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<CPSInformationRequest-FormComponent Name="CPSInformationRequest-FormComponent"><![CDATA[<html>
<head>
<title></title>
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<p>
<form action="PreBuilt/asp/CPSInformationRequest-FormProcess.asp" 
method=post name="frmCPSInfoRequest" id="CPSfrmInfoRequest" onSubmit="MM_validateForm('firstname','','R','lastname','','R','emailaddress','','R','address','','R','city','','R','zip','','R');return document.MM_returnValue">
  <table width="650" border=0>
    <tr>
      <td colspan=2 height=26><hr>
      </td>
    </tr>
    <tr bgcolor=#ffffff>
      <td width=190><p><strong><font color=black>First Name:</font> </strong></p></td>
      <td width=100%><font 
      color=#ff3333><i><b>
        <input name=firstname id="firstname" size=25>
        *</b></i></font></td>
    </tr>
    <tr>
      <td width=190><strong><font color=black>Last Name:</font> </strong></td>
      <td width=100%><input size="25" name="lastname">
        <b><i><font color="#ff3333"> *</font></i></b><font 
      color=#ff3333>&nbsp;</font> </td>
    </tr>
    <tr>
      <td width=190><strong><font color="black">E-mail Address:</font> </strong></td>
      <td width=100%><input size="60" name="emailaddress">
        <font 
      color=#ff3333><i><b>*</b></i></font></td>
    </tr>
    <tr>
      <td width="190" align="left"><b>Mailing Address:</b></td>
      <td width="100%" align="left" valign="top"><input maxlength="100" size="60" name="address">
        <font 
      color="#ff3333"><i><b>*</b></i></font></td>
    </tr>
    <tr>
      <td width="190" align="left"><b>City:</b></td>
      <td width="100%" align="left" valign="top"><input size="50" name="city">
        <font 
      color="#ff3333"><i><b>*</b></i></font></td>
    </tr>
    <tr>
      <td width="190" align="left"><b>State:</b></td>
      <td width="100%" align="left"><select id="select1" 
      style="WIDTH: 100px; HEIGHT: 22px" name=state>
          <option>AK</option>
          <option>AL</option>
          <option>AR</option>
          <option>AZ</option>
          <option>CA</option>
          <option>CO</option>
          <option>CT</option>
          <option>DC</option>
          <option>DE</option>
          <option>FL</option>
          <option>GA</option>
          <option>HI</option>
          <option>IA</option>
          <option>ID</option>
          <option>IL</option>
          <option>IN</option>
          <option>KS</option>
          <option>KY</option>
          <option>LA</option>
          <option>MA</option>
          <option>MD</option>
          <option>ME</option>
          <option>MI</option>
          <option>MN</option>
          <option>MO</option>
          <option>MS</option>
          <option>MT</option>
          <option>NC</option>
          <option>ND</option>
          <option>NE</option>
          <option>NH</option>
          <option>NJ</option>
          <option>NM</option>
          <option>NV</option>
          <option>NY</option>
          <option>OH</option>
          <option>OK</option>
          <option>OR</option>
          <option>PA</option>
          <option>PR</option>
          <option>RI</option>
          <option>SC</option>
          <option>SD</option>
          <option>TN</option>
          <option>TX</option>
          <option>UT</option>
          <option>VA</option>
          <option>VI</option>
          <option>VT</option>
          <option>WA</option>
          <option>WI</option>
          <option>WV</option>
          <option>WY</option>
          <option selected>Select State</option>
        </select>
        <font 
      color=#ff3333>&nbsp;</font> </td>
    </tr>
    <tr>
      <td width="190" align="left" valign="top"><b>Zip:</b></td>
      <td width="100%" align="left" valign="top"><input size="25" name="zip">
        <font 
      color="#ff3333"><i><b>*</b></i></font></td>
    </tr>
    <tr>
      <td width="190" align="left" valign="top"><b>Country(if other than USA):</b></td>
      <td width="100%" align="left" valign="top"><input size="25" name="country">
      </td>
    </tr>
    <tr>
      <td width="190" align="left" valign="top"><strong>Home Phone:</strong> </td>
      <td width="100%" align="left" valign="top"><input name="homephone" id="homephone" size="25"></td>
    </tr>
    <tr>
      <td align="left" valign="top"><strong>Work Phone: </strong></td>
      <td align="left" valign="top"><input name="workphone" id="workphone" size="25"></td>
    </tr>
    <tr>
      <td width="190" align="left" valign="top"><strong>Age Confirmation:</strong></td>
      <td width="100%" align="left" valign="top"><table width="100%" border="0" cellspacing="0">
          <tr>
            <td width="4%" align="right"><input id="AgeConfirm" type="checkbox" value="I confirm that I am 22 years of age or older" 
      name="AgeConfirm"></td>
            <td width="96%">I am 22 years of age or older (required for the CPS
              programs)</td>
          </tr>
        </table></td>
    </tr>
    <tr>
      <td width="190" valign="top"><b>Information Request:</b></td>
      <td width="100%" valign="top"><table width="100%"  border="0">
          <tr>
            <td colspan="2"><strong>I am interested in finding out more about the BS in Organizational Leadership </strong></td>
          </tr>
          <tr>
            <td width="3%" align="right"><input id="InfoRequest" type="checkbox" value="to receive undergraduate admissions material" 
      name="InfoRequest"></td>
            <td width="97%">Please send Undergraduate Admissions Material </td>
          </tr>
          <tr>
            <td align="right"><input id="InfoRequest" type="checkbox" value="to be contacted by a CPS Advisor" 
      name="InfoRequest"></td>
            <td>I would like to be contacted by a CPS advisor </td>
          </tr>
          <tr>
            <td align="right" valign="top"><input id="InfoRequest" type="checkbox" value="more information about completing my Bachelors degree in Organizational Leadership" 
      name="InfoRequest"></td>
            <td>I would like more information about completing my Bachelors degree in Organizational Leadership</td>
          </tr>
          <tr>
            <td align="right" valign="top">&nbsp;</td>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td colspan="2" valign="top"><strong>I would like more information about the MS in Organizational Leadership</strong></td>
          </tr>
          <tr>
            <td align="right" valign="top"><input id="InfoRequestMasters" type="checkbox" value="to receive graduate admissions material" 
      name="InfoRequestMasters"></td>
            <td>Please send Graduate Admissions Material </td>
          </tr>
          <tr>
            <td align="right" valign="top"><input id="InfoRequestMasters" type="checkbox" value="o be contacted by a CPS Advisor" 
      name="InfoRequestMasters"></td>
            <td>I would like to be contacted by a CPS advisor </td>
          </tr>
          <tr>
            <td align="right" valign="top"><input id="InfoRequestMasters" type="checkbox" value="more information about completing my Masters degree in Organizational Leadership" 
      name="InfoRequestMasters"></td>
            <td>I would like more information about completing my Masters degree in Organizational Leadership</td>
          </tr>
          <tr>
            <td colspan="2">&nbsp;</td>
          </tr>
          <tr>
            <!--<td colspan="2"><strong>I would like more information about the following
                Organizational Leadership courses:</strong></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL100" 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x14083.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
            100 Quantitative Skills for Leadership </a>(3 credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL101" 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11201.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  101 Self Development</a> (3 credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL102" 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11200.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  102 Mastering Persuasive Written and Oral Communication</a> (3
                  credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL102L"
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x14084.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  102L Persuasive Communication Writing Lab </a> (3 credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL210"
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11199.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  210 Ethics in Leadership</a> (3 credits)</span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL220" 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11193.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
            220 Business Accounting</a> (3 credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL230" 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11192.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  230 Creativity and Innovation: Entrepreneurial Thinking in
            the Workplace</a> (3 credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value=OL235 degree in organizational leadership 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x14086.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
            235 Evaluating Business Opportunities</a> (3 credits)</span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL240" 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11191.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  240 Making Technology Work for your Organization</a>&nbsp; (3
            credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value="OL250"
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11189.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
            250 Business Law</a> (3 credits)</span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value=OL255 degree in organizational leadership 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x14087.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
            255 Applications of Intellectual Property Law </a> (3 credits)</span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value=OL260 degree in organizational leadership 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x14088.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
            260 Transcultural Management </a>(3 credits)</span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value=OL301 degree in organizational leadership 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11198.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  301 Leadership:&nbsp; Individual and Team Processes</a> (3
                  credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value=OL310 degree in organizational leadership 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11197.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  310 Customer Development and Management</a> (3 credits) </span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value=OL350 degree in organizational leadership 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11196.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  350 Quality Systems and Project Management</a> (3 credits)</span></td>
          </tr>
          <tr>
            <td align="right"><input id="OLCourses" type="checkbox" value=OL410 degree in organizational leadership 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11195.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
            410 Change Management Initiating and Copying with Change </a>(3 credits) </span></td>
          </tr>
          <tr>
            <td align="right" valign="top"><input id="OLCourses" type="checkbox" value="OL450" 
      name="OLCourses"></td>
            <td><span class="bodytext"><a href="javascript:;" onClick="MM_openBrWindow('x11194.xml','CPSCourses','toolbar=yes,location=yes,status=yes,menubar=yes,scrollbars=yes,resizable=yes,width=800,height=600')">OL
                  450 Building Successful Organizations through Strategic Decision-Making</a> -
                  Capstone Course (3 credits) </span></td> -->
          </tr>
      </table></td>
    </tr>
    <tr>
      <td align="left" valign="top"><strong>How did you hear about the program? </strong></td>
      <td align="left" valign="top"><input name="hearabout" type="radio" value="E-mail">
      E-mail&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
        <input name="hearabout" type="radio" value="Mailing">
        Mailing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <input name="hearabout" type="radio" value="Education Fair">
        Education Fair&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;
        <input name="hearabout" type="radio" value="Article in Print">
        Article in Print<br>
        <input name="hearabout" type="radio" value="Print Advertisement">
        Print Advertisement&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <input name="hearabout" type="radio" value="Radio Advertisement">
        Radio Advertisement&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <input name="hearabout" type="radio" value="QU Web site">
        QU Web site<br>
        <input name="hearabout" type="radio" value="Word of Mouth">
        Word of Mouth&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <input name="hearabout" type="radio" value="WTNH.com">
        WTNH.com&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <input name="hearabout" type="radio" value="Courant.com/Careerbuilder ">
        Courant.com/Careerbuilder<br>
        <input name="hearabout" type="radio" value="NewHavenRegister.com/CTCentral ">
        Newhavenregister.com/CTCentral<br>        
        
        <input name="hearabout" type="radio" value="Other">
        Other:
        <input name="hearabouttextfield" type="text" id="hearabouttextfield" size="45">
      </td>
    </tr>
    <tr>
      <td align="left"><strong>Have
      you ever attended <st1:place w:st="on"><st1:PlaceName 
w:st="on">Quinnipiac</st1:PlaceName> <st1:PlaceType 
w:st="on">University</st1:PlaceType></st1:place>?&nbsp;</strong> </td>
      <td align="left" valign="top"><input name="attendedQU" type="radio" value="Yes">
        Yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <input name="attendedQU" type="radio" value="No">
        No</td>
    </tr>
    <tr>
      <td width="190" align="left"><img height="15" width="190" src="http://www.quinnipiac.edu/images/stylesheet/spacer.gif" alt="spacer" /></td>
      <td width="100%" align="left" valign="top">&nbsp;</td>
    </tr>
    <tr>
      <td width="190" align="left">&nbsp;</td>
      <td width="100%" align="left" valign="top"><p>Please verify all information
          is correct, then click "<i>Submit Form</i>" below.</p>
        <p>
          <input onClick="MM_validateForm('firstname','','R','lastname','','R','emailaddress','','isEmail','address','','R');return document.MM_returnValue" type="submit" value="Submit Form" name="submit">
          <input type="reset" value="Clear Form" name="submit2">
        </p></td>
    </tr>
    <tr>
      <td valign="top" align="left" colspan=2><hr>
      </td>
    </tr>
  </table>
</form>
</p>
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