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survey.htm
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<!DOCTYPE html>
<html lange = "en">
<head>
<title>Prospective Students</title>
<meta charset = "utf-8" />
<link rel="stylesheet" type="text/css" href="style.css"></link>
</head>
<body>
<div class="header">
<div id="pic">
<a href="http://www.spsu.edu" alt="SPSU Home Page"><img src="img/spsu_logo.jpg" alt="SPSU Logo" /></a>
</div>
<p>
<div id="title">
<h1>
CSE Center for Health Information Technology
</h1>
</div>
<div id="navigation">
<a href="index.htm" alt="Home Page">CSE CHIT</a>
<a href="faculty.htm" alt="Faculty Page">Faculty</a>
<a href="survey.htm" alt="Survey Page">Prospective Students</a>
</div>
</p>
</div>
<div class="content">
<h2 align="center">For more information please fill out the form below and click submit</h2>
<form action="">
<label>First Name:
<input type="text" name="fname" size="30" />
</label>
<br />
<label>Last Name:
<input type="text" name="lname" size="30" />
</label>
<br />
<label>Phone Number:
<input type="text" name="number" size="10" />
</label>
<br />
<label>Email:
<input type="text" name="email" size="75" />
</label>
<br />
<label>Major:
<input type="text" name="major" size="30" />
</label>
<br />
<table>
<tr>
<th colspan = "3">What would you like more information on</th>
</tr>
<tr>
<td>
<label><input type="checkbox" name="info" value="EHR" checked="checked" />EHR</label>
</td>
</tr>
<tr>
<td>
<label><input type="checkbox" name="info" value="HIT" />HIT</label>
</td>
</tr>
<tr>
<td>
<label><input type="checkbox" name="info" value="cert" />Certification</label>
</td>
</tr>
<tr>
<td>
<label><input type="checkbox" name="info" value="testing" />Compliance Testing</label>
</td>
</tr>
</table>
<p>
<input type="submit" value="Submit" />
<input type="reset" value="Clear form" />
</p>
</form>
</div>
<div class="footer">
<p>
For more information on the SPSU School of Computing and Software Engineering please visit <a href="http://cse.spsu.edu" alt="SPSU CSE">SPSU CSE Home page</a>
</p>
</div>
</body>
</html>