trpassessment.com
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18.164.124.37
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URL:
https://trpassessment.com/
Submission: On May 07 via manual from CA — Scanned from CA
Submission: On May 07 via manual from CA — Scanned from CA
Form analysis
1 forms found in the DOM<form id="login_frm">
<div class="login_form">
<input id="cg_fist_name" name="cg_fist_name" class="text caregiver-inputs" type="text" value="" placeholder="Caregiver's First Name" required="">
<input id="cg_last_name" name="cg_last_name" class="text caregiver-inputs" type="text" value="" placeholder="Caregiver's Last Name" required="">
<input id="cg_email" name="cg_email" class="text caregiver-inputs" type="text" value="" placeholder="Caregiver's Email Address" required="">
<input id="cg_num" name="cg_num" class="text caregiver-inputs" type="text" value="" placeholder="Caregiver's Phone Number" required="">
<input id="fist_name" name="fist_name" class="text child-inputs input-hidden" type="text" value="" placeholder="Child's First Name" required="">
<input id="last_name" name="last_name" class="text child-inputs input-hidden" type="text" value="" placeholder="Child's Last Name" required="">
<select id="child_grade" name="child_grade" class="text child-inputs input-hidden" required="">
<option value="" disabled="" selected="">Child's grade</option>
<option value="PK">Pre Kindergarten</option>
<option value="JK">Junior Kindergarten</option>
<option value="SK">Senior Kindergarten</option>
<option value="1">Grade 1</option>
<option value="2">Grade 2</option>
<option value="Other">Other</option>
</select>
<input id="dob" name="dob" class="text child-inputs input-hidden hasDatepicker" type="text" value="" placeholder="Child's Birthday" autocomplete="off" required="">
<select id="partnerName" name="partnerName" class="text child-inputs input-hidden last" required="">
<option value="" disabled="" selected="">Program host</option>
</select>
</div>
<button id="nextButton"> <img src="img\Arrow-next-blue.svg" alt="Next">
</button>
<div class="login_btn input-hidden">
<button id="btn_login" style="display: block;">
<div style="width: 100%;">
<img src="Assets\Elements\arrow_next_purple.svg" alt="login icon">
</div>
</button>
</div>
<button id="backButton" style="display: none;"><img src="img\backButtonBlue.svg" alt="back"></button>
</form>
Text Content
Hi, let's get to know you! Enter your information below: Child's grade Pre Kindergarten Junior Kindergarten Senior Kindergarten Grade 1 Grade 2 Other Program host o e a Congratulations! The butterfly reached the sun! Thank you for completing your assessment! The Reading Partnership hopes to teach you soon! Complete