"MBA\" >Master of Business Admin</option>"+"\n");
document.write("        <option value=\"MD\" >Doctor of Medicine</option>"+"\n");
document.write("        <option value=\"MED\" >Master of Education</option>"+"\n");
document.write("        <option value=\"MEE\" >Master of Extension Education</option>"+"\n");
document.write("        <option value=\"MPA\" >Master of Public Admin</option>"+"\n");
document.write("        <option value=\"MPT\" >Master of Physical Therapy</option>"+"\n");
document.write("        <option value=\"MS\" >Master of Science</option>"+"\n");
document.write("        <option value=\"MSD\" >Master of Dietetics</option>"+"\n");
document.write("        <option value=\"MST\" >M.S. for Teachers</option>"+"\n");
document.write("        <option value=\"MSW\" >Master of Social Work</option>"+"\n");
document.write("        <option value=\"PBC\" >Post Baccalaureate Certificate</option>"+"\n");
document.write("        <option value=\"PMC\" >Post Masters Certificate</option>"+"\n");
document.write("        <option value=\"TMP\" >Trsfr Master Publishing</option>"+"\n");
document.write("        <option value=\"PMNC\" >Post Masters Nursing Certif</option>"+"\n");
document.write("        <option value=\"CAS\" >Certificate of Advanced Study</option>"+"\n");
document.write("        <option value=\"CECR\" >CE Certificate</option>"+"\n");
document.write("        <option value=\"CGS\" >Certificate of Graduate Study</option>"+"\n");
document.write("        <option value=\"CGS1\" >Cert Grad Stdy in Ecol Econ</option>"+"\n");
document.write("        <option value=\"CGS2\" >Cert Grad Stdy Intdsc Stdy Dsb</option>"+"\n");
document.write("        <option value=\"CGS3\" >Cert Grad Stdy Clin&amp;Trans Sci</option>"+"\n");
document.write("        <option value=\"CGS4\" >Cert Grad Stdy Ecol Design</option>"+"\n");
document.write("        <option value=\"CGS5\" >Cert Grad Stdy Complex Systems</option>"+"\n");
document.write("        <option value=\"CGS6\" >Cert Grad Stdy Grk&amp;Lat Lang</option>"+"\n");
document.write("        <option value=\"PHD\" >Doctor of Philosophy</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection16835333\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">College #2</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-139\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669971\" aria-describedby=\"fsSupporting10669971\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669971\" class=\"fsLabel fsRequiredLabel\" for=\"field10669971\">College 2  (choose state or province)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10669971\" name=\"field10669971\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"DC\" >District of Columbia</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WI\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"WY\" >Wyoming</option>"+"\n");
document.write("        <option value=\"ust\" >US TERRITORIES</option>"+"\n");
document.write("        <option value=\"AS\" >American Samoa</option>"+"\n");
document.write("        <option value=\"GU\" >Guam</option>"+"\n");
document.write("        <option value=\"MP\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"PR\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"VI\" >Virgin Islands</option>"+"\n");
document.write("        <option value=\"FM\" >Federated States of Micronesia</option>"+"\n");
document.write("        <option value=\"MH\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"PW\" >Palau</option>"+"\n");
document.write("        <option value=\"can\" >CANADIAN PROVINCES</option>"+"\n");
document.write("        <option value=\"ON\" >Ontario</option>"+"\n");
document.write("        <option value=\"QC\" >Quebec</option>"+"\n");
document.write("        <option value=\"NS\" >Nova Scotia</option>"+"\n");
document.write("        <option value=\"NB\" >New Brunswick</option>"+"\n");
document.write("        <option value=\"MB\" >Manitoba</option>"+"\n");
document.write("        <option value=\"BC\" >British Columbia</option>"+"\n");
document.write("        <option value=\"PE\" >Prince Edward Island</option>"+"\n");
document.write("        <option value=\"SK\" >Saskatchewan</option>"+"\n");
document.write("        <option value=\"AB\" >Alberta</option>"+"\n");
document.write("        <option value=\"NL\" >Newfoundland and Labrador</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10669971\" class=\"fsSupporting\">"+"\n");
document.write("                                 Select the US State, Provice, or Territory in which your college or university is located"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-140\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669989\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669989\" class=\"fsLabel\" for=\"field10669989\">College 2 (select name of college or university)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10669989\" name=\"field10669989\" size=\"50\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-141\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell11011637\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label11011637\" class=\"fsLabel\" for=\"field11011637\">College 2- College Name  -- hidden to users                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field11011637\" name=\"field11011637\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-142\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596567\" aria-describedby=\"fsSupporting10596567\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596567\" class=\"fsLabel fsRequiredLabel\" for=\"field10596567\">Start date of attendance (College #2)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596567\" name=\"field10596567\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596567\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-143\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596598\" aria-describedby=\"fsSupporting10596598\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596598\" class=\"fsLabel fsRequiredLabel\" for=\"field10596598\">End date of attendance (College #2)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596598\" name=\"field10596598\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596598\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-144\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596754\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596754\" class=\"fsLabel fsRequiredLabel\" for=\"field10596754\">Degree received (College #2)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10596754\" name=\"field10596754\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"--\" >-please select-</option>"+"\n");
document.write("        <option value=\"ND\" >Non Degree</option>"+"\n");
document.write("        <option value=\"0\" >Undeclared Degree</option>"+"\n");
document.write("        <option value=\"AS\" >Associate in Science</option>"+"\n");
document.write("        <option value=\"ASHS\" >Associate in Health Science</option>"+"\n");
document.write("        <option value=\"ASPS\" >Associate in Prof Studies</option>"+"\n");
document.write("        <option value=\"T2YR\" >Transfer - 2 Yr Degree</option>"+"\n");
document.write("        <option value=\"BA\" >Bachelor of Arts</option>"+"\n");
document.write("        <option value=\"BAE\" >Bachelor of Arts in Engineering</option>"+"\n");
document.write("        <option value=\"BE\" >Bachelor of Engineering</option>"+"\n");
document.write("        <option value=\"BMUS\" >Bachelor of Music</option>"+"\n");
document.write("        <option value=\"BS\" >Bachelor of Science</option>"+"\n");
document.write("        <option value=\"BSAE\" >B.S. Art Education</option>"+"\n");
document.write("        <option value=\"BSBA\" >B.S. Business Administration</option>"+"\n");
document.write("        <option value=\"BSBE\" >B.S. Business Education</option>"+"\n");
document.write("        <option value=\"BSC\" >B.S. Chemistry</option>"+"\n");
document.write("        <option value=\"BSC&amp;E\" >B.S. Commerce &amp; Economics</option>"+"\n");
document.write("        <option value=\"BSCE\" >B.S. Civil Engineering</option>"+"\n");
document.write("        <option value=\"BSCS\" >B.S. Computer Science</option>"+"\n");
document.write("        <option value=\"BSE\" >B.S. Engineering</option>"+"\n");
document.write("        <option value=\"BSED\" >B.S. Education</option>"+"\n");
document.write("        <option value=\"BSEE\" >B.S. Electrical Engineering</option>"+"\n");
document.write("        <option value=\"BSEM\" >B.S. Engineering Management</option>"+"\n");
document.write("        <option value=\"BSEV\" >B.S.Environmental Engineering</option>"+"\n");
document.write("        <option value=\"BSG\" >B.S. Geology</option>"+"\n");
document.write("        <option value=\"BSHE\" >B.S. Home Economics</option>"+"\n");
document.write("        <option value=\"BSM\" >B.S. Mathematics</option>"+"\n");
document.write("        <option value=\"BSME\" >B.S. Mechanical Engineering</option>"+"\n");
document.write("        <option value=\"BSMM\" >B.S. Mfg &amp; Mgt Engineering</option>"+"\n");
document.write("        <option value=\"BSMS\" >B.S. Music Education</option>"+"\n");
document.write("        <option value=\"BSP\" >B.S. Physics</option>"+"\n");
document.write("        <option value=\"T4YR\" >Transfer - 4 Yr Degree</option>"+"\n");
document.write("        <option value=\"TBC\" >Trsfr Bachelor Commerce</option>"+"\n");
document.write("        <option value=\"DHC\" >Dental Hygiene Certificate</option>"+"\n");
document.write("        <option value=\"DPT\" >Doctor of Physical Therapy</option>"+"\n");
document.write("        <option value=\"EDD\" >Doctor of Education</option>"+"\n");
document.write("        <option value=\"FYR\" >Fifth-Year Certificate in Educ</option>"+"\n");
document.write("        <option value=\"MA\" >Master of Arts</option>"+"\n");
document.write("        <option value=\"MACC\" >Master of Accountancy</option>"+"\n");
document.write("        <option value=\"MAT\" >M.A. in Teaching</option>"+"\n");
document.write("        <option value=\"MBA\" >Master of Business Admin</option>"+"\n");
document.write("        <option value=\"MD\" >Doctor of Medicine</option>"+"\n");
document.write("        <option value=\"MED\" >Master of Education</option>"+"\n");
document.write("        <option value=\"MEE\" >Master of Extension Education</option>"+"\n");
document.write("        <option value=\"MPA\" >Master of Public Admin</option>"+"\n");
document.write("        <option value=\"MPT\" >Master of Physical Therapy</option>"+"\n");
document.write("        <option value=\"MS\" >Master of Science</option>"+"\n");
document.write("        <option value=\"MSD\" >Master of Dietetics</option>"+"\n");
document.write("        <option value=\"MST\" >M.S. for Teachers</option>"+"\n");
document.write("        <option value=\"MSW\" >Master of Social Work</option>"+"\n");
document.write("        <option value=\"PBC\" >Post Baccalaureate Certificate</option>"+"\n");
document.write("        <option value=\"PMC\" >Post Masters Certificate</option>"+"\n");
document.write("        <option value=\"TMP\" >Trsfr Master Publishing</option>"+"\n");
document.write("        <option value=\"PMNC\" >Post Masters Nursing Certif</option>"+"\n");
document.write("        <option value=\"CAS\" >Certificate of Advanced Study</option>"+"\n");
document.write("        <option value=\"CECR\" >CE Certificate</option>"+"\n");
document.write("        <option value=\"CGS\" >Certificate of Graduate Study</option>"+"\n");
document.write("        <option value=\"CGS1\" >Cert Grad Stdy in Ecol Econ</option>"+"\n");
document.write("        <option value=\"CGS2\" >Cert Grad Stdy Intdsc Stdy Dsb</option>"+"\n");
document.write("        <option value=\"CGS3\" >Cert Grad Stdy Clin&amp;Trans Sci</option>"+"\n");
document.write("        <option value=\"CGS4\" >Cert Grad Stdy Ecol Design</option>"+"\n");
document.write("        <option value=\"CGS5\" >Cert Grad Stdy Complex Systems</option>"+"\n");
document.write("        <option value=\"CGS6\" >Cert Grad Stdy Grk&amp;Lat Lang</option>"+"\n");
document.write("        <option value=\"PHD\" >Doctor of Philosophy</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection16835339\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">College #3</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-146\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669970\" aria-describedby=\"fsSupporting10669970\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669970\" class=\"fsLabel fsRequiredLabel\" for=\"field10669970\">College 3 (choose state or province)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10669970\" name=\"field10669970\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"DC\" >District of Columbia</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WI\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"WY\" >Wyoming</option>"+"\n");
document.write("        <option value=\"ust\" >US TERRITORIES</option>"+"\n");
document.write("        <option value=\"AS\" >American Samoa</option>"+"\n");
document.write("        <option value=\"GU\" >Guam</option>"+"\n");
document.write("        <option value=\"MP\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"PR\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"VI\" >Virgin Islands</option>"+"\n");
document.write("        <option value=\"FM\" >Federated States of Micronesia</option>"+"\n");
document.write("        <option value=\"MH\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"PW\" >Palau</option>"+"\n");
document.write("        <option value=\"can\" >CANADIAN PROVINCES</option>"+"\n");
document.write("        <option value=\"ON\" >Ontario</option>"+"\n");
document.write("        <option value=\"QC\" >Quebec</option>"+"\n");
document.write("        <option value=\"NS\" >Nova Scotia</option>"+"\n");
document.write("        <option value=\"NB\" >New Brunswick</option>"+"\n");
document.write("        <option value=\"MB\" >Manitoba</option>"+"\n");
document.write("        <option value=\"BC\" >British Columbia</option>"+"\n");
document.write("        <option value=\"PE\" >Prince Edward Island</option>"+"\n");
document.write("        <option value=\"SK\" >Saskatchewan</option>"+"\n");
document.write("        <option value=\"AB\" >Alberta</option>"+"\n");
document.write("        <option value=\"NL\" >Newfoundland and Labrador</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10669970\" class=\"fsSupporting\">"+"\n");
document.write("                                 Select the US State, Provice, or Territory in which your college or university is located"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-147\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669988\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669988\" class=\"fsLabel\" for=\"field10669988\">College 3 (select name of college or university)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10669988\" name=\"field10669988\" size=\"50\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-148\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell11011636\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label11011636\" class=\"fsLabel\" for=\"field11011636\">College 3- College Name  -- hidden to users                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field11011636\" name=\"field11011636\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-149\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596595\" aria-describedby=\"fsSupporting10596595\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596595\" class=\"fsLabel fsRequiredLabel\" for=\"field10596595\">Start date of attendance (College #3)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596595\" name=\"field10596595\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596595\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-150\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596626\" aria-describedby=\"fsSupporting10596626\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596626\" class=\"fsLabel fsRequiredLabel\" for=\"field10596626\">End date of attendance (College #3)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596626\" name=\"field10596626\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596626\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-151\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596757\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596757\" class=\"fsLabel fsRequiredLabel\" for=\"field10596757\">Degree received (College #3)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10596757\" name=\"field10596757\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"--\" >-please select-</option>"+"\n");
document.write("        <option value=\"ND\" >Non Degree</option>"+"\n");
document.write("        <option value=\"0\" >Undeclared Degree</option>"+"\n");
document.write("        <option value=\"AS\" >Associate in Science</option>"+"\n");
document.write("        <option value=\"ASHS\" >Associate in Health Science</option>"+"\n");
document.write("        <option value=\"ASPS\" >Associate in Prof Studies</option>"+"\n");
document.write("        <option value=\"T2YR\" >Transfer - 2 Yr Degree</option>"+"\n");
document.write("        <option value=\"BA\" >Bachelor of Arts</option>"+"\n");
document.write("        <option value=\"BAE\" >Bachelor of Arts in Engineering</option>"+"\n");
document.write("        <option value=\"BE\" >Bachelor of Engineering</option>"+"\n");
document.write("        <option value=\"BMUS\" >Bachelor of Music</option>"+"\n");
document.write("        <option value=\"BS\" >Bachelor of Science</option>"+"\n");
document.write("        <option value=\"BSAE\" >B.S. Art Education</option>"+"\n");
document.write("        <option value=\"BSBA\" >B.S. Business Administration</option>"+"\n");
document.write("        <option value=\"BSBE\" >B.S. Business Education</option>"+"\n");
document.write("        <option value=\"BSC\" >B.S. Chemistry</option>"+"\n");
document.write("        <option value=\"BSC&amp;E\" >B.S. Commerce &amp; Economics</option>"+"\n");
document.write("        <option value=\"BSCE\" >B.S. Civil Engineering</option>"+"\n");
document.write("        <option value=\"BSCS\" >B.S. Computer Science</option>"+"\n");
document.write("        <option value=\"BSE\" >B.S. Engineering</option>"+"\n");
document.write("        <option value=\"BSED\" >B.S. Education</option>"+"\n");
document.write("        <option value=\"BSEE\" >B.S. Electrical Engineering</option>"+"\n");
document.write("        <option value=\"BSEM\" >B.S. Engineering Management</option>"+"\n");
document.write("        <option value=\"BSEV\" >B.S.Environmental Engineering</option>"+"\n");
document.write("        <option value=\"BSG\" >B.S. Geology</option>"+"\n");
document.write("        <option value=\"BSHE\" >B.S. Home Economics</option>"+"\n");
document.write("        <option value=\"BSM\" >B.S. Mathematics</option>"+"\n");
document.write("        <option value=\"BSME\" >B.S. Mechanical Engineering</option>"+"\n");
document.write("        <option value=\"BSMM\" >B.S. Mfg &amp; Mgt Engineering</option>"+"\n");
document.write("        <option value=\"BSMS\" >B.S. Music Education</option>"+"\n");
document.write("        <option value=\"BSP\" >B.S. Physics</option>"+"\n");
document.write("        <option value=\"T4YR\" >Transfer - 4 Yr Degree</option>"+"\n");
document.write("        <option value=\"TBC\" >Trsfr Bachelor Commerce</option>"+"\n");
document.write("        <option value=\"DHC\" >Dental Hygiene Certificate</option>"+"\n");
document.write("        <option value=\"DPT\" >Doctor of Physical Therapy</option>"+"\n");
document.write("        <option value=\"EDD\" >Doctor of Education</option>"+"\n");
document.write("        <option value=\"FYR\" >Fifth-Year Certificate in Educ</option>"+"\n");
document.write("        <option value=\"MA\" >Master of Arts</option>"+"\n");
document.write("        <option value=\"MACC\" >Master of Accountancy</option>"+"\n");
document.write("        <option value=\"MAT\" >M.A. in Teaching</option>"+"\n");
document.write("        <option value=\"MBA\" >Master of Business Admin</option>"+"\n");
document.write("        <option value=\"MD\" >Doctor of Medicine</option>"+"\n");
document.write("        <option value=\"MED\" >Master of Education</option>"+"\n");
document.write("        <option value=\"MEE\" >Master of Extension Education</option>"+"\n");
document.write("        <option value=\"MPA\" >Master of Public Admin</option>"+"\n");
document.write("        <option value=\"MPT\" >Master of Physical Therapy</option>"+"\n");
document.write("        <option value=\"MS\" >Master of Science</option>"+"\n");
document.write("        <option value=\"MSD\" >Master of Dietetics</option>"+"\n");
document.write("        <option value=\"MST\" >M.S. for Teachers</option>"+"\n");
document.write("        <option value=\"MSW\" >Master of Social Work</option>"+"\n");
document.write("        <option value=\"PBC\" >Post Baccalaureate Certificate</option>"+"\n");
document.write("        <option value=\"PMC\" >Post Masters Certificate</option>"+"\n");
document.write("        <option value=\"TMP\" >Trsfr Master Publishing</option>"+"\n");
document.write("        <option value=\"PMNC\" >Post Masters Nursing Certif</option>"+"\n");
document.write("        <option value=\"CAS\" >Certificate of Advanced Study</option>"+"\n");
document.write("        <option value=\"CECR\" >CE Certificate</option>"+"\n");
document.write("        <option value=\"CGS\" >Certificate of Graduate Study</option>"+"\n");
document.write("        <option value=\"CGS1\" >Cert Grad Stdy in Ecol Econ</option>"+"\n");
document.write("        <option value=\"CGS2\" >Cert Grad Stdy Intdsc Stdy Dsb</option>"+"\n");
document.write("        <option value=\"CGS3\" >Cert Grad Stdy Clin&amp;Trans Sci</option>"+"\n");
document.write("        <option value=\"CGS4\" >Cert Grad Stdy Ecol Design</option>"+"\n");
document.write("        <option value=\"CGS5\" >Cert Grad Stdy Complex Systems</option>"+"\n");
document.write("        <option value=\"CGS6\" >Cert Grad Stdy Grk&amp;Lat Lang</option>"+"\n");
document.write("        <option value=\"PHD\" >Doctor of Philosophy</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection16835342\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">College #4</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-153\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669969\" aria-describedby=\"fsSupporting10669969\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669969\" class=\"fsLabel fsRequiredLabel\" for=\"field10669969\">College 4 (choose state or province)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10669969\" name=\"field10669969\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"DC\" >District of Columbia</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WI\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"WY\" >Wyoming</option>"+"\n");
document.write("        <option value=\"ust\" >US TERRITORIES</option>"+"\n");
document.write("        <option value=\"AS\" >American Samoa</option>"+"\n");
document.write("        <option value=\"GU\" >Guam</option>"+"\n");
document.write("        <option value=\"MP\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"PR\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"VI\" >Virgin Islands</option>"+"\n");
document.write("        <option value=\"FM\" >Federated States of Micronesia</option>"+"\n");
document.write("        <option value=\"MH\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"PW\" >Palau</option>"+"\n");
document.write("        <option value=\"can\" >CANADIAN PROVINCES</option>"+"\n");
document.write("        <option value=\"ON\" >Ontario</option>"+"\n");
document.write("        <option value=\"QC\" >Quebec</option>"+"\n");
document.write("        <option value=\"NS\" >Nova Scotia</option>"+"\n");
document.write("        <option value=\"NB\" >New Brunswick</option>"+"\n");
document.write("        <option value=\"MB\" >Manitoba</option>"+"\n");
document.write("        <option value=\"BC\" >British Columbia</option>"+"\n");
document.write("        <option value=\"PE\" >Prince Edward Island</option>"+"\n");
document.write("        <option value=\"SK\" >Saskatchewan</option>"+"\n");
document.write("        <option value=\"AB\" >Alberta</option>"+"\n");
document.write("        <option value=\"NL\" >Newfoundland and Labrador</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10669969\" class=\"fsSupporting\">"+"\n");
document.write("                                 Select the US State, Provice, or Territory in which your college or university is located"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-154\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669987\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669987\" class=\"fsLabel\" for=\"field10669987\">College 4 (select name of college or university)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10669987\" name=\"field10669987\" size=\"50\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-155\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell11011634\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label11011634\" class=\"fsLabel\" for=\"field11011634\">College 4- College Name  -- hidden to users                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field11011634\" name=\"field11011634\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-156\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596627\" aria-describedby=\"fsSupporting10596627\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596627\" class=\"fsLabel fsRequiredLabel\" for=\"field10596627\">Start date of attendance (College #4)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596627\" name=\"field10596627\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596627\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-157\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596623\" aria-describedby=\"fsSupporting10596623\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596623\" class=\"fsLabel fsRequiredLabel\" for=\"field10596623\">End date of attendance (College #4)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596623\" name=\"field10596623\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596623\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-158\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596758\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596758\" class=\"fsLabel fsRequiredLabel\" for=\"field10596758\">Degree received (College #4)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10596758\" name=\"field10596758\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"--\" >-please select-</option>"+"\n");
document.write("        <option value=\"ND\" >Non Degree</option>"+"\n");
document.write("        <option value=\"0\" >Undeclared Degree</option>"+"\n");
document.write("        <option value=\"AS\" >Associate in Science</option>"+"\n");
document.write("        <option value=\"ASHS\" >Associate in Health Science</option>"+"\n");
document.write("        <option value=\"ASPS\" >Associate in Prof Studies</option>"+"\n");
document.write("        <option value=\"T2YR\" >Transfer - 2 Yr Degree</option>"+"\n");
document.write("        <option value=\"BA\" >Bachelor of Arts</option>"+"\n");
document.write("        <option value=\"BAE\" >Bachelor of Arts in Engineering</option>"+"\n");
document.write("        <option value=\"BE\" >Bachelor of Engineering</option>"+"\n");
document.write("        <option value=\"BMUS\" >Bachelor of Music</option>"+"\n");
document.write("        <option value=\"BS\" >Bachelor of Science</option>"+"\n");
document.write("        <option value=\"BSAE\" >B.S. Art Education</option>"+"\n");
document.write("        <option value=\"BSBA\" >B.S. Business Administration</option>"+"\n");
document.write("        <option value=\"BSBE\" >B.S. Business Education</option>"+"\n");
document.write("        <option value=\"BSC\" >B.S. Chemistry</option>"+"\n");
document.write("        <option value=\"BSC&amp;E\" >B.S. Commerce &amp; Economics</option>"+"\n");
document.write("        <option value=\"BSCE\" >B.S. Civil Engineering</option>"+"\n");
document.write("        <option value=\"BSCS\" >B.S. Computer Science</option>"+"\n");
document.write("        <option value=\"BSE\" >B.S. Engineering</option>"+"\n");
document.write("        <option value=\"BSED\" >B.S. Education</option>"+"\n");
document.write("        <option value=\"BSEE\" >B.S. Electrical Engineering</option>"+"\n");
document.write("        <option value=\"BSEM\" >B.S. Engineering Management</option>"+"\n");
document.write("        <option value=\"BSEV\" >B.S.Environmental Engineering</option>"+"\n");
document.write("        <option value=\"BSG\" >B.S. Geology</option>"+"\n");
document.write("        <option value=\"BSHE\" >B.S. Home Economics</option>"+"\n");
document.write("        <option value=\"BSM\" >B.S. Mathematics</option>"+"\n");
document.write("        <option value=\"BSME\" >B.S. Mechanical Engineering</option>"+"\n");
document.write("        <option value=\"BSMM\" >B.S. Mfg &amp; Mgt Engineering</option>"+"\n");
document.write("        <option value=\"BSMS\" >B.S. Music Education</option>"+"\n");
document.write("        <option value=\"BSP\" >B.S. Physics</option>"+"\n");
document.write("        <option value=\"T4YR\" >Transfer - 4 Yr Degree</option>"+"\n");
document.write("        <option value=\"TBC\" >Trsfr Bachelor Commerce</option>"+"\n");
document.write("        <option value=\"DHC\" >Dental Hygiene Certificate</option>"+"\n");
document.write("        <option value=\"DPT\" >Doctor of Physical Therapy</option>"+"\n");
document.write("        <option value=\"EDD\" >Doctor of Education</option>"+"\n");
document.write("        <option value=\"FYR\" >Fifth-Year Certificate in Educ</option>"+"\n");
document.write("        <option value=\"MA\" >Master of Arts</option>"+"\n");
document.write("        <option value=\"MACC\" >Master of Accountancy</option>"+"\n");
document.write("        <option value=\"MAT\" >M.A. in Teaching</option>"+"\n");
document.write("        <option value=\"MBA\" >Master of Business Admin</option>"+"\n");
document.write("        <option value=\"MD\" >Doctor of Medicine</option>"+"\n");
document.write("        <option value=\"MED\" >Master of Education</option>"+"\n");
document.write("        <option value=\"MEE\" >Master of Extension Education</option>"+"\n");
document.write("        <option value=\"MPA\" >Master of Public Admin</option>"+"\n");
document.write("        <option value=\"MPT\" >Master of Physical Therapy</option>"+"\n");
document.write("        <option value=\"MS\" >Master of Science</option>"+"\n");
document.write("        <option value=\"MSD\" >Master of Dietetics</option>"+"\n");
document.write("        <option value=\"MST\" >M.S. for Teachers</option>"+"\n");
document.write("        <option value=\"MSW\" >Master of Social Work</option>"+"\n");
document.write("        <option value=\"PBC\" >Post Baccalaureate Certificate</option>"+"\n");
document.write("        <option value=\"PMC\" >Post Masters Certificate</option>"+"\n");
document.write("        <option value=\"TMP\" >Trsfr Master Publishing</option>"+"\n");
document.write("        <option value=\"PMNC\" >Post Masters Nursing Certif</option>"+"\n");
document.write("        <option value=\"CAS\" >Certificate of Advanced Study</option>"+"\n");
document.write("        <option value=\"CECR\" >CE Certificate</option>"+"\n");
document.write("        <option value=\"CGS\" >Certificate of Graduate Study</option>"+"\n");
document.write("        <option value=\"CGS1\" >Cert Grad Stdy in Ecol Econ</option>"+"\n");
document.write("        <option value=\"CGS2\" >Cert Grad Stdy Intdsc Stdy Dsb</option>"+"\n");
document.write("        <option value=\"CGS3\" >Cert Grad Stdy Clin&amp;Trans Sci</option>"+"\n");
document.write("        <option value=\"CGS4\" >Cert Grad Stdy Ecol Design</option>"+"\n");
document.write("        <option value=\"CGS5\" >Cert Grad Stdy Complex Systems</option>"+"\n");
document.write("        <option value=\"CGS6\" >Cert Grad Stdy Grk&amp;Lat Lang</option>"+"\n");
document.write("        <option value=\"PHD\" >Doctor of Philosophy</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                </div>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                                "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                                    "+"\n");
document.write("             "+"\n");
document.write("            "+"\n");
document.write("            <div class=\"fsSection fs1Col fsHidden\" id=\"fsSection16835345\">           "+"\n");
document.write("            "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("            <div class=\"fsSectionHeader\">"+"\n");
document.write("            <h2 class=\"fsSectionHeading\">College #5</h2>"+"\n");
document.write("        "+"\n");
document.write("    </div>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-160\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669968\" aria-describedby=\"fsSupporting10669968\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669968\" class=\"fsLabel fsRequiredLabel\" for=\"field10669968\">College 5 (choose state or province)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10669968\" name=\"field10669968\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"-please select-\" >-please select-</option>"+"\n");
document.write("        <option value=\"AL\" >Alabama</option>"+"\n");
document.write("        <option value=\"AK\" >Alaska</option>"+"\n");
document.write("        <option value=\"AZ\" >Arizona</option>"+"\n");
document.write("        <option value=\"AR\" >Arkansas</option>"+"\n");
document.write("        <option value=\"CA\" >California</option>"+"\n");
document.write("        <option value=\"CO\" >Colorado</option>"+"\n");
document.write("        <option value=\"CT\" >Connecticut</option>"+"\n");
document.write("        <option value=\"DE\" >Delaware</option>"+"\n");
document.write("        <option value=\"DC\" >District of Columbia</option>"+"\n");
document.write("        <option value=\"FL\" >Florida</option>"+"\n");
document.write("        <option value=\"GA\" >Georgia</option>"+"\n");
document.write("        <option value=\"HI\" >Hawaii</option>"+"\n");
document.write("        <option value=\"ID\" >Idaho</option>"+"\n");
document.write("        <option value=\"IL\" >Illinois</option>"+"\n");
document.write("        <option value=\"IN\" >Indiana</option>"+"\n");
document.write("        <option value=\"IA\" >Iowa</option>"+"\n");
document.write("        <option value=\"KS\" >Kansas</option>"+"\n");
document.write("        <option value=\"KY\" >Kentucky</option>"+"\n");
document.write("        <option value=\"LA\" >Louisiana</option>"+"\n");
document.write("        <option value=\"ME\" >Maine</option>"+"\n");
document.write("        <option value=\"MD\" >Maryland</option>"+"\n");
document.write("        <option value=\"MA\" >Massachusetts</option>"+"\n");
document.write("        <option value=\"MI\" >Michigan</option>"+"\n");
document.write("        <option value=\"MN\" >Minnesota</option>"+"\n");
document.write("        <option value=\"MS\" >Mississippi</option>"+"\n");
document.write("        <option value=\"MO\" >Missouri</option>"+"\n");
document.write("        <option value=\"MT\" >Montana</option>"+"\n");
document.write("        <option value=\"NE\" >Nebraska</option>"+"\n");
document.write("        <option value=\"NV\" >Nevada</option>"+"\n");
document.write("        <option value=\"NH\" >New Hampshire</option>"+"\n");
document.write("        <option value=\"NJ\" >New Jersey</option>"+"\n");
document.write("        <option value=\"NM\" >New Mexico</option>"+"\n");
document.write("        <option value=\"NY\" >New York</option>"+"\n");
document.write("        <option value=\"NC\" >North Carolina</option>"+"\n");
document.write("        <option value=\"ND\" >North Dakota</option>"+"\n");
document.write("        <option value=\"OH\" >Ohio</option>"+"\n");
document.write("        <option value=\"OK\" >Oklahoma</option>"+"\n");
document.write("        <option value=\"OR\" >Oregon</option>"+"\n");
document.write("        <option value=\"PA\" >Pennsylvania</option>"+"\n");
document.write("        <option value=\"RI\" >Rhode Island</option>"+"\n");
document.write("        <option value=\"SC\" >South Carolina</option>"+"\n");
document.write("        <option value=\"SD\" >South Dakota</option>"+"\n");
document.write("        <option value=\"TN\" >Tennessee</option>"+"\n");
document.write("        <option value=\"TX\" >Texas</option>"+"\n");
document.write("        <option value=\"UT\" >Utah</option>"+"\n");
document.write("        <option value=\"VT\" >Vermont</option>"+"\n");
document.write("        <option value=\"VA\" >Virginia</option>"+"\n");
document.write("        <option value=\"WA\" >Washington</option>"+"\n");
document.write("        <option value=\"WV\" >West Virginia</option>"+"\n");
document.write("        <option value=\"WI\" >Wisconsin</option>"+"\n");
document.write("        <option value=\"WY\" >Wyoming</option>"+"\n");
document.write("        <option value=\"ust\" >US TERRITORIES</option>"+"\n");
document.write("        <option value=\"AS\" >American Samoa</option>"+"\n");
document.write("        <option value=\"GU\" >Guam</option>"+"\n");
document.write("        <option value=\"MP\" >Northern Mariana Islands</option>"+"\n");
document.write("        <option value=\"PR\" >Puerto Rico</option>"+"\n");
document.write("        <option value=\"VI\" >Virgin Islands</option>"+"\n");
document.write("        <option value=\"FM\" >Federated States of Micronesia</option>"+"\n");
document.write("        <option value=\"MH\" >Marshall Islands</option>"+"\n");
document.write("        <option value=\"PW\" >Palau</option>"+"\n");
document.write("        <option value=\"can\" >CANADIAN PROVINCES</option>"+"\n");
document.write("        <option value=\"ON\" >Ontario</option>"+"\n");
document.write("        <option value=\"QC\" >Quebec</option>"+"\n");
document.write("        <option value=\"NS\" >Nova Scotia</option>"+"\n");
document.write("        <option value=\"NB\" >New Brunswick</option>"+"\n");
document.write("        <option value=\"MB\" >Manitoba</option>"+"\n");
document.write("        <option value=\"BC\" >British Columbia</option>"+"\n");
document.write("        <option value=\"PE\" >Prince Edward Island</option>"+"\n");
document.write("        <option value=\"SK\" >Saskatchewan</option>"+"\n");
document.write("        <option value=\"AB\" >Alberta</option>"+"\n");
document.write("        <option value=\"NL\" >Newfoundland and Labrador</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10669968\" class=\"fsSupporting\">"+"\n");
document.write("                                 Select the US State, Provice, or Territory in which your college or university is located"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-161\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10669986\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10669986\" class=\"fsLabel\" for=\"field10669986\">College 5 (select name of college or university)                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10669986\" name=\"field10669986\" size=\"50\"    value=\"\"  class=\"fsField  \"  disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-162\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell11011633\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label11011633\" class=\"fsLabel\" for=\"field11011633\">College 5- College Name  -- hidden to users                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field11011633\" name=\"field11011633\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-163\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596628\" aria-describedby=\"fsSupporting10596628\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596628\" class=\"fsLabel fsRequiredLabel\" for=\"field10596628\">Start date of attendance (College #5)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596628\" name=\"field10596628\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596628\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-164\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596629\" aria-describedby=\"fsSupporting10596629\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596629\" class=\"fsLabel fsRequiredLabel\" for=\"field10596629\">End date of attendance (College #5)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10596629\" name=\"field10596629\" size=\"8\" required   value=\"\"  class=\"fsField fsRequired \" aria-required=\"true\" disabled=\"disabled\" />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10596629\" class=\"fsSupporting\">"+"\n");
document.write("                                Please enter with no dashes or hyphens (ex: MMDDYYYY)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-165\" class=\"fsRow fsFieldRow fsLastRow\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical  fsSpan100 \" id=\"fsCell10596760\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10596760\" class=\"fsLabel fsRequiredLabel\" for=\"field10596760\">Degree received (College #5)<span class=\"fsRequiredMarker\">*</span>                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10596760\" name=\"field10596760\" size=\"1\"  required class=\"fsField fsRequired\" aria-required=\"true\" disabled=\"disabled\">"+"\n");
document.write("        <option value=\"--\" >-please select-</option>"+"\n");
document.write("        <option value=\"ND\" >Non Degree</option>"+"\n");
document.write("        <option value=\"0\" >Undeclared Degree</option>"+"\n");
document.write("        <option value=\"AS\" >Associate in Science</option>"+"\n");
document.write("        <option value=\"ASHS\" >Associate in Health Science</option>"+"\n");
document.write("        <option value=\"ASPS\" >Associate in Prof Studies</option>"+"\n");
document.write("        <option value=\"T2YR\" >Transfer - 2 Yr Degree</option>"+"\n");
document.write("        <option value=\"BA\" >Bachelor of Arts</option>"+"\n");
document.write("        <option value=\"BAE\" >Bachelor of Arts in Engineering</option>"+"\n");
document.write("        <option value=\"BE\" >Bachelor of Engineering</option>"+"\n");
document.write("        <option value=\"BMUS\" >Bachelor of Music</option>"+"\n");
document.write("        <option value=\"BS\" >Bachelor of Science</option>"+"\n");
document.write("        <option value=\"BSAE\" >B.S. Art Education</option>"+"\n");
document.write("        <option value=\"BSBA\" >B.S. Business Administration</option>"+"\n");
document.write("        <option value=\"BSBE\" >B.S. Business Education</option>"+"\n");
document.write("        <option value=\"BSC\" >B.S. Chemistry</option>"+"\n");
document.write("        <option value=\"BSC&amp;E\" >B.S. Commerce &amp; Economics</option>"+"\n");
document.write("        <option value=\"BSCE\" >B.S. Civil Engineering</option>"+"\n");
document.write("        <option value=\"BSCS\" >B.S. Computer Science</option>"+"\n");
document.write("        <option value=\"BSE\" >B.S. Engineering</option>"+"\n");
document.write("        <option value=\"BSED\" >B.S. Education</option>"+"\n");
document.write("        <option value=\"BSEE\" >B.S. Electrical Engineering</option>"+"\n");
document.write("        <option value=\"BSEM\" >B.S. Engineering Management</option>"+"\n");
document.write("        <option value=\"BSEV\" >B.S.Environmental Engineering</option>"+"\n");
document.write("        <option value=\"BSG\" >B.S. Geology</option>"+"\n");
document.write("        <option value=\"BSHE\" >B.S. Home Economics</option>"+"\n");
document.write("        <option value=\"BSM\" >B.S. Mathematics</option>"+"\n");
document.write("        <option value=\"BSME\" >B.S. Mechanical Engineering</option>"+"\n");
document.write("        <option value=\"BSMM\" >B.S. Mfg &amp; Mgt Engineering</option>"+"\n");
document.write("        <option value=\"BSMS\" >B.S. Music Education</option>"+"\n");
document.write("        <option value=\"BSP\" >B.S. Physics</option>"+"\n");
document.write("        <option value=\"T4YR\" >Transfer - 4 Yr Degree</option>"+"\n");
document.write("        <option value=\"TBC\" >Trsfr Bachelor Commerce</option>"+"\n");
document.write("        <option value=\"DHC\" >Dental Hygiene Certificate</option>"+"\n");
document.write("        <option value=\"DPT\" >Doctor of Physical Therapy</option>"+"\n");
document.write("        <option value=\"EDD\" >Doctor of Education</option>"+"\n");
document.write("        <option value=\"FYR\" >Fifth-Year Certificate in Educ</option>"+"\n");
document.write("        <option value=\"MA\" >Master of Arts</option>"+"\n");
document.write("        <option value=\"MACC\" >Master of Accountancy</option>"+"\n");
document.write("        <option value=\"MAT\" >M.A. in Teaching</option>"+"\n");
document.write("        <option value=\"MBA\" >Master of Business Admin</option>"+"\n");
document.write("        <option value=\"MD\" >Doctor of Medicine</option>"+"\n");
document.write("        <option value=\"MED\" >Master of Education</option>"+"\n");
document.write("        <option value=\"MEE\" >Master of Extension Education</option>"+"\n");
document.write("        <option value=\"MPA\" >Master of Public Admin</option>"+"\n");
document.write("        <option value=\"MPT\" >Master of Physical Therapy</option>"+"\n");
document.write("        <option value=\"MS\" >Master of Science</option>"+"\n");
document.write("        <option value=\"MSD\" >Master of Dietetics</option>"+"\n");
document.write("        <option value=\"MST\" >M.S. for Teachers</option>"+"\n");
document.write("        <option value=\"MSW\" >Master of Social Work</option>"+"\n");
document.write("        <option value=\"PBC\" >Post Baccalaureate Certificate</option>"+"\n");
document.write("        <option value=\"PMC\" >Post Masters Certificate</option>"+"\n");
document.write("        <option value=\"TMP\" >Trsfr Master Publishing</option>"+"\n");
document.write("        <option value=\"PMNC\" >Post Masters Nursing Certif</option>"+"\n");
document.write("        <option value=\"CAS\" >Certificate of Advanced Study</option>"+"\n");
document.write("        <option value=\"CECR\" >CE Certificate</option>"+"\n");
document.write("        <option value=\"CGS\" >Certificate of Graduate Study</option>"+"\n");
document.write("        <option value=\"CGS1\" >Cert Grad Stdy in Ecol Econ</option>"+"\n");
document.write("        <option value=\"CGS2\" >Cert Grad Stdy Intdsc Stdy Dsb</option>"+"\n");
document.write("        <option value=\"CGS3\" >Cert Grad Stdy Clin&amp;Trans Sci</option>"+"\n");
document.write("        <option value=\"CGS4\" >Cert Grad Stdy Ecol Design</option>"+"\n");
document.write("        <option value=\"CGS5\" >Cert Grad Stdy Complex Systems</option>"+"\n");
document.write("        <option value=\"CGS6\" >Cert Grad Stdy Grk&amp;Lat Lang</option>"+"\n");
document.write("        <option value=\"PHD\" >Doctor of Philosophy</option>"+"\n");
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document.write("                                                                    "+"\n");
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document.write("            <h2 class=\"fsSectionHeading\">Additional Colleges</h2>"+"\n");
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document.write("                                                   "+"\n");
document.write("                <h3>Below, please list any additional undergraduate, graduate or professional schools attended beyond the five listed above</h3>"+"\n");
document.write("<h3>Please send&#160;official transcripts for all schools listed.</h3>"+"\n");
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document.write("                                Please list any additional colleges or universities attended, one per line"+"\n");
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document.write("                                Please see our admissions requirements page for personal statement guidelines"+"\n");
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document.write("        <option value=\"--\" >-please select-</option>"+"\n");
document.write("        <option value=\"HSRT\" selected=\"selected\">High School Reduced Tuition/Academically Talented</option>"+"\n");
document.write("        <option value=\"DUAL\" >Dual Enrollment</option>"+"\n");
document.write("        <option value=\"HSOS\" >High school out-of-state</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17205443\" class=\"fsSupporting\">"+"\n");
document.write("                                <ul>   <li class=\"hsrt\"><a href=\"http://learn.uvm.edu/high-school-2/payment-options/academically-talented/\" target=\"_blank\">Learn more about High School Reduced Tuition/Academically Talented</a></li>   <li class=\"dual\"><a href=\"http://learn.uvm.edu/high-school-2/payment-options/dual-enrollment/\" target=\"_blank\">Learn more about Dual Enrollment</a></li> </ul>"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
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document.write("                </div>"+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-180\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell17238487\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17238487\" class=\"fsLabel\" for=\"field17238487\">Voucher Number                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17238487\" name=\"field17238487\" size=\"10\"    value=\"\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-181\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10605043\" aria-describedby=\"fsSupporting10605043\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10605043\" class=\"fsLabel\" for=\"field10605043\">residency                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10605043\" name=\"field10605043\" size=\"50\"  maxlength=\"1\"  value=\"O\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10605043\" class=\"fsSupporting\">"+"\n");
document.write("                                hidden field"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
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document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-182\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10648922\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10648922\" class=\"fsLabel\" for=\"field10648922\">College                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10648922\" name=\"field10648922\" size=\"50\"    value=\"70\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-183\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10650041\" aria-describedby=\"fsSupporting10650041\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10650041\" class=\"fsLabel\" for=\"field10650041\">program_attribute                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field10650041\" name=\"field10650041\" size=\"1\"   class=\"fsField \"  >"+"\n");
document.write("        <option value=\"PBPM\" >PBPM</option>"+"\n");
document.write("        <option value=\"SLPA\" >SLPA</option>"+"\n");
document.write("        <option value=\"ETEC\" >ETEC</option>"+"\n");
document.write("        <option value=\"BTEC\" >BTEC</option>"+"\n");
document.write("        <option value=\"BRLG\" >BRLG</option>"+"\n");
document.write("        <option value=\"HMGT\" >HMGT</option>"+"\n");
document.write("        <option value=\"LBMI\" >LBMI</option>"+"\n");
document.write("        <option value=\"MILT\" >MILT</option>"+"\n");
document.write("        <option value=\"GAP\" >GAP</option>"+"\n");
document.write("        <option value=\"SLP\" >SLP</option>"+"\n");
document.write("        <option value=\"PGAP\" >PGAP</option>"+"\n");
document.write("        <option value=\"LBM2\" >LBM2</option>"+"\n");
document.write("        <option value=\"SUMA\" >SUMA</option>"+"\n");
document.write("        <option value=\"DUBL\" >DUBL</option>"+"\n");
document.write("        <option value=\"HSGE\" selected=\"selected\">HSGE</option>"+"\n");
document.write("        <option value=\"JUMP\" >JUMP</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting10650041\" class=\"fsSupporting\">"+"\n");
document.write("                                add all program to this list"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-184\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell14616618\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label14616618\" class=\"fsLabel\" for=\"field14616618\">output_file                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <select id=\"field14616618\" name=\"field14616618\" size=\"1\"   class=\"fsField \"  >"+"\n");
document.write("        <option value=\"pbpmappdata.csv\" >pbpmappdata.csv</option>"+"\n");
document.write("        <option value=\"celoadappdata.csv\" selected=\"selected\">celoadappdata.csv</option>"+"\n");
document.write("</select>"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-185\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10648923\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10648923\" class=\"fsLabel\" for=\"field10648923\">Degree                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10648923\" name=\"field10648923\" size=\"50\"    value=\"CECR\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-186\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10648925\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label10648925\" class=\"fsLabel\" for=\"field10648925\">Major                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field10648925\" name=\"field10648925\" size=\"50\"    value=\"CECR\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
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document.write("                </div>"+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-187\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell16478894\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label16478894\" class=\"fsLabel\" for=\"field16478894\">ce source                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field16478894\" name=\"field16478894\" size=\"50\"    value=\"application\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
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document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-188\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell16478898\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label16478898\" class=\"fsLabel\" for=\"field16478898\">inquiry status                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field16478898\" name=\"field16478898\" size=\"50\"    value=\"Application/Prereg\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                    <label id=\"label16819861\" class=\"fsLabel\" for=\"field16819861\">record type                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field16819861\" name=\"field16819861\" size=\"50\"    value=\"012U0000000Q8Um\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting16819861\" class=\"fsSupporting\">"+"\n");
document.write("                                for salesforce"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("            "+"\n");
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document.write("                </div>"+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
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document.write("                        "+"\n");
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document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                    <label id=\"label16483152\" class=\"fsLabel\" for=\"field16483152\">interest                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field16483152\" name=\"field16483152\" size=\"50\"    value=\"PreCollege: 21 - HS\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
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document.write("                        "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
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document.write("                "+"\n");
document.write("                                    <label id=\"label16504998\" class=\"fsLabel\" for=\"field16504998\">url                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field16504998\" name=\"field16504998\" size=\"50\"    value=\"http://learn.uvm.edu/high-school-2/apply/\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
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document.write("            "+"\n");
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document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
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document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-192\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell10953076\">"+"\n");
document.write("                "+"\n");
document.write("                                    <fieldset id=\"label10953076\">"+"\n");
document.write("                        <legend class=\"fsLabel fsLabelVertical\"><span>timeStamp</span></legend>"+"\n");
document.write("            			<div class=\"fieldset-content\">"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("    <!-- Used to pull in url for jquery -->"+"\n");
document.write("    <span style=\"display:none;\" id=\"fsCalendar10953076ImageUrl\">https://www.formstack.com/forms/images/2/calendar.png</span>"+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("    "+"\n");
document.write("    <input type=\"hidden\" id=\"field10953076Format\" name=\"field10953076Format\" value=\"MDY\" />"+"\n");
document.write("    "+"\n");
document.write("                    <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field10953076M\">Month</label>"+"\n");
document.write("        <select id=\"field10953076M\" name=\"field10953076M\" class=\"fsField \"   >"+"\n");
document.write("                    <option value=\"\" > </option>"+"\n");
document.write("                    <option value=\"Jan\" >Jan</option>"+"\n");
document.write("                    <option value=\"Feb\" >Feb</option>"+"\n");
document.write("                    <option value=\"Mar\" >Mar</option>"+"\n");
document.write("                    <option value=\"Apr\" >Apr</option>"+"\n");
document.write("                    <option value=\"May\" >May</option>"+"\n");
document.write("                    <option value=\"Jun\" >Jun</option>"+"\n");
document.write("                    <option value=\"Jul\" >Jul</option>"+"\n");
document.write("                    <option value=\"Aug\" >Aug</option>"+"\n");
document.write("                    <option value=\"Sep\" >Sep</option>"+"\n");
document.write("                    <option value=\"Oct\" >Oct</option>"+"\n");
document.write("                    <option value=\"Nov\" >Nov</option>"+"\n");
document.write("                    <option value=\"Dec\" >Dec</option>"+"\n");
document.write("                </select>"+"\n");
document.write("             <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field10953076D\">Day</label>"+"\n");
document.write("        <select id=\"field10953076D\" name=\"field10953076D\" class=\"fsField \"   >"+"\n");
document.write("                    <option value=\"\" > </option>"+"\n");
document.write("                    <option value=\"01\" >01</option>"+"\n");
document.write("                    <option value=\"02\" >02</option>"+"\n");
document.write("                    <option value=\"03\" >03</option>"+"\n");
document.write("                    <option value=\"04\" >04</option>"+"\n");
document.write("                    <option value=\"05\" >05</option>"+"\n");
document.write("                    <option value=\"06\" >06</option>"+"\n");
document.write("                    <option value=\"07\" >07</option>"+"\n");
document.write("                    <option value=\"08\" >08</option>"+"\n");
document.write("                    <option value=\"09\" >09</option>"+"\n");
document.write("                    <option value=\"10\" >10</option>"+"\n");
document.write("                    <option value=\"11\" >11</option>"+"\n");
document.write("                    <option value=\"12\" >12</option>"+"\n");
document.write("                    <option value=\"13\" >13</option>"+"\n");
document.write("                    <option value=\"14\" >14</option>"+"\n");
document.write("                    <option value=\"15\" >15</option>"+"\n");
document.write("                    <option value=\"16\" >16</option>"+"\n");
document.write("                    <option value=\"17\" >17</option>"+"\n");
document.write("                    <option value=\"18\" >18</option>"+"\n");
document.write("                    <option value=\"19\" >19</option>"+"\n");
document.write("                    <option value=\"20\" >20</option>"+"\n");
document.write("                    <option value=\"21\" >21</option>"+"\n");
document.write("                    <option value=\"22\" >22</option>"+"\n");
document.write("                    <option value=\"23\" >23</option>"+"\n");
document.write("                    <option value=\"24\" >24</option>"+"\n");
document.write("                    <option value=\"25\" >25</option>"+"\n");
document.write("                    <option value=\"26\" >26</option>"+"\n");
document.write("                    <option value=\"27\" >27</option>"+"\n");
document.write("                    <option value=\"28\" >28</option>"+"\n");
document.write("                    <option value=\"29\" >29</option>"+"\n");
document.write("                    <option value=\"30\" >30</option>"+"\n");
document.write("                    <option value=\"31\" >31</option>"+"\n");
document.write("                </select>"+"\n");
document.write("             <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field10953076Y\">Year</label>"+"\n");
document.write("        <select id=\"field10953076Y\" name=\"field10953076Y\" class=\"fsField \"  >"+"\n");
document.write("                    <option value=\"\" > </option>"+"\n");
document.write("                    <option value=\"2008\" >2008</option>"+"\n");
document.write("                    <option value=\"2009\" >2009</option>"+"\n");
document.write("                    <option value=\"2010\" >2010</option>"+"\n");
document.write("                    <option value=\"2011\" >2011</option>"+"\n");
document.write("                    <option value=\"2012\" >2012</option>"+"\n");
document.write("                    <option value=\"2013\" >2013</option>"+"\n");
document.write("                    <option value=\"2014\" >2014</option>"+"\n");
document.write("                    <option value=\"2015\" >2015</option>"+"\n");
document.write("                    <option value=\"2016\" >2016</option>"+"\n");
document.write("                    <option value=\"2017\" >2017</option>"+"\n");
document.write("                    <option value=\"2018\" >2018</option>"+"\n");
document.write("                </select>"+"\n");
document.write("    "+"\n");
document.write("    "+"\n");
document.write("            <script type=\"text/javascript\">"+"\n");
document.write("            if(window.addEventListener) {"+"\n");
document.write("                window.addEventListener(\'load\', function() {"+"\n");
document.write("                    Formstack.Util.setDate(10953076);"+"\n");
document.write("                }, false);"+"\n");
document.write("            } else if(window.attachEvent) {"+"\n");
document.write("                window.attachEvent(\'onload\', function() {"+"\n");
document.write("                    Formstack.Util.setDate(10953076);"+"\n");
document.write("                });"+"\n");
document.write("            } else {"+"\n");
document.write("                Formstack.Util.setDate(10953076);"+"\n");
document.write("            }"+"\n");
document.write("        </script>"+"\n");
document.write("        "+"\n");
document.write("    <input type=\"text\" id=\"fsCalendar10953076Link\" class=\"fsCalendarPickerLink\" style=\"display:none;\"   />"+"\n");
document.write("    "+"\n");
document.write("    <div id=\"fsCalendar10953076\" class=\"fsCalendar\" style=\" position:absolute\"></div>"+"\n");
document.write("        "+"\n");
document.write("    &nbsp;"+"\n");
document.write("    <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field10953076H\">Hour</label>"+"\n");
document.write("    <select id=\"field10953076H\" name=\"field10953076H\" class=\"fsField \"  >"+"\n");
document.write("    "+"\n");
document.write("            <option value=\"\" > </option>"+"\n");
document.write("            <option value=\"01\" >01</option>"+"\n");
document.write("            <option value=\"02\" >02</option>"+"\n");
document.write("            <option value=\"03\" >03</option>"+"\n");
document.write("            <option value=\"04\" >04</option>"+"\n");
document.write("            <option value=\"05\" >05</option>"+"\n");
document.write("            <option value=\"06\" >06</option>"+"\n");
document.write("            <option value=\"07\" >07</option>"+"\n");
document.write("            <option value=\"08\" >08</option>"+"\n");
document.write("            <option value=\"09\" >09</option>"+"\n");
document.write("            <option value=\"10\" >10</option>"+"\n");
document.write("            <option value=\"11\" >11</option>"+"\n");
document.write("            <option value=\"12\" >12</option>"+"\n");
document.write("        "+"\n");
document.write("    </select>"+"\n");
document.write("    "+"\n");
document.write("    <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field10953076I\">Minute</label>"+"\n");
document.write("    <span>:</span> <select id=\"field10953076I\" name=\"field10953076I\" class=\"fsField \"   >"+"\n");
document.write("    "+"\n");
document.write("            <option value=\"\" > </option>"+"\n");
document.write("            <option value=\"00\" >00</option>"+"\n");
document.write("            <option value=\"01\" >01</option>"+"\n");
document.write("            <option value=\"02\" >02</option>"+"\n");
document.write("            <option value=\"03\" >03</option>"+"\n");
document.write("            <option value=\"04\" >04</option>"+"\n");
document.write("            <option value=\"05\" >05</option>"+"\n");
document.write("            <option value=\"06\" >06</option>"+"\n");
document.write("            <option value=\"07\" >07</option>"+"\n");
document.write("            <option value=\"08\" >08</option>"+"\n");
document.write("            <option value=\"09\" >09</option>"+"\n");
document.write("            <option value=\"10\" >10</option>"+"\n");
document.write("            <option value=\"11\" >11</option>"+"\n");
document.write("            <option value=\"12\" >12</option>"+"\n");
document.write("            <option value=\"13\" >13</option>"+"\n");
document.write("            <option value=\"14\" >14</option>"+"\n");
document.write("            <option value=\"15\" >15</option>"+"\n");
document.write("            <option value=\"16\" >16</option>"+"\n");
document.write("            <option value=\"17\" >17</option>"+"\n");
document.write("            <option value=\"18\" >18</option>"+"\n");
document.write("            <option value=\"19\" >19</option>"+"\n");
document.write("            <option value=\"20\" >20</option>"+"\n");
document.write("            <option value=\"21\" >21</option>"+"\n");
document.write("            <option value=\"22\" >22</option>"+"\n");
document.write("            <option value=\"23\" >23</option>"+"\n");
document.write("            <option value=\"24\" >24</option>"+"\n");
document.write("            <option value=\"25\" >25</option>"+"\n");
document.write("            <option value=\"26\" >26</option>"+"\n");
document.write("            <option value=\"27\" >27</option>"+"\n");
document.write("            <option value=\"28\" >28</option>"+"\n");
document.write("            <option value=\"29\" >29</option>"+"\n");
document.write("            <option value=\"30\" >30</option>"+"\n");
document.write("            <option value=\"31\" >31</option>"+"\n");
document.write("            <option value=\"32\" >32</option>"+"\n");
document.write("            <option value=\"33\" >33</option>"+"\n");
document.write("            <option value=\"34\" >34</option>"+"\n");
document.write("            <option value=\"35\" >35</option>"+"\n");
document.write("            <option value=\"36\" >36</option>"+"\n");
document.write("            <option value=\"37\" >37</option>"+"\n");
document.write("            <option value=\"38\" >38</option>"+"\n");
document.write("            <option value=\"39\" >39</option>"+"\n");
document.write("            <option value=\"40\" >40</option>"+"\n");
document.write("            <option value=\"41\" >41</option>"+"\n");
document.write("            <option value=\"42\" >42</option>"+"\n");
document.write("            <option value=\"43\" >43</option>"+"\n");
document.write("            <option value=\"44\" >44</option>"+"\n");
document.write("            <option value=\"45\" >45</option>"+"\n");
document.write("            <option value=\"46\" >46</option>"+"\n");
document.write("            <option value=\"47\" >47</option>"+"\n");
document.write("            <option value=\"48\" >48</option>"+"\n");
document.write("            <option value=\"49\" >49</option>"+"\n");
document.write("            <option value=\"50\" >50</option>"+"\n");
document.write("            <option value=\"51\" >51</option>"+"\n");
document.write("            <option value=\"52\" >52</option>"+"\n");
document.write("            <option value=\"53\" >53</option>"+"\n");
document.write("            <option value=\"54\" >54</option>"+"\n");
document.write("            <option value=\"55\" >55</option>"+"\n");
document.write("            <option value=\"56\" >56</option>"+"\n");
document.write("            <option value=\"57\" >57</option>"+"\n");
document.write("            <option value=\"58\" >58</option>"+"\n");
document.write("            <option value=\"59\" >59</option>"+"\n");
document.write("        "+"\n");
document.write("    </select>"+"\n");
document.write("    "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("        &nbsp;"+"\n");
document.write("        <label class=\"fsHiddenLabel\" style=\"display: none\" for=\"field10953076A\">AM/PM</label>"+"\n");
document.write("        <select id=\"field10953076A\" name=\"field10953076A\" class=\"fsField \"  >"+"\n");
document.write("        "+"\n");
document.write("                    <option value=\"\" > </option>"+"\n");
document.write("                    <option value=\"AM\" >AM</option>"+"\n");
document.write("                    <option value=\"PM\" >PM</option>"+"\n");
document.write("                "+"\n");
document.write("        </select>"+"\n");
document.write("        "+"\n");
document.write("    "+"\n");
document.write("            <script type=\"text/javascript\">"+"\n");
document.write("            if(window.addEventListener) {"+"\n");
document.write("                window.addEventListener(\'load\', function() {"+"\n");
document.write("                    Formstack.Util.setTime(10953076);"+"\n");
document.write("                }, false);"+"\n");
document.write("            } else if(window.attachEvent) {"+"\n");
document.write("                window.attachEvent(\'onload\', function() {"+"\n");
document.write("                    Formstack.Util.setTime(10953076);"+"\n");
document.write("                });"+"\n");
document.write("            } else {"+"\n");
document.write("                Formstack.Util.setTime(10953076);"+"\n");
document.write("            }"+"\n");
document.write("        </script>"+"\n");
document.write("        "+"\n");
document.write("                "+"\n");
document.write("                                                                    "+"\n");
document.write("                "+"\n");
document.write("                            			</div></fieldset>"+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-193\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell17438838\" aria-describedby=\"fsSupporting17438838\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17438838\" class=\"fsLabel\" for=\"field17438838\">orderType                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17438838\" name=\"field17438838\" size=\"50\"    value=\"UVM CEPBPM\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17438838\" class=\"fsSupporting\">"+"\n");
document.write("                                for Nelnet integration"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-194\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell17438847\" aria-describedby=\"fsSupporting17438847\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17438847\" class=\"fsLabel\" for=\"field17438847\">amount                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                "+"\n");
document.write("    "+"\n");
document.write("    <input type=\"number\" id=\"field17438847\" name=\"field17438847\" size=\"50\"  value=\"5000\" readonly=\"readonly\" class=\"fsField fsFormatNumber     fsNumberDecimals-0 \"     />"+"\n");
document.write("    "+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17438847\" class=\"fsSupporting\">"+"\n");
document.write("                                (in cents: i.e. 5000 = $50) for Nelnet integration"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-195\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell17438871\" aria-describedby=\"fsSupporting17438871\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17438871\" class=\"fsLabel\" for=\"field17438871\">redirectURL                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17438871\" name=\"field17438871\" size=\"50\"    value=\"https://aisweb1.uvm.edu/pls/owa_prod/cm_returnpbpm.P_Process_Payment\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17438871\" class=\"fsSupporting\">"+"\n");
document.write("                                for Nelnet integration"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-196\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsReadOnly fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell17438879\" aria-describedby=\"fsSupporting17438879\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17438879\" class=\"fsLabel\" for=\"field17438879\">TransactionID                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17438879\" name=\"field17438879\" size=\"50\"    value=\"\" readonly=\"readonly\" class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17438879\" class=\"fsSupporting\">"+"\n");
document.write("                                for Nelnet integration (populated after Nelnet transaction is completed)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
document.write("            </div>"+"\n");
document.write("            "+"\n");
document.write("                            "+"\n");
document.write("                </div>"+"\n");
document.write("                        "+"\n");
document.write("        "+"\n");
document.write("        "+"\n");
document.write("            "+"\n");
document.write("                "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                                                "+"\n");
document.write("                <div id=\"fsRow1031780-197\" class=\"fsRow fsFieldRow fsLastRow fsHidden\">"+"\n");
document.write("                        "+"\n");
document.write("                                                    "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                        "+"\n");
document.write("                                                                "+"\n");
document.write("            <div class=\"fsRowBody fsCell fsFieldCell  fsFirst fsLast fsLabelVertical fsHidden fsSpan100 fsHiddenByFieldSetting\" id=\"fsCell17438884\" aria-describedby=\"fsSupporting17438884\">"+"\n");
document.write("                "+"\n");
document.write("                                    <label id=\"label17438884\" class=\"fsLabel\" for=\"field17438884\">TransactionType                                            </label>"+"\n");
document.write("                                "+"\n");
document.write("                                                   "+"\n");
document.write("                <input type=\"text\" id=\"field17438884\" name=\"field17438884\" size=\"50\"    value=\"\"  class=\"fsField  \"   />"+"\n");
document.write("                "+"\n");
document.write("                                                                                        <div id=\"fsSupporting17438884\" class=\"fsSupporting\">"+"\n");
document.write("                                (1= credit card) for Nelnet integration (populated after Nelnet transaction is completed)"+"\n");
document.write("                            </div>"+"\n");
document.write("                                                                            "+"\n");
document.write("                "+"\n");
document.write("                "+"\n");
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