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Form analysis
1 forms found in the DOM

POST handlepost.php

<form id="form" action="handlepost.php" method="POST">
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  <input type="hidden" name="page" value="full-reg">
  <input type="hidden" id="city" name="city" value="">
  <input type="hidden" id="state" name="state" value="">
  <input type="text" id="emailidaddress" name="emailidaddress" value="" style="display: none;">
  <div class="form form--1" data-step="1">
    <p class="h1 text-center text-blue">
      <strong>What is your housing status?</strong>
    </p>
    <div class="row justify-content-center mb-2">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <label class="radio form-submit btn-homeowner-status" data-check="none" for="homeowner_renting">
            <input type="radio" id="homeowner_renting" name="personal_question_attribute[homeowner_status]" value="rent_home">
            <span class="radio__radio"></span>
            <span class="radio__label">RENTING</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-homeowner-status" data-check="none" for="homeowner_homeowner">
            <input type="radio" id="homeowner_homeowner" name="personal_question_attribute[homeowner_status]" value="own_home">
            <span class="radio__radio"></span>
            <span class="radio__label">HOMEOWNER</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-homeowner-status" data-check="none" for="homeowner_living_with_fam">
            <input type="radio" id="homeowner_living_with_fam" name="personal_question_attribute[homeowner_status]" value="home:living_with_family">
            <span class="radio__radio"></span>
            <span class="radio__label">LIVING WITH FAMILY/FRIEND</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-homeowner-status" data-check="none" for="homeowner_homeless">
            <input type="radio" id="homeowner_homeless" name="personal_question_attribute[homeowner_status]" value="home:homeless">
            <span class="radio__radio"></span>
            <span class="radio__label">HOMELESS/IN A SHELTER</span>
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        </div>
      </div>
    </div>
    <div class="row justify-content-center mb-4">
      <div class="col-12 col-sm-9">
        <div class="form-group">
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        </div>
      </div>
    </div>
  </div>
  <div class="form form--2 d-none" data-step="2">
    <p class="h1 text-center text-blue">
      <strong>What Is Your Employment Status?</strong>
    </p>
    <div class="row justify-content-center mb-2">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <label class="radio btn-employment" for="employment_unable">
            <input type="radio" id="employment_unable" name="personal_question_attribute[employment_status]" value="ssdi_eligibility">
            <span class="radio__radio"></span>
            <span class="radio__label">DISABILITY (SSDI)</span>
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        </div>
        <div class="form-group">
          <label class="radio btn-employment" for="employment_fulltime">
            <input type="radio" id="employment_fulltime" name="personal_question_attribute[employment_status]" value="employed:full_time">
            <span class="radio__radio"></span>
            <span class="radio__label">FULL-TIME</span>
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        </div>
        <div class="form-group">
          <label class="radio btn-employment" for="employment_parttime">
            <input type="radio" id="employment_parttime" name="personal_question_attribute[employment_status]" value="employed:part_time">
            <span class="radio__radio"></span>
            <span class="radio__label">PART-TIME</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio btn-employment" for="employment_unemployed">
            <input type="radio" id="employment_unemployed" name="personal_question_attribute[employment_status]" value="unemployed">
            <span class="radio__radio"></span>
            <span class="radio__label">UNEMPLOYED</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio btn-employment" for="employment_student">
            <input type="radio" id="employment_student" name="personal_question_attribute[employment_status]" value="student">
            <span class="radio__radio"></span>
            <span class="radio__label">STUDENT</span>
          </label>
        </div>
      </div>
    </div>
    <div class="row justify-content-center mb-4">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <button type="button" id="form-employment-submit" class="btn btn-primary w-100 form-submit" data-check="none"> Next <i class="btn-arrow"></i>
          </button>
        </div>
      </div>
    </div>
  </div>
  <div class="form form--3 d-none" data-step="3">
    <p class="h1 text-center text-blue">
      <strong>What is your marital status?</strong>
    </p>
    <div class="row justify-content-center mb-2">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <label class="radio form-submit btn-marital-status" data-check="none" for="marital_single">
            <input type="radio" id="marital_single" name="personal_question_attribute[marital_status]" value="marital_status:single">
            <span class="radio__radio"></span>
            <span class="radio__label">SINGLE - NEVER MARRIED</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-marital-status" data-check="none" for="marital_married">
            <input type="radio" id="marital_married" name="personal_question_attribute[marital_status]" value="marital_status:married">
            <span class="radio__radio"></span>
            <span class="radio__label">MARRIED OR DOMESTIC PARTNERSHIP</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-marital-status" data-check="none" for="marital_widowed">
            <input type="radio" id="marital_widowed" name="personal_question_attribute[marital_status]" value="marital_status:widowed">
            <span class="radio__radio"></span>
            <span class="radio__label">WIDOWED</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-marital-status" data-check="none" for="marital_divorced">
            <input type="radio" id="marital_divorced" name="personal_question_attribute[marital_status]" value="marital_status:divorced">
            <span class="radio__radio"></span>
            <span class="radio__label">DIVORCED</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-marital-status" data-check="none" for="marital_separated">
            <input type="radio" id="marital_separated" name="personal_question_attribute[marital_status]" value="marital_status:separated">
            <span class="radio__radio"></span>
            <span class="radio__label">SEPARATED</span>
          </label>
        </div>
      </div>
    </div>
    <div class="row justify-content-center mb-4">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <button type="button" id="form-marital-submit" class="btn btn-primary w-100 form-submit" data-check="none"> Next <i class="btn-arrow"></i>
          </button>
        </div>
      </div>
    </div>
  </div>
  <div class="form form--4 d-none" data-step="4">
    <p class="h1 text-center text-blue">
      <strong>What is your education level?</strong>
    </p>
    <div class="row justify-content-center mb-2">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <label class="radio form-submit btn-education" data-check="none" for="education_dropout">
            <input type="radio" id="education_dropout" name="personal_question_attribute[education_level]" value="education:did_not_graduate_highschool">
            <span class="radio__radio"></span>
            <span class="radio__label">DID NOT GRADUATE HIGH SCHOOL</span>
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        </div>
        <div class="form-group">
          <label class="radio form-submit btn-education" data-check="none" for="education_hs_graduate">
            <input type="radio" id="education_hs_graduate" name="personal_question_attribute[education_level]" value="education:high_school_diploma_ged">
            <span class="radio__radio"></span>
            <span class="radio__label">HIGH SCHOOL DIPLOMA / GED</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-education" data-check="none" for="education_some_college">
            <input type="radio" id="education_some_college" name="personal_question_attribute[education_level]" value="education:some_college">
            <span class="radio__radio"></span>
            <span class="radio__label">SOME COLLEGE COMPLETED</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-education" data-check="none" for="education_college_graduate">
            <input type="radio" id="education_college_graduate" name="personal_question_attribute[education_level]" value="education:college_graduate">
            <span class="radio__radio"></span>
            <span class="radio__label">GRADUATED COLLEGE</span>
          </label>
        </div>
        <div class="form-group">
          <label class="radio form-submit btn-education" data-check="none" for="education_graduate_degree">
            <input type="radio" id="education_graduate_degree" name="personal_question_attribute[education_level]" value="education:graduate_level_or_above">
            <span class="radio__radio"></span>
            <span class="radio__label">GRADUATE DEGREE OR ABOVE</span>
          </label>
        </div>
      </div>
    </div>
    <div class="row justify-content-center mb-4">
      <div class="col-12 col-sm-9">
        <button type="button" id="form-education-submit" class="btn btn-primary w-100 form-submit" data-check="none"> Next <i class="btn-arrow"></i>
        </button>
      </div>
    </div>
  </div>
  <div class="form form--5 d-none" data-step="5">
    <p class="h1 text-center text-blue mb-0">
      <strong>What is your date of birth?</strong>
    </p>
    <p class="text-small mb-3 text-center">(You Must Be 18 Years Or Older To Receive Benefits)</p>
    <div class="row justify-content-center mb-3">
      <div class="col-12 col-sm-9">
        <div class="form-group position-relative">
          <div class="form-input">
            <input id="dob" class="input form-control text-center" type="tel" name="dob" maxlength="10" minlength="10" placeholder="Date of Birth e.g. 01-01-1950" required="" value="">
          </div>
        </div>
      </div>
    </div>
    <div class="row justify-content-center mb-4">
      <div class="col-12 col-sm-9">
        <button type="button" id="form-dob-button" class="btn btn-primary w-100 form-submit" data-check="date"> Continue <i class="btn-arrow"></i>
        </button>
      </div>
    </div>
  </div>
  <div class="form form--6 d-none" data-step="6">
    <p class="h1 text-center text-blue mb-0">
      <strong>What is your address?</strong>
    </p>
    <p class="text-small mb-3 text-center">(Benefits may vary by location)</p>
    <div class="row justify-content-center mb-0">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <div class="form-input">
            <input id="address" class="input form-control" type="text" name="address" placeholder="Street Address" required="" value="">
          </div>
        </div>
        <div class="form-group">
          <div class="form-input">
            <input id="zip" class="input form-control" type="text" name="zip" maxlength="5" minlength="5" title="" pattern="[0-9]{5}" placeholder="Zip Code" required="" value="">
          </div>
        </div>
      </div>
    </div>
    <div class="row justify-content-center mb-4">
      <div class="col-12 col-sm-9">
        <button type="button" id="form-address-button" class="btn btn-primary w-100 form-submit" data-check="streetzip"> Next <i class="btn-arrow"></i>
        </button>
      </div>
    </div>
  </div>
  <div class="form form--7 d-none" data-step="7">
    <div class="row justify-content-center">
      <div class="col-12 col-sm-9">
        <div class="form-group">
          <div class="form-input">
            <input id="first_name" class="input form-control" type="text" name="first" placeholder="First Name" required="" value="">
          </div>
        </div>
        <div class="form-group">
          <div class="form-input">
            <input id="last_name" class="input form-control" type="text" name="last" placeholder="Last Name" required="" value="">
          </div>
        </div>
        <div class="form-group">
          <div class="form-input">
            <input id="phone_mobile" class="input form-control" type="tel" name="phone_mobile" placeholder="Phone (E.G. 000-000-0000)" required="" value="">
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        </div>
        <div class="form-group">
          <div class="form-input">
            <input id="email" class="input form-control" type="email" name="email" placeholder="Email Address" required="" value="">
          </div>
        </div>
        <div class="form-group">
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            <span class="form-optin__checkbox"></span>
            <span class="form-optin__label">
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        </div>
        <div class="form-group mt-3">
          <p class="text-gray text-terms text-center"> By clicking "Click To See Your Results" I give my electronic signature agreeing to the
            <a href="https://smarterseniorliving.com/terms" target="_blank" class="text-gray hover-gray focus-gray">Terms</a>, including my agreement to
            <a href="https://smarterseniorliving.com/terms/#arbitration" target="_blank" class="text-gray hover-gray focus-gray">Arbitration</a> of any disputes, and the
            <a href="https://smarterseniorliving.com/privacy/" target="_blank" class="text-gray hover-gray focus-gray">Privacy Policy</a>, and I expressly consent to be contacted via telephone using an automated telephone dialing system, pre-recorded
            messages, artificial voice and to receive text messages by Smarter Senior Living (SSL), United Family network, and our
            <a href="https://benefits.smarterseniorliving.com/e/9/6?affid=381&amp;ld=8&amp;mv=e-g-c&amp;ne=1&amp;session_id=278661b6-1b9b-4a19-8cbc-7cfee292a1f0&amp;sid=6a96df2d-ce40-4fd4-bce8-b43176c605be&amp;type=Computer#" target="_blank" class="text-gray hover-gray focus-gray">Marketing Partners</a>
            regarding various offers, on the number I provided. Reply HELP at any time, or STOP to opt-out. Msg &amp; Data rates may apply. Consent is not required to use SSL's service and you can access content <span id="opt-out-anchor"
              class="text-gray hover-gray focus-gray text-decoration-underline">here</span>
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        </div>
      </div>
    </div>
    <div class="row justify-content-center mb-4">
      <div class="col-12 col-sm-9">
        <button type="submit" id="form-submit-button" class="btn btn-primary w-100"> Click To See Your Results <i class="btn-arrow"></i>
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</form>

Text Content

Find Local & National Assistance Benefits Today. Qualify For Free.

Almost Done, Just A Few More Steps

Last Step: Complete Your Profile & See Your Results:



What is your housing status?

RENTING
HOMEOWNER
LIVING WITH FAMILY/FRIEND
HOMELESS/IN A SHELTER
Next

What Is Your Employment Status?

DISABILITY (SSDI)
FULL-TIME
PART-TIME
UNEMPLOYED
STUDENT
Next

What is your marital status?

SINGLE - NEVER MARRIED
MARRIED OR DOMESTIC PARTNERSHIP
WIDOWED
DIVORCED
SEPARATED
Next

What is your education level?

DID NOT GRADUATE HIGH SCHOOL
HIGH SCHOOL DIPLOMA / GED
SOME COLLEGE COMPLETED
GRADUATED COLLEGE
GRADUATE DEGREE OR ABOVE
Next

What is your date of birth?

(You Must Be 18 Years Or Older To Receive Benefits)


Continue

What is your address?

(Benefits may vary by location)


Next
I confirm all my information is accurate and consent to be texted as provided
below.

By clicking "Click To See Your Results" I give my electronic signature agreeing
to the Terms, including my agreement to Arbitration of any disputes, and the
Privacy Policy, and I expressly consent to be contacted via telephone using an
automated telephone dialing system, pre-recorded messages, artificial voice and
to receive text messages by Smarter Senior Living (SSL), United Family network,
and our Marketing Partners regarding various offers, on the number I provided.
Reply HELP at any time, or STOP to opt-out. Msg & Data rates may apply. Consent
is not required to use SSL's service and you can access content here

Click To See Your Results

Medical assistance

Smarter Senior Living can help you discover medical benefits for you and your
family. Whether it is Medicare or aides for your ailments, there are resources
avaialable that you may qualify for.

Financial Resources

Need help with pressing financial matters? Smarter Senior Living has a number of
resources and benefits to help you realign your financial goals.

Home Living

Home is where the heart is and we understand that is why at Smart Senior Living
we have partnered up with a number of home service providers to help you easily
maintain your home.

Family Assurance

Whether your family is growing or you need to simply provide care for the ones
you love Smarter Senior Living has you covered.

Smarter Senior Living (smarterseniorliving.com) is a privately held for profit
entity. smarterseniorliving.com has no affiliation or relationship (financial or
otherwise) with any political party, government agency, or any other outside
group or persons. We pay our operating costs through our advertising revenue.
Furthermore, smarterseniorliving.com is not affiliated with or endorsed by the
U.S. Department of Education. We urge you not to pay any products that you can
get for free elsewhere. This site is directed at, and made available to, persons
in the continental U.S., Alaska and Hawaii only. 8 The Green, Suite #11855,
Dover, DE 19901


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