2015/scholarships/index.html

   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>
   9
  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
  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>
  13
  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>
  15
  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">
  17
  18   <div>
  19         <input name="postURL" type="hidden"
  20                    value="https://libreplanet.org/2015/scholarships/confirmation.html" />
  21         <input name="entryURL" type="hidden"
  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" />
  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">CuraÃ§ao</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">
 438                 <textarea rows="4" data-crm-custom="LP15_Scholarship:Why_do_you_want_to_attend_LibrePlanet_2015_"
 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
 474                 <input formattype="birth" startoffset="100" endoffset="0" format="mm/dd/yy"
 475                            name="birth_date" type="text" id="birth_date" class="form-text"
 476                            style="display: none;"/>
 477                 <input type="text" name="birth_date_display" id="birth_date_display"
 478                            class="form-control" autocomplete="off"/>
 479
 480                 <span>
 481                   <a href="#" onclick="clearDateTime( 'birth_date' ); return false;">
 482                         clear</a>
 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
 525 <!--    <div id="editrow-custom_204" class="form-group">
 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>
 554 -->
 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">
 572                   <a href="#" title="unselect" onclick="unselectRadio('custom_206', 'Edit'); return false;">clear</a>
 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>
 584         </div>
 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" />
 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" /> -->
 602           </div>
 603         </div>
 604
 605         </div>
 606
 607   </div>
 608 </form>
 609
 610 <!--#include virtual="/server/2015/footer.html"-->
 611 <!--#include virtual="/server/2015/scholarship_js.html"-->
 612
 613 <!--#include virtual="/server/2015/close.html" -->