projects / libreplanet-static.git / blame
? search:
summary | shortlog | log | commit | commitdiff | tree
blob | blame (incremental) | history | HEAD
added 2015/program/
[libreplanet-static.git] / 2015 / scholarships / index.html
CommitLineData
b675bd48
ZR		 1<!--#include virtual="/server/2015/header.html"-->
2
3<title>Scholarship Application</title>
4
5<!--#include virtual="/server/2015/banner.html"-->
6<!--#include virtual="/server/2015/sidebar.html"-->
7
8<h2>Scholarship Application</h2>
b675bd48 9
f9ab3707
ZR		 10<p style="font-weight: bold;">The official deadline for scholarship applications is passed. Please don't submit one unless the FSF asks you to.</p>
11
4177269d 12<p>We are offering a limited number of travel scholarships to assist with expenses related to attending LibrePlanet. While we cannot offer stipends to everyone who applies, we will do our best to bring as many people as possible from as many communities as possible. We are generally unable to cover 100% of your travel and hotel costs, applicants should be prepared to cover some portion of travel expenses. <strong>The application deadline for travel stipends is Sunday, November 30th, 2014 at 19:59 EST (23:59 UTC).</strong></p>
b675bd48 13
a58a76cb 14<p>One of the goals of our scholarship program is to increase participation by marginalized groups in our conference, so we ask some questions about identity. Remember that all of these fields are optional.</p>
44a93234 15
47a032d5 16<form action="https://my.fsf.org/civicrm/profile/create?gid=334&amp;reset=1" class="form-horizontal margin-top" method="post" name="Edit" id="Edit">
a58a76cb 17
18 <div>
dce8c121 19 <input name="postURL" type="hidden"
acc364b0 20 value="https://libreplanet.org/2015/scholarships/confirmation.html" />
a58a76cb 21 <input name="entryURL" type="hidden"
47a032d5 22 value="https://my.fsf.org/civicrm/profile/create?gid=334&amp;reset=1/update?action=update&amp;amp;id=334&amp;amp;reset=1&amp;amp;context=field" />
a58a76cb 23 <input name="gid" type="hidden" value="334" />
24 <input name="_qf_default" type="hidden" value="Edit:cancel" />
25 </div>
26
27
28 <div class="crm-profile-name-GNU_30th_scholarship_application_334"> <!-- div 1 -->
29
30 <div id="crm-container" class="crm-container crm-public" lang="en" xml:lang="en"> <!-- div 2 -->
31
32 <div id="editrow-first_name" class="form-group">
33 <label for="first_name" class="col-sm-3 control-label">
34 First Name
35 <span class="field-required">*</span>
36 </label>
37
38 <div class="col-sm-5">
39 <input name="first_name" type="text" id="first_name" class="form-control" required>
40 </div>
41 </div>
42
43
44 <div id="editrow-last_name" class="form-group">
45 <label for="last_name" class="control-label col-sm-3">
46 Last Name
47 <span class="field-required">*</span>
48 </label>
49 <div class="col-sm-5">
50 <input name="last_name" type="text" id="last_name" class="form-control" required>
51 </div>
52 </div>
53
54 <div id="editrow-email-Primary" class="form-group">
55 <label for="email-Primary" class="control-label col-sm-3">Email
56 <span class="field-required">*</span>
57 </label>
58
59 <div class="col-sm-5">
60 <input name="email-Primary" type="email" id="email-Primary" class="form-control" required>
61 </div>
62 </div>
63
64 <div class="form-group">
65 <div class="col-sm-offset-3 col-sm-5" id="helprow-street_address-Primary">
66 <p class="help-block scholarship-input-annotation">
67 <small>Please tell us where you're coming from.</small>
68 </p>
69 </div>
70 </div>
71
72 <div id="editrow-street_address-Primary" class="form-group">
73 <label for="street_address-Primary" class="col-sm-3 control-label">
74 Street Address</label>
75
76 <div class="col-sm-5">
77 <input name="street_address-Primary" type="text" id="street_address-Primary" class="form-control" />
78 </div>
79 </div>
80
81 <div id="editrow-city-Primary" class="form-group">
82 <label class="col-sm-3 control-label" for="city-Primary">City</label>
83 <div class="col-sm-5">
84 <input name="city-Primary" type="text" id="city-Primary" class="form-control" />
85 </div>
86 </div>
87
88 <div id="editrow-postal_code-Primary" class="form-group">
89 <label class="control-label col-sm-3" for="postal_code-Primary">
90 Postal Code
91 </label>
92 <div class="col-sm-5">
93 <input name="postal_code-Primary" type="number" id="postal_code-Primary" class="form-control" />
94 </div>
95 </div>
96
97 <div id="editrow-country-Primary" class="form-group">
98 <label class="control-label col-sm-3" for="country-Primary">
99 Country
100 <span class="field-required">*</span>
101 </label>
102
103 <div class="col-sm-5">
104 <select name="country-Primary" id="country-Primary" class="form-control">
105 <option value="">- select -</option>
106 <option value="1228" selected="selected">United States</option>
107 <option value="1001">Afghanistan</option>
108 <option value="1241">Åland Islands</option>
109 <option value="1002">Albania</option>
110 <option value="1003">Algeria</option>
111 <option value="1004">American Samoa</option>
112 <option value="1005">Andorra</option>
113 <option value="1006">Angola</option>
114 <option value="1007">Anguilla</option>
115 <option value="1008">Antarctica</option>
116 <option value="1009">Antigua and Barbuda</option>
117 <option value="1010">Argentina</option>
118 <option value="1011">Armenia</option>
119 <option value="1012">Aruba</option>
120 <option value="1013">Australia</option>
121 <option value="1014">Austria</option>
122 <option value="1015">Azerbaijan</option>
123 <option value="1212">Bahamas</option>
124 <option value="1016">Bahrain</option>
125 <option value="1017">Bangladesh</option>
126 <option value="1018">Barbados</option>
127 <option value="1019">Belarus</option>
128 <option value="1020">Belgium</option>
129 <option value="1021">Belize</option>
130 <option value="1022">Benin</option>
131 <option value="1023">Bermuda</option>
132 <option value="1024">Bhutan</option>
133 <option value="1025">Bolivia</option>
134 <option value="1250">Bonaire, Saint Eustatius and Saba</option>
135 <option value="1026">Bosnia and Herzegovina</option>
136 <option value="1027">Botswana</option>
137 <option value="1028">Bouvet Island</option>
138 <option value="1029">Brazil</option>
139 <option value="1030">British Indian Ocean Territory</option>
140 <option value="1032">Brunei Darussalam</option>
141 <option value="1033">Bulgaria</option>
142 <option value="1034">Burkina Faso</option>
143 <option value="1036">Burundi</option>
144 <option value="1037">Cambodia</option>
145 <option value="1038">Cameroon</option>
146 <option value="1039">Canada</option>
147 <option value="1040">Cape Verde</option>
148 <option value="1041">Cayman Islands</option>
149 <option value="1042">Central African Republic</option>
150 <option value="1043">Chad</option>
151 <option value="1044">Chile</option>
152 <option value="1045">China</option>
153 <option value="1046">Christmas Island</option>
154 <option value="1047">Cocos (Keeling) Islands</option>
155 <option value="1048">Colombia</option>
156 <option value="1049">Comoros</option>
157 <option value="1051">Congo, Republic of the</option>
158 <option value="1050">Congo, The Democratic Republic of the</option>
159 <option value="1052">Cook Islands</option>
160 <option value="1053">Costa Rica</option>
161 <option value="1054">Côte d'Ivoire</option>
162 <option value="1055">Croatia</option>
163 <option value="1056">Cuba</option>
164 <option value="1248">Curaçao</option>
165 <option value="1057">Cyprus</option>
166 <option value="1058">Czech Republic</option>
167 <option value="1059">Denmark</option>
168 <option value="1060">Djibouti</option>
169 <option value="1061">Dominica</option>
170 <option value="1062">Dominican Republic</option>
171 <option value="1064">Ecuador</option>
172 <option value="1065">Egypt</option>
173 <option value="1066">El Salvador</option>
174 <option value="1067">Equatorial Guinea</option>
175 <option value="1068">Eritrea</option>
176 <option value="1069">Estonia</option>
177 <option value="1070">Ethiopia</option>
178 <option value="1072">Falkland Islands (Malvinas)</option>
179 <option value="1073">Faroe Islands</option>
180 <option value="1074">Fiji</option>
181 <option value="1075">Finland</option>
182 <option value="1076">France</option>
183 <option value="1077">French Guiana</option>
184 <option value="1078">French Polynesia</option>
185 <option value="1079">French Southern Territories</option>
186 <option value="1080">Gabon</option>
187 <option value="1213">Gambia</option>
188 <option value="1081">Georgia</option>
189 <option value="1082">Germany</option>
190 <option value="1083">Ghana</option>
191 <option value="1084">Gibraltar</option>
192 <option value="1085">Greece</option>
193 <option value="1086">Greenland</option>
194 <option value="1087">Grenada</option>
195 <option value="1088">Guadeloupe</option>
196 <option value="1089">Guam</option>
197 <option value="1090">Guatemala</option>
198 <option value="1245">Guernsey</option>
199 <option value="1091">Guinea</option>
200 <option value="1092">Guinea-Bissau</option>
201 <option value="1093">Guyana</option>
202 <option value="1094">Haiti</option>
203 <option value="1095">Heard Island and McDonald Islands</option>
204 <option value="1096">Holy See (Vatican City State)</option>
205 <option value="1097">Honduras</option>
206 <option value="1098">Hong Kong</option>
207 <option value="1099">Hungary</option>
208 <option value="1100">Iceland</option>
209 <option value="1101">India</option>
210 <option value="1102">Indonesia</option>
211 <option value="1103">Iran, Islamic Republic of</option>
212 <option value="1104">Iraq</option>
213 <option value="1105">Ireland</option>
214 <option value="1246">Isle of Man</option>
215 <option value="1106">Israel</option>
216 <option value="1107">Italy</option>
217 <option value="1108">Jamaica</option>
218 <option value="1109">Japan</option>
219 <option value="1244">Jersey</option>
220 <option value="1110">Jordan</option>
221 <option value="1111">Kazakhstan</option>
222 <option value="1112">Kenya</option>
223 <option value="1113">Kiribati</option>
224 <option value="1114">Korea, Democratic People's Republic of</option>
225 <option value="1115">Korea, Republic of</option>
226 <option value="1251">Kosovo</option>
227 <option value="1116">Kuwait</option>
228 <option value="1117">Kyrgyzstan</option>
229 <option value="1118">Lao People's Democratic Republic</option>
230 <option value="1119">Latvia</option>
231 <option value="1120">Lebanon</option>
232 <option value="1121">Lesotho</option>
233 <option value="1122">Liberia</option>
234 <option value="1123">Libya</option>
235 <option value="1124">Liechtenstein</option>
236 <option value="1125">Lithuania</option>
237 <option value="1126">Luxembourg</option>
238 <option value="1127">Macao</option>
239 <option value="1128">Macedonia, Republic of</option>
240 <option value="1129">Madagascar</option>
241 <option value="1130">Malawi</option>
242 <option value="1131">Malaysia</option>
243 <option value="1132">Maldives</option>
244 <option value="1133">Mali</option>
245 <option value="1134">Malta</option>
246 <option value="1135">Marshall Islands</option>
247 <option value="1136">Martinique</option>
248 <option value="1137">Mauritania</option>
249 <option value="1138">Mauritius</option>
250 <option value="1139">Mayotte</option>
251 <option value="1140">Mexico</option>
252 <option value="1141">Micronesia, Federated States of</option>
253 <option value="1142">Moldova</option>
254 <option value="1143">Monaco</option>
255 <option value="1144">Mongolia</option>
256 <option value="1243">Montenegro</option>
257 <option value="1145">Montserrat</option>
258 <option value="1146">Morocco</option>
259 <option value="1147">Mozambique</option>
260 <option value="1035">Myanmar</option>
261 <option value="1148">Namibia</option>
262 <option value="1149">Nauru</option>
263 <option value="1150">Nepal</option>
264 <option value="1152">Netherlands</option>
265 <option value="1153">New Caledonia</option>
266 <option value="1154">New Zealand</option>
267 <option value="1155">Nicaragua</option>
268 <option value="1156">Niger</option>
269 <option value="1157">Nigeria</option>
270 <option value="1158">Niue</option>
271 <option value="1159">Norfolk Island</option>
272 <option value="1160">Northern Mariana Islands</option>
273 <option value="1161">Norway</option>
274 <option value="1162">Oman</option>
275 <option value="1163">Pakistan</option>
276 <option value="1164">Palau</option>
277 <option value="1165">Palestinian Territory, Occupied</option>
278 <option value="1166">Panama</option>
279 <option value="1167">Papua New Guinea</option>
280 <option value="1168">Paraguay</option>
281 <option value="1169">Peru</option>
282 <option value="1170">Philippines</option>
283 <option value="1171">Pitcairn</option>
284 <option value="1172">Poland</option>
285 <option value="1173">Portugal</option>
286 <option value="1174">Puerto Rico</option>
287 <option value="1175">Qatar</option>
288 <option value="1179">Reunion</option>
289 <option value="1176">Romania</option>
290 <option value="1177">Russian Federation</option>
291 <option value="1178">Rwanda</option>
292 <option value="1180">Saint Helena</option>
293 <option value="1181">Saint Kitts and Nevis</option>
294 <option value="1182">Saint Lucia</option>
295 <option value="1183">Saint Pierre and Miquelon</option>
296 <option value="1184">Saint Vincent and the Grenadines</option>
297 <option value="1185">Samoa</option>
298 <option value="1186">San Marino</option>
299 <option value="1207">Sao Tome and Principe</option>
300 <option value="1187">Saudi Arabia</option>
301 <option value="1188">Senegal</option>
302 <option value="1242">Serbia</option>
303 <option value="1238">Serbia and Montenegro</option>
304 <option value="1189">Seychelles</option>
305 <option value="1190">Sierra Leone</option>
306 <option value="1191">Singapore</option>
307 <option value="1249">Sint Maarten (Dutch Part)</option>
308 <option value="1192">Slovakia</option>
309 <option value="1193">Slovenia</option>
310 <option value="1194">Solomon Islands</option>
311 <option value="1195">Somalia</option>
312 <option value="1196">South Africa</option>
313 <option value="1197">South Georgia and the South Sandwich Islands</option>
314 <option value="1247">South Sudan</option>
315 <option value="1198">Spain</option>
316 <option value="1199">Sri Lanka</option>
317 <option value="1200">Sudan</option>
318 <option value="1201">Suriname</option>
319 <option value="1202">Svalbard and Jan Mayen</option>
320 <option value="1203">Swaziland</option>
321 <option value="1204">Sweden</option>
322 <option value="1205">Switzerland</option>
323 <option value="1206">Syrian Arab Republic</option>
324 <option value="1208">Taiwan</option>
325 <option value="1209">Tajikistan</option>
326 <option value="1210">Tanzania, United Republic of</option>
327 <option value="1211">Thailand</option>
328 <option value="1063">Timor-Leste</option>
329 <option value="1214">Togo</option>
330 <option value="1215">Tokelau</option>
331 <option value="1216">Tonga</option>
332 <option value="1217">Trinidad and Tobago</option>
333 <option value="1218">Tunisia</option>
334 <option value="1219">Turkey</option>
335 <option value="1220">Turkmenistan</option>
336 <option value="1221">Turks and Caicos Islands</option>
337 <option value="1222">Tuvalu</option>
338 <option value="1223">Uganda</option>
339 <option value="1224">Ukraine</option>
340 <option value="1225">United Arab Emirates</option>
341 <option value="1226">United Kingdom</option>
342 <option value="1227">United States Minor Outlying Islands</option>
343 <option value="1229">Uruguay</option>
344 <option value="1230">Uzbekistan</option>
345 <option value="1231">Vanuatu</option>
346 <option value="1232">Venezuela</option>
347 <option value="1233">Viet Nam</option>
348 <option value="1031">Virgin Islands, British</option>
349 <option value="1234">Virgin Islands, U.S.</option>
350 <option value="1235">Wallis and Futuna</option>
351 <option value="1236">Western Sahara</option>
352 <option value="1237">Yemen</option>
353 <option value="1239">Zambia</option>
354 <option value="1240">Zimbabwe</option>
355 </select>
356 </div>
357 </div>
358
359 <div id="editrow-state_province-Primary" class="form-group">
360 <label class="control-label col-sm-3" for="state_province-Primary">State or Province</label>
361
362 <div class="col-sm-5">
363 <select name="state_province-Primary" id="state_province-Primary" class="form-control">
364 <option value="">- select -</option>
365 <option value="1000">Alabama</option>
366 <option value="1001">Alaska</option>
367 <option value="1052">American Samoa</option>
368 <option value="1002">Arizona</option>
369 <option value="1003">Arkansas</option>
370 <option value="1060">Armed Forces Americas</option>
371 <option value="1059">Armed Forces Europe</option>
372 <option value="1061">Armed Forces Pacific</option>
373 <option value="1004">California</option>
374 <option value="1005">Colorado</option>
375 <option value="1006">Connecticut</option>
376 <option value="1007">Delaware</option>
377 <option value="1050">District of Columbia</option>
378 <option value="1008">Florida</option>
379 <option value="1009">Georgia</option>
380 <option value="1053">Guam</option>
381 <option value="1010">Hawaii</option>
382 <option value="1011">Idaho</option>
383 <option value="1012">Illinois</option>
384 <option value="1013">Indiana</option>
385 <option value="1014">Iowa</option>
386 <option value="1015">Kansas</option>
387 <option value="1016">Kentucky</option>
388 <option value="1017">Louisiana</option>
389 <option value="1018">Maine</option>
390 <option value="1019">Maryland</option>
391 <option value="1020">Massachusetts</option>
392 <option value="1021">Michigan</option>
393 <option value="1022">Minnesota</option>
394 <option value="1023">Mississippi</option>
395 <option value="1024">Missouri</option>
396 <option value="1025">Montana</option>
397 <option value="1026">Nebraska</option>
398 <option value="1027">Nevada</option>
399 <option value="1028">New Hampshire</option>
400 <option value="1029">New Jersey</option>
401 <option value="1030">New Mexico</option>
402 <option value="1031">New York</option>
403 <option value="1032">North Carolina</option>
404 <option value="1033">North Dakota</option>
405 <option value="1055">Northern Mariana Islands</option>
406 <option value="1034">Ohio</option>
407 <option value="1035">Oklahoma</option>
408 <option value="1036">Oregon</option>
409 <option value="1037">Pennsylvania</option>
410 <option value="1056">Puerto Rico</option>
411 <option value="1038">Rhode Island</option>
412 <option value="1039">South Carolina</option>
413 <option value="1040">South Dakota</option>
414 <option value="1041">Tennessee</option>
415 <option value="1042">Texas</option>
416 <option value="1058">United States Minor Outlying Islands</option>
417 <option value="1043">Utah</option>
418 <option value="1044">Vermont</option>
419 <option value="1057">Virgin Islands</option>
420 <option value="1045">Virginia</option>
421 <option value="1046">Washington</option>
422 <option value="1047">West Virginia</option>
423 <option value="1048">Wisconsin</option>
424 <option value="1049">Wyoming</option>
425 </select>
426 </div>
427 </div>
428
429 <div class="form-group" id="helprow-state_province-Primary">
430 <div class="col-sm-offset-3 col-sm-9">
431 <hr />
432 </div>
433 </div>
434
435 <div id="editrow-custom_199" class="form-group">
436 <label class="control-label col-sm-3" for="custom_199">Why do you want to attend LibrePlanet 2015?</label>
437 <div class="col-sm-9">
47a032d5 438 <textarea rows="4" data-crm-custom="LP15_Scholarship:Why_do_you_want_to_attend_LibrePlanet_2015_"
a58a76cb 439 name="custom_199" id="custom_199" class="form-control"></textarea>
440 </div>
441 </div>
442
443 <div class="form-group" id="helprow-custom_184">
444 <div class="col-sm-offset-3 col-sm-9">
445 <p class="help-block scholarship-input-annotation">
446 <small>We are working to increase the participation of marginalized
447 groups at LibrePlanet. Please share any identity information
448 you feel is important.</small>
449 </p>
450 </div>
451 </div>
452
453 <div id="editrow-custom_184" class="form-group">
454 <label class="col-sm-3 control-label" for="custom_184">Gender</label>
455
456 <div class="col-sm-5">
457 <input data-crm-custom="Identity_Free_Response:Gender" name="custom_184" type="text" id="custom_184" class="form-control" />
458 </div>
459 </div>
460
461 <div id="editrow-custom_185" class="form-group">
462 <label class="col-sm-3 control-label" for="custom_185">Race/Ethnicity</label>
463
464 <div class="col-sm-5">
465 <input data-crm-custom="Identity_Free_Response:Race_Ethnicity" name="custom_185" type="text" id="custom_185" class="form-control" />
466 </div>
467 </div>
468
469 <div id="editrow-birth_date" class="form-group">
470 <label class="col-sm-3 control-label" for="birth_date_display">Birth Date</label>
471
472 <div class="col-sm-5">
473
5bab8604 474 <input formattype="birth" startoffset="100" endoffset="0" format="mm/dd/yy"
a58a76cb 475 name="birth_date" type="text" id="birth_date" class="form-text"
5bab8604 476 style="display: none;"/>
a58a76cb 477 <input type="text" name="birth_date_display" id="birth_date_display"
478 class="form-control" autocomplete="off"/>
479
480 <span>
b1707ce3
ZR		 481 <a href="#" onclick="clearDateTime( 'birth_date' ); return false;">
482 clear</a>
a58a76cb 483 </span>
484
485 </div>
486 </div>
487
488 <div class="form-group" id="helprow-custom_186">
489 <div class="col-sm-offset-3 col-sm-9"><p class="help-block scholarship-input-annotation"><small>A space for you to Include any other identity information that doesn't fit in the provided fields, like class background, ability/disability, national origin/citizenship status, sexuality, religion/spiritual practice, geography/regional affiliations, education, types of work, etc.</small></p>
490 </div>
491 </div>
492
493 <div id="editrow-custom_186" class="form-group">
494 <label class="control-label col-sm-3" for="custom_186">
495 Anything else you'd like to tell us about yourself?</label>
496 <div class="col-sm-9">
497 <textarea data-crm-custom="Identity_Free_Response:How_do_you_self_identify_"
498 rows="4" name="custom_186" id="custom_186"
499 class="form-control"></textarea>
500 </div>
501 </div>
502
503 <div id="editrow-custom_200" class="form-group">
504
505 <label class="control-label col-sm-3" for="custom_200">How do
506 you plan to bring your experience back to your
507 community?</label>
508
509 <div class="col-sm-9">
510 <textarea data-crm-custom="LP15_Scholarship:How_do_you_plan_to_bring_your_experience_back_to_your_community_"
511 rows="4" name="custom_200" id="custom_200" class="form-control"></textarea>
512 </div>
513 </div>
514
515 <div id="editrow-custom_203" class="form-group">
516 <label class="control-label col-sm-3" for="custom_203">
517 Estimated travel and hotel expenses
518 </label>
519 <div class="col-sm-9">
520 <textarea data-crm-custom="LP15_Scholarship:Estimated_travel_and_hotel_expenses" rows="4"
521 name="custom_203" id="custom_203" class="form-control"></textarea>
522 </div>
523 </div>
524
f4c52429 525<!-- <div id="editrow-custom_204" class="form-group">
a58a76cb 526 <label class="control-label col-sm-3" for="custom_204">
527 Are there any special accommodations that would make it easier for you to attend LibrePlanet?
528 </label>
529 <div class="col-sm-9">
530 <textarea data-crm-custom="LP15_Scholarship:Are_there_any_special_accommodations_that_would_make_it_easier_f" rows="4"
531 name="custom_204" id="custom_204" class="form-control"></textarea>
532 <span class="help-block">Examples: ASL interpretation, wheelchair accessibility, etc.</span>
533 </div>
534 </div>
535
536 <div id="editrow-custom_205" class="form-group">
537 <label class="control-label col-sm-3">Would you be willing to volunteer at the event?</label>
538
539 <div class="col-sm-5">
540 <label class="radio-inline" for="CIVICRM_QFID_1_2">
541 <input data-crm-custom="LP15_Scholarship:Would_you_be_willing_to_volunteer_at_the_event_"
542 value="1" type="radio" id="CIVICRM_QFID_1_2" name="custom_205" />
543 Yes
544 </label>
545
546 <label class="radio-inline" for="CIVICRM_QFID_0_4">
547 <input data-crm-custom="LP15_Scholarship:Would_you_be_willing_to_volunteer_at_the_event_"
548 value="0" type="radio" id="CIVICRM_QFID_0_4" name="custom_205" />No
549 </label>
550
551 <span class="radio-clear-link">(<a href="#" title="unselect" onclick="unselectRadio('custom_205', 'Edit'); return false;">clear</a>)</span>
552 </div>
553 </div>
db2a42b2 554-->
a58a76cb 555
556 <div id="editrow-custom_206" class="form-group">
557 <label class="control-label col-sm-3">Are you a student?</label>
558
559 <div class="col-sm-5">
560 <label class="radio-inline" for="CIVICRM_QFID_1_6">
561 <input data-crm-custom="LP15_Scholarship:Are_you_a_student_"
562 value="1" type="radio" id="CIVICRM_QFID_1_6" name="custom_206" />
563 Yes
564 </label>
565
566 <label class="radio-inline" for="CIVICRM_QFID_0_8">
567 <input data-crm-custom="LP15_Scholarship:Are_you_a_student_" value="0"
568 type="radio" id="CIVICRM_QFID_0_8" name="custom_206" />No
569 </label>
570
571 <span class="radio-clear-link">
b1707ce3 572 <a href="#" title="unselect" onclick="unselectRadio('custom_206', 'Edit'); return false;">clear</a>
a58a76cb 573 </span>
574 </div>
575 </div>
576
577 <div id="editrow-custom_207" class="form-group">
578 <label class="control-label col-sm-3" for="custom_207">Free software project affiliation, if any</label>
579
580 <div class="col-sm-5">
581 <input data-crm-custom="LP15_Scholarship:Free_software_project_affiliation_if_any"
582 name="custom_207" type="text" id="custom_207" class="form-control" />
583 </div>
9864b7b2 584 </div>
a58a76cb 585
586 <div class="form-group">
587 <div class="col-sm-12">
588 <p>
589 We will not publish or share
590 your information with any party outside the FSF. See our
591 <a href="https://my.fsf.org/donate/privacypolicy.html">
592 privacy policy</a> for more information.
593 </p>
594 </div>
595 </div>
596
597 <div class="form-group">
598 <div class="col-sm-12">
599
600 <input class="btn btn-default" accesskey="S" name="_qf_Edit_next" value="Save" type="submit" id="_qf_Edit_next" />
47a032d5 601<!-- <input onclick="location.href='https://my.fsf.org/civicrm/profile?reset=1&amp;gid=334'; return false;" class="cancel form-submit default" name="_qf_Edit_cancel" value="Cancel" type="submit" id="_qf_Edit_cancel" /> -->
a58a76cb 602 </div>
603 </div>
604
605 </div>
606
607 </div>
608</form>
b675bd48
ZR		 609
610<!--#include virtual="/server/2015/footer.html"-->
a58a76cb 611<!--#include virtual="/server/2015/scholarship_js.html"-->
b04c37e7 612
b675bd48 613<!--#include virtual="/server/2015/close.html" -->