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Submitted URL: https://my.regentinfo.org/f/r/8ed21931ec754f79c392512f1?ct=YTo2OntzOjY6InNvdXJjZSI7YToyOntpOjA7czo1OiJlbWFpbCI7aToxO2k6MzQ...
Effective URL: https://www.regentinfo.org/apply/?utm_campaign=fast&utm_source=enroll360_apply&utm_medium=email&utm_content=apply&ct=YToxOn...
Submission: On September 19 via manual from US — Scanned from DE
Effective URL: https://www.regentinfo.org/apply/?utm_campaign=fast&utm_source=enroll360_apply&utm_medium=email&utm_content=apply&ct=YToxOn...
Submission: On September 19 via manual from US — Scanned from DE
Form analysis 6 forms found in the DOM
POST
<form aria-live="polite" role="region" action="" autocomplete="off" id="studentdata" class="royall-form studentdata" method="post">
<input type="hidden" name="__page_type" id="__page_type" value="datacollection"><input type="hidden" name="__page_name" id="__page_name" value="step_one"><input type="hidden" name="__page_id" id="__page_id" value="1"><input type="hidden"
name="__showhide" id="__showhide" value=""><input type="hidden" name="__page_action" id="__page_action" value="save">
<div class="rte-s" id="rte-s-1">
<div class="first section">
<h3 class="rte-s-label">Your Personal Information</h3>
<div class="rte-g" id="rte-g-1090389">
<div class=" group">
<div class="rte-text rte-q" id="question-258"><a name="q258"></a>
<div class="question type_text field_fname">
<label for="question-inputtext-258" class="rte-q-label">First Name</label>
<input autocomplete="off" name="fname" id="question-inputtext-258" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-text rte-q" id="question-265"><a name="q265"></a>
<div class="question type_text field_mname">
<label for="question-inputtext-265" class="rte-q-label">Middle Name</label>
<input autocomplete="off" name="mname" id="question-inputtext-265" type="text" class="question-field question-text" maxlength="20">
</div>
</div>
<div class="rte-text rte-q" id="question-259"><a name="q259"></a>
<div class="question type_text field_lname">
<label for="question-inputtext-259" class="rte-q-label">Last Name</label>
<input autocomplete="off" name="lname" id="question-inputtext-259" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-text rte-q" id="question-282"><a name="q282"></a>
<div class="question type_text field_pname">
<label for="question-inputtext-282" class="rte-q-label">Preferred Name</label>
<input autocomplete="off" name="pname" id="question-inputtext-282" type="text" class="question-field question-text" maxlength="20">
</div>
</div>
</div>
</div>
<div class="rte-g" id="rte-g-1090390">
<div class=" group">
<div class="rte-text rte-q" id="question-261"><a name="q261"></a>
<div class="question type_text field_email">
<label for="question-inputtext-261" class="rte-q-label">Email Address</label>
<input autocomplete="off" name="email" id="question-inputtext-261" type="text" class="question-field question-text" maxlength="60">
</div>
</div>
<div class="rte-custom-telephone rte-q" id="question-273"><a name="q273"></a>
<div class="question type_telephone field_phone_no_home_area">
<div class="desc rte-q-label" id="question-273-label">Home Phone Number</div>
<div class="telephone" aria-labelledby="question-273-label" role="group">
<input class="question-field question-text" name="phone_no_home_area" id="question-telephone1-273" type="tel" size="3" maxlength="3" title="Home Phone Number: Area Code">
<input class="question-field question-text" name="phone_no_home_prefix" id="question-telephone2-273" type="tel" size="3" maxlength="3" title="Home Phone Number: Prefix">
<input class="question-field question-text" name="phone_no_home_last4" id="question-telephone3-273" type="tel" size="4" maxlength="4" title="Home Phone Number: Last Four Digits">
</div>
</div>
</div>
<div class="rte-custom-telephone rte-q" id="question-283"><a name="q283"></a>
<div class="question type_telephone field_phone_no_cell_area">
<div class="desc rte-q-label" id="question-283-label">Cell Phone Number</div>
<div class="telephone" aria-labelledby="question-283-label" role="group">
<input class="question-field question-text" name="phone_no_cell_area" id="question-telephone1-283" type="tel" size="3" maxlength="3" title="Cell Phone Number: Area Code">
<input class="question-field question-text" name="phone_no_cell_prefix" id="question-telephone2-283" type="tel" size="3" maxlength="3" title="Cell Phone Number: Prefix">
<input class="question-field question-text" name="phone_no_cell_last4" id="question-telephone3-283" type="tel" size="4" maxlength="4" title="Cell Phone Number: Last Four Digits">
</div>
</div>
</div>
</div>
</div>
<div class="rte-g" id="rte-g-8">
<div class=" group">
<div class="rte-radio rte-q" id="question-263"><a name="q263"></a>
<div class="question type_radio ui-controlgroup field_gender">
<div class="desc rte-q-label ui-controlgroup-label" id="question-263-label">Gender</div>
<div class="choice ui-controlgroup-controls" aria-labelledby="question-263-label" role="radiogroup">
<span id="container-question-263_1">
<input class="question-field" id="question-263_1" name="gender" value="M" type="radio">
<label for="question-263_1">Male</label>
</span>
<span id="container-question-263_2">
<input class="question-field" id="question-263_2" name="gender" value="F" type="radio">
<label for="question-263_2">Female</label>
</span>
</div>
</div>
</div>
<div class="rte-custom-date-ddmmyyyy rte-q" id="question-452"><a name="q452"></a>
<div class="question type_date ui-controlgroup field_birth_month">
<div class="desc rte-q-label ui-controlgroup-label" id="question-452-label">Date of Birth</div>
<div class="ui-controlgroup-controls mmddyyyy" aria-labelledby="question-452-label" role="group">
<span class="month">
<select class="question-field" name="birth_month" id="dateddmmyyyy_452_month" title="Date of Birth: Month">
<optgroup>
<option value="">--</option>
<option value="01">January</option>
<option value="02">February</option>
<option value="03">March</option>
<option value="04">April</option>
<option value="05">May</option>
<option value="06">June</option>
<option value="07">July</option>
<option value="08">August</option>
<option value="09">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</optgroup>
</select>
</span>
<span class="day">
<select class="question-field" name="birth_day" id="dateddmmyyyy_452_day" title="Date of Birth: Day">
<optgroup>
<option value="">--</option>
<option value="01">1</option>
<option value="02">2</option>
<option value="03">3</option>
<option value="04">4</option>
<option value="05">5</option>
<option value="06">6</option>
<option value="07">7</option>
<option value="08">8</option>
<option value="09">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</optgroup>
</select>
</span>
<span class="year">
<select class="question-field" name="birth_year" id="dateddmmyyyy_452_year" title="Date of Birth: Year">
<optgroup>
<option value="">--</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
</optgroup>
</select>
</span>
</div>
</div>
</div>
<div class="rte-radio rte-q" id="question-1020514"><a name="q1020514"></a>
<div class="question type_radio ui-controlgroup field_fin_aid">
<div class="desc rte-q-label ui-controlgroup-label" id="question-1020514-label">Do you plan to apply for financial aid?</div>
<div class="choice ui-controlgroup-controls" aria-labelledby="question-1020514-label" aria-describedby="question-1020514-help" role="radiogroup">
<span id="container-question-1020514_1">
<input class="question-field" id="question-1020514_1" name="fin_aid" value="Y" type="radio">
<label for="question-1020514_1">Yes</label>
</span>
<span id="container-question-1020514_2">
<input class="question-field" id="question-1020514_2" name="fin_aid" value="N" type="radio">
<label for="question-1020514_2">No</label>
</span>
</div>
<div class="help" id="question-1020514-help">If you're applying for financial aid, your Social Security number is required.</div>
</div>
</div>
<div class="rte-custom-socialnumber rte-q" id="question-454"><a name="q454"></a>
<div class="question type_ssn field_ss_no_left">
<div class="desc rte-q-label" id="question-454-label">Social Security Number <span class="tip">(optional)</span></div>
<div>
<div class="ssn" aria-labelledby="question-454-label" role="group">
<span class="ssn_l"><input class="question-field question-text" name="ss_no_left" id="question-socialnumber1-454" maxlength="3" type="text" size="3" style="font-family:password;" title="Social Security Area"></span>
<span class="ssn_m"><input class="question-field question-text" name="ss_no_middle" id="question-socialnumber2-454" maxlength="2" type="text" size="2" style="font-family:password;" title="Social Security Group"></span>
<span class="ssn_r"><input class="question-field question-text" name="ss_no_right" id="question-socialnumber3-454" maxlength="4" type="text" size="4" style="font-family:password;" title="Social Security Serial"></span>
</div>
<div class="rte-checkbox rte-q" id="question-454"><a name="q454"></a>
<input id="question-454-checkbox" type="checkbox" onclick="r.r.callCheckboxOnChange(this);toggleSSNMask_454();" rteonchecked="void(null);" rteonunchecked="void(null);">
<label for="question-454-checkbox" class="rte-q-label">Show Social Security Number</label>
<input id="question-454-checkboxvalue" class="question-field" type="hidden">
</div>
</div>
</div>
<script type="text/javascript">
function toggleSSNMask_454() {
if (document.getElementById("question-454-checkbox").checked) {
document.getElementById("question-socialnumber1-454").setAttribute("style", "font-family:");
document.getElementById("question-socialnumber2-454").setAttribute("style", "font-family:");
document.getElementById("question-socialnumber3-454").setAttribute("style", "font-family:");
} else {
document.getElementById("question-socialnumber1-454").setAttribute("style", "font-family:password");
document.getElementById("question-socialnumber2-454").setAttribute("style", "font-family:password");
document.getElementById("question-socialnumber3-454").setAttribute("style", "font-family:password");
}
}
</script>
</div>
</div>
</div>
</div>
</div>
<div class="rte-s" id="rte-s-18">
<div class=" section">
<h3 class="rte-s-label">Mailing Address</h3>
<div class="rte-g" id="rte-g-9">
<div class=" group">
<div class="rte-text rte-q" id="question-267"><a name="q267"></a>
<div class="question type_text field_addr1">
<label for="question-inputtext-267" class="rte-q-label">Address</label>
<input autocomplete="off" name="addr1" id="question-inputtext-267" type="text" class="question-field question-text" maxlength="45">
</div>
</div>
<div class="rte-text rte-q" id="question-268"><a name="q268"></a>
<div class="question type_text field_addr2">
<label for="question-inputtext-268" class="rte-q-label">Apt. #</label>
<input autocomplete="off" name="addr2" id="question-inputtext-268" type="text" class="question-field question-text" maxlength="45">
</div>
</div>
<div class="rte-text rte-q" id="question-269"><a name="q269"></a>
<div class="question type_text field_city">
<label for="question-inputtext-269" class="rte-q-label">City</label>
<input autocomplete="off" name="city" id="question-inputtext-269" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-select rte-q" id="question-262"><a name="q262"></a>
<div class="question type_select field_state">
<label for="question-select-262" class="rte-q-label">State/Province</label>
<span>
<select id="question-select-262" class="question-field" name="state" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-262-1" value="AL">Alabama</option>
<option id="q-s-o-262-2" value="AK">Alaska</option>
<option id="q-s-o-262-3" value="AB">Alberta</option>
<option id="q-s-o-262-4" value="AS">American Samoa</option>
<option id="q-s-o-262-5" value="AZ">Arizona</option>
<option id="q-s-o-262-6" value="AR">Arkansas</option>
<option id="q-s-o-262-7" value="AA">Armed Forces Americas</option>
<option id="q-s-o-262-8" value="AE">Armed Forces Europe</option>
<option id="q-s-o-262-9" value="AP">Armed Forces Pacific</option>
<option id="q-s-o-262-10" value="BC">British Columbia</option>
<option id="q-s-o-262-11" value="CA">California</option>
<option id="q-s-o-262-12" value="CO">Colorado</option>
<option id="q-s-o-262-13" value="CT">Connecticut</option>
<option id="q-s-o-262-14" value="DE">Delaware</option>
<option id="q-s-o-262-15" value="DC">District of Columbia</option>
<option id="q-s-o-262-16" value="FL">Florida</option>
<option id="q-s-o-262-17" value="GA">Georgia</option>
<option id="q-s-o-262-18" value="GU">Guam</option>
<option id="q-s-o-262-19" value="HI">Hawaii</option>
<option id="q-s-o-262-20" value="ID">Idaho</option>
<option id="q-s-o-262-21" value="IL">Illinois</option>
<option id="q-s-o-262-22" value="IN">Indiana</option>
<option id="q-s-o-262-23" value="IA">Iowa</option>
<option id="q-s-o-262-24" value="KS">Kansas</option>
<option id="q-s-o-262-25" value="KY">Kentucky</option>
<option id="q-s-o-262-26" value="LA">Louisiana</option>
<option id="q-s-o-262-27" value="ME">Maine</option>
<option id="q-s-o-262-28" value="MB">Manitoba</option>
<option id="q-s-o-262-29" value="MH">Marshall Islands</option>
<option id="q-s-o-262-30" value="MD">Maryland</option>
<option id="q-s-o-262-31" value="MA">Massachusetts</option>
<option id="q-s-o-262-32" value="MI">Michigan</option>
<option id="q-s-o-262-33" value="MN">Minnesota</option>
<option id="q-s-o-262-34" value="MS">Mississippi</option>
<option id="q-s-o-262-35" value="MO">Missouri</option>
<option id="q-s-o-262-36" value="MT">Montana</option>
<option id="q-s-o-262-37" value="MP">N. Mariana Islands</option>
<option id="q-s-o-262-38" value="NE">Nebraska</option>
<option id="q-s-o-262-39" value="NV">Nevada</option>
<option id="q-s-o-262-40" value="NB">New Brunswick</option>
<option id="q-s-o-262-41" value="NH">New Hampshire</option>
<option id="q-s-o-262-42" value="NJ">New Jersey</option>
<option id="q-s-o-262-43" value="NM">New Mexico</option>
<option id="q-s-o-262-44" value="NY">New York</option>
<option id="q-s-o-262-45" value="NL">Newfoundland/Labrador</option>
<option id="q-s-o-262-46" value="NC">North Carolina</option>
<option id="q-s-o-262-47" value="ND">North Dakota</option>
<option id="q-s-o-262-48" value="NT">Northwest Territories</option>
<option id="q-s-o-262-49" value="NS">Nova Scotia</option>
<option id="q-s-o-262-50" value="NU">Nunavut</option>
<option id="q-s-o-262-51" value="OH">Ohio</option>
<option id="q-s-o-262-52" value="OK">Oklahoma</option>
<option id="q-s-o-262-53" value="ON">Ontario</option>
<option id="q-s-o-262-54" value="OR">Oregon</option>
<option id="q-s-o-262-55" value="PA">Pennsylvania</option>
<option id="q-s-o-262-56" value="PE">Prince Edward Island</option>
<option id="q-s-o-262-57" value="PR">Puerto Rico</option>
<option id="q-s-o-262-58" value="QC">Quebec</option>
<option id="q-s-o-262-59" value="RI">Rhode Island</option>
<option id="q-s-o-262-60" value="SK">Saskatchewan</option>
<option id="q-s-o-262-61" value="SC">South Carolina</option>
<option id="q-s-o-262-62" value="SD">South Dakota</option>
<option id="q-s-o-262-63" value="TN">Tennessee</option>
<option id="q-s-o-262-64" value="TX">Texas</option>
<option id="q-s-o-262-65" value="UT">Utah</option>
<option id="q-s-o-262-66" value="VT">Vermont</option>
<option id="q-s-o-262-67" value="VI">Virgin Islands</option>
<option id="q-s-o-262-68" value="VA">Virginia</option>
<option id="q-s-o-262-69" value="WA">Washington</option>
<option id="q-s-o-262-70" value="WV">West Virginia</option>
<option id="q-s-o-262-71" value="WI">Wisconsin</option>
<option id="q-s-o-262-72" value="WY">Wyoming</option>
<option id="q-s-o-262-73" value="YT">Yukon</option>
</optgroup>
</select>
</span>
</div>
</div>
<div class="rte-text rte-q" id="question-276"><a name="q276"></a>
<div class="question type_text field_zip5_dash_zip4">
<label for="question-inputtext-276" class="rte-q-label">ZIP/Postal Code</label>
<input autocomplete="off" name="zip5_dash_zip4" id="question-inputtext-276" type="text" class="question-field question-text" maxlength="10">
</div>
</div>
<div class="rte-select rte-q" id="question-281"><a name="q281"></a>
<div class="question type_select field_country_cd">
<label for="question-select-281" class="rte-q-label">Country</label>
<span>
<select id="question-select-281" class="question-field" name="country_cd" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-281-1" value="USA" rteonchange="evt_281_1();">United States</option>
<option id="q-s-o-281-2" value="AFG" rteonchange="evt_281_2();">Afghanistan</option>
<option id="q-s-o-281-3" value="ALB" rteonchange="evt_281_3();">Albania</option>
<option id="q-s-o-281-4" value="ALG" rteonchange="evt_281_4();">Algeria</option>
<option id="q-s-o-281-5" value="AND" rteonchange="evt_281_5();">Andorra</option>
<option id="q-s-o-281-6" value="ANG" rteonchange="evt_281_6();">Angola</option>
<option id="q-s-o-281-7" value="ANU" rteonchange="evt_281_7();">Anguilla</option>
<option id="q-s-o-281-8" value="ANT" rteonchange="evt_281_8();">Antigua and Barbuda</option>
<option id="q-s-o-281-9" value="ARG" rteonchange="evt_281_9();">Argentina</option>
<option id="q-s-o-281-10" value="ARM" rteonchange="evt_281_10();">Armenia</option>
<option id="q-s-o-281-11" value="ARU" rteonchange="evt_281_11();">Aruba</option>
<option id="q-s-o-281-12" value="AUS" rteonchange="evt_281_12();">Australia</option>
<option id="q-s-o-281-13" value="AST" rteonchange="evt_281_13();">Austria</option>
<option id="q-s-o-281-14" value="AZE" rteonchange="evt_281_14();">Azerbaijan</option>
<option id="q-s-o-281-15" value="BAH" rteonchange="evt_281_15();">Bahamas, The</option>
<option id="q-s-o-281-16" value="BHR" rteonchange="evt_281_16();">Bahrain</option>
<option id="q-s-o-281-17" value="BNG" rteonchange="evt_281_17();">Bangladesh</option>
<option id="q-s-o-281-18" value="BAR" rteonchange="evt_281_18();">Barbados</option>
<option id="q-s-o-281-19" value="BEL" rteonchange="evt_281_19();">Belarus</option>
<option id="q-s-o-281-20" value="BLG" rteonchange="evt_281_20();">Belgium</option>
<option id="q-s-o-281-21" value="BZE" rteonchange="evt_281_21();">Belize</option>
<option id="q-s-o-281-22" value="BEN" rteonchange="evt_281_22();">Benin</option>
<option id="q-s-o-281-23" value="BER" rteonchange="evt_281_23();">Bermuda</option>
<option id="q-s-o-281-24" value="BHU" rteonchange="evt_281_24();">Bhutan</option>
<option id="q-s-o-281-25" value="BOL" rteonchange="evt_281_25();">Bolivia</option>
<option id="q-s-o-281-26" value="BOS" rteonchange="evt_281_26();">Bosnia and Herzegovina</option>
<option id="q-s-o-281-27" value="BOT" rteonchange="evt_281_27();">Botswana</option>
<option id="q-s-o-281-28" value="BRA" rteonchange="evt_281_28();">Brazil</option>
<option id="q-s-o-281-29" value="BRU" rteonchange="evt_281_29();">Brunei</option>
<option id="q-s-o-281-30" value="BUL" rteonchange="evt_281_30();">Bulgaria</option>
<option id="q-s-o-281-31" value="BUR" rteonchange="evt_281_31();">Burkina Faso</option>
<option id="q-s-o-281-32" value="BDI" rteonchange="evt_281_32();">Burundi</option>
<option id="q-s-o-281-33" value="CAM" rteonchange="evt_281_33();">Cambodia</option>
<option id="q-s-o-281-34" value="COO" rteonchange="evt_281_34();">Cameroon</option>
<option id="q-s-o-281-35" value="CAN" rteonchange="evt_281_35();">Canada</option>
<option id="q-s-o-281-36" value="CVE" rteonchange="evt_281_36();">Cape Verde</option>
<option id="q-s-o-281-37" value="CAY" rteonchange="evt_281_37();">Cayman Islands</option>
<option id="q-s-o-281-38" value="CAR" rteonchange="evt_281_38();">Central African Republic</option>
<option id="q-s-o-281-39" value="CHA" rteonchange="evt_281_39();">Chad</option>
<option id="q-s-o-281-40" value="CHI" rteonchange="evt_281_40();">Chile</option>
<option id="q-s-o-281-41" value="CHN" rteonchange="evt_281_41();">China</option>
<option id="q-s-o-281-42" value="COL" rteonchange="evt_281_42();">Colombia</option>
<option id="q-s-o-281-43" value="COM" rteonchange="evt_281_43();">Comoros</option>
<option id="q-s-o-281-44" value="CON" rteonchange="evt_281_44();">Congo, Democratic Republic of the</option>
<option id="q-s-o-281-45" value="COG" rteonchange="evt_281_45();">Congo, Republic of the</option>
<option id="q-s-o-281-46" value="CSA" rteonchange="evt_281_46();">Costa Rica</option>
<option id="q-s-o-281-47" value="CTE" rteonchange="evt_281_47();">Cote d'Ivoire</option>
<option id="q-s-o-281-48" value="CRO" rteonchange="evt_281_48();">Croatia</option>
<option id="q-s-o-281-49" value="CUB" rteonchange="evt_281_49();">Cuba</option>
<option id="q-s-o-281-50" value="CUR" rteonchange="evt_281_50();">Curacao</option>
<option id="q-s-o-281-51" value="CYP" rteonchange="evt_281_51();">Cyprus</option>
<option id="q-s-o-281-52" value="CZE" rteonchange="evt_281_52();">Czech Republic</option>
<option id="q-s-o-281-53" value="DEN" rteonchange="evt_281_53();">Denmark</option>
<option id="q-s-o-281-54" value="DJI" rteonchange="evt_281_54();">Djibouti</option>
<option id="q-s-o-281-55" value="DOM" rteonchange="evt_281_55();">Dominica</option>
<option id="q-s-o-281-56" value="DNR" rteonchange="evt_281_56();">Dominican Republic</option>
<option id="q-s-o-281-57" value="ECU" rteonchange="evt_281_57();">Ecuador</option>
<option id="q-s-o-281-58" value="EGY" rteonchange="evt_281_58();">Egypt</option>
<option id="q-s-o-281-59" value="ELD" rteonchange="evt_281_59();">El Salvador</option>
<option id="q-s-o-281-60" value="EQU" rteonchange="evt_281_60();">Equatorial Guinea</option>
<option id="q-s-o-281-61" value="ERI" rteonchange="evt_281_61();">Eritrea</option>
<option id="q-s-o-281-62" value="EST" rteonchange="evt_281_62();">Estonia</option>
<option id="q-s-o-281-63" value="ETH" rteonchange="evt_281_63();">Ethiopia</option>
<option id="q-s-o-281-64" value="FIJ" rteonchange="evt_281_64();">Fiji</option>
<option id="q-s-o-281-65" value="FIN" rteonchange="evt_281_65();">Finland</option>
<option id="q-s-o-281-66" value="FRA" rteonchange="evt_281_66();">France</option>
<option id="q-s-o-281-67" value="FRG" rteonchange="evt_281_67();">French Guiana</option>
<option id="q-s-o-281-68" value="FRP" rteonchange="evt_281_68();">French Polynesia</option>
<option id="q-s-o-281-69" value="GAB" rteonchange="evt_281_69();">Gabon</option>
<option id="q-s-o-281-70" value="BAM" rteonchange="evt_281_70();">Gambia, The</option>
<option id="q-s-o-281-71" value="GEO" rteonchange="evt_281_71();">Georgia</option>
<option id="q-s-o-281-72" value="GER" rteonchange="evt_281_72();">Germany</option>
<option id="q-s-o-281-73" value="GHA" rteonchange="evt_281_73();">Ghana</option>
<option id="q-s-o-281-74" value="GIB" rteonchange="evt_281_74();">Gibraltar</option>
<option id="q-s-o-281-75" value="GRE" rteonchange="evt_281_75();">Greece</option>
<option id="q-s-o-281-76" value="GRL" rteonchange="evt_281_76();">Greenland</option>
<option id="q-s-o-281-77" value="GRD" rteonchange="evt_281_77();">Grenada</option>
<option id="q-s-o-281-78" value="GDL" rteonchange="evt_281_78();">Guadeloupe</option>
<option id="q-s-o-281-79" value="GUA" rteonchange="evt_281_79();">Guatemala</option>
<option id="q-s-o-281-80" value="GUI" rteonchange="evt_281_80();">Guinea</option>
<option id="q-s-o-281-81" value="GUB" rteonchange="evt_281_81();">Guinea-Bissau</option>
<option id="q-s-o-281-82" value="GUY" rteonchange="evt_281_82();">Guyana</option>
<option id="q-s-o-281-83" value="HAI" rteonchange="evt_281_83();">Haiti</option>
<option id="q-s-o-281-84" value="HON" rteonchange="evt_281_84();">Honduras</option>
<option id="q-s-o-281-85" value="HGK" rteonchange="evt_281_85();">Hong Kong</option>
<option id="q-s-o-281-86" value="HUN" rteonchange="evt_281_86();">Hungary</option>
<option id="q-s-o-281-87" value="ICE" rteonchange="evt_281_87();">Iceland</option>
<option id="q-s-o-281-88" value="IND" rteonchange="evt_281_88();">India</option>
<option id="q-s-o-281-89" value="INA" rteonchange="evt_281_89();">Indonesia</option>
<option id="q-s-o-281-90" value="IRA" rteonchange="evt_281_90();">Iran</option>
<option id="q-s-o-281-91" value="IRQ" rteonchange="evt_281_91();">Iraq</option>
<option id="q-s-o-281-92" value="IRL" rteonchange="evt_281_92();">Ireland</option>
<option id="q-s-o-281-93" value="ISR" rteonchange="evt_281_93();">Israel</option>
<option id="q-s-o-281-94" value="ITY" rteonchange="evt_281_94();">Italy</option>
<option id="q-s-o-281-95" value="JAM" rteonchange="evt_281_95();">Jamaica</option>
<option id="q-s-o-281-96" value="JAP" rteonchange="evt_281_96();">Japan</option>
<option id="q-s-o-281-97" value="JOR" rteonchange="evt_281_97();">Jordan</option>
<option id="q-s-o-281-98" value="KAZ" rteonchange="evt_281_98();">Kazakhstan</option>
<option id="q-s-o-281-99" value="KEN" rteonchange="evt_281_99();">Kenya</option>
<option id="q-s-o-281-100" value="KIR" rteonchange="evt_281_100();">Kiribati</option>
<option id="q-s-o-281-101" value="KOR" rteonchange="evt_281_101();">Korea, North</option>
<option id="q-s-o-281-102" value="KRR" rteonchange="evt_281_102();">Korea, South</option>
<option id="q-s-o-281-103" value="KOS" rteonchange="evt_281_103();">Kosovo</option>
<option id="q-s-o-281-104" value="KUW" rteonchange="evt_281_104();">Kuwait</option>
<option id="q-s-o-281-105" value="KYR" rteonchange="evt_281_105();">Kyrgyzstan</option>
<option id="q-s-o-281-106" value="LAO" rteonchange="evt_281_106();">Laos</option>
<option id="q-s-o-281-107" value="LAT" rteonchange="evt_281_107();">Latvia</option>
<option id="q-s-o-281-108" value="LEB" rteonchange="evt_281_108();">Lebanon</option>
<option id="q-s-o-281-109" value="LES" rteonchange="evt_281_109();">Lesotho</option>
<option id="q-s-o-281-110" value="LIB" rteonchange="evt_281_110();">Liberia</option>
<option id="q-s-o-281-111" value="LIY" rteonchange="evt_281_111();">Libya</option>
<option id="q-s-o-281-112" value="LIE" rteonchange="evt_281_112();">Liechtenstein</option>
<option id="q-s-o-281-113" value="LIT" rteonchange="evt_281_113();">Lithuania</option>
<option id="q-s-o-281-114" value="LUX" rteonchange="evt_281_114();">Luxembourg</option>
<option id="q-s-o-281-115" value="MAC" rteonchange="evt_281_115();">Macau</option>
<option id="q-s-o-281-116" value="MAD" rteonchange="evt_281_116();">Macedonia</option>
<option id="q-s-o-281-117" value="MDG" rteonchange="evt_281_117();">Madagascar</option>
<option id="q-s-o-281-118" value="MAL" rteonchange="evt_281_118();">Malawi</option>
<option id="q-s-o-281-119" value="MAY" rteonchange="evt_281_119();">Malaysia</option>
<option id="q-s-o-281-120" value="MLD" rteonchange="evt_281_120();">Maldives</option>
<option id="q-s-o-281-121" value="MLI" rteonchange="evt_281_121();">Mali</option>
<option id="q-s-o-281-122" value="MTA" rteonchange="evt_281_122();">Malta</option>
<option id="q-s-o-281-123" value="MAU" rteonchange="evt_281_123();">Mauritania</option>
<option id="q-s-o-281-124" value="MRI" rteonchange="evt_281_124();">Mauritius</option>
<option id="q-s-o-281-125" value="MEX" rteonchange="evt_281_125();">Mexico</option>
<option id="q-s-o-281-126" value="MIC" rteonchange="evt_281_126();">Micronesia, Federated States of</option>
<option id="q-s-o-281-127" value="MOL" rteonchange="evt_281_127();">Moldova</option>
<option id="q-s-o-281-128" value="MNA" rteonchange="evt_281_128();">Monaco</option>
<option id="q-s-o-281-129" value="MNG" rteonchange="evt_281_129();">Mongolia</option>
<option id="q-s-o-281-130" value="MON" rteonchange="evt_281_130();">Montenegro</option>
<option id="q-s-o-281-131" value="MOR" rteonchange="evt_281_131();">Morocco</option>
<option id="q-s-o-281-132" value="MOZ" rteonchange="evt_281_132();">Mozambique</option>
<option id="q-s-o-281-133" value="MYA" rteonchange="evt_281_133();">Myanmar</option>
<option id="q-s-o-281-134" value="NAM" rteonchange="evt_281_134();">Namibia</option>
<option id="q-s-o-281-135" value="NEP" rteonchange="evt_281_135();">Nepal</option>
<option id="q-s-o-281-136" value="NET" rteonchange="evt_281_136();">Netherlands</option>
<option id="q-s-o-281-137" value="NCL" rteonchange="evt_281_137();">New Caledonia</option>
<option id="q-s-o-281-138" value="NZE" rteonchange="evt_281_138();">New Zealand</option>
<option id="q-s-o-281-139" value="NIC" rteonchange="evt_281_139();">Nicaragua</option>
<option id="q-s-o-281-140" value="NIG" rteonchange="evt_281_140();">Niger</option>
<option id="q-s-o-281-141" value="NGA" rteonchange="evt_281_141();">Nigeria</option>
<option id="q-s-o-281-142" value="NOR" rteonchange="evt_281_142();">Norway</option>
<option id="q-s-o-281-143" value="OMA" rteonchange="evt_281_143();">Oman</option>
<option id="q-s-o-281-144" value="PAK" rteonchange="evt_281_144();">Pakistan</option>
<option id="q-s-o-281-145" value="PAN" rteonchange="evt_281_145();">Panama</option>
<option id="q-s-o-281-146" value="PAP" rteonchange="evt_281_146();">Papua New Guinea</option>
<option id="q-s-o-281-147" value="PAR" rteonchange="evt_281_147();">Paraguay</option>
<option id="q-s-o-281-148" value="PER" rteonchange="evt_281_148();">Peru</option>
<option id="q-s-o-281-149" value="PHI" rteonchange="evt_281_149();">Philippines</option>
<option id="q-s-o-281-150" value="POL" rteonchange="evt_281_150();">Poland</option>
<option id="q-s-o-281-151" value="POR" rteonchange="evt_281_151();">Portugal</option>
<option id="q-s-o-281-152" value="QAT" rteonchange="evt_281_152();">Qatar</option>
<option id="q-s-o-281-153" value="ROM" rteonchange="evt_281_153();">Romania</option>
<option id="q-s-o-281-154" value="RUS" rteonchange="evt_281_154();">Russia</option>
<option id="q-s-o-281-155" value="RWA" rteonchange="evt_281_155();">Rwanda</option>
<option id="q-s-o-281-156" value="SKN" rteonchange="evt_281_156();">Saint Kitts and Nevis</option>
<option id="q-s-o-281-157" value="SLU" rteonchange="evt_281_157();">Saint Lucia</option>
<option id="q-s-o-281-158" value="SVT" rteonchange="evt_281_158();">Saint Vincent and The Grenadines</option>
<option id="q-s-o-281-159" value="SAM" rteonchange="evt_281_159();">Samoa</option>
<option id="q-s-o-281-160" value="SNM" rteonchange="evt_281_160();">San Marino</option>
<option id="q-s-o-281-161" value="STP" rteonchange="evt_281_161();">Sao Tome and Principe</option>
<option id="q-s-o-281-162" value="SAA" rteonchange="evt_281_162();">Saudi Arabia</option>
<option id="q-s-o-281-163" value="SEN" rteonchange="evt_281_163();">Senegal</option>
<option id="q-s-o-281-164" value="SER" rteonchange="evt_281_164();">Serbia</option>
<option id="q-s-o-281-165" value="SIE" rteonchange="evt_281_165();">Sierra Leone</option>
<option id="q-s-o-281-166" value="SNG" rteonchange="evt_281_166();">Singapore</option>
<option id="q-s-o-281-167" value="SIN" rteonchange="evt_281_167();">Sint Maarten</option>
<option id="q-s-o-281-168" value="SLO" rteonchange="evt_281_168();">Slovakia</option>
<option id="q-s-o-281-169" value="SVE" rteonchange="evt_281_169();">Slovenia</option>
<option id="q-s-o-281-170" value="SOL" rteonchange="evt_281_170();">Solomon Islands</option>
<option id="q-s-o-281-171" value="SOM" rteonchange="evt_281_171();">Somalia</option>
<option id="q-s-o-281-172" value="SAF" rteonchange="evt_281_172();">South Africa</option>
<option id="q-s-o-281-173" value="SSD" rteonchange="evt_281_173();">South Sudan</option>
<option id="q-s-o-281-174" value="SPA" rteonchange="evt_281_174();">Spain</option>
<option id="q-s-o-281-175" value="SRI" rteonchange="evt_281_175();">Sri Lanka</option>
<option id="q-s-o-281-176" value="SUD" rteonchange="evt_281_176();">Sudan</option>
<option id="q-s-o-281-177" value="SUR" rteonchange="evt_281_177();">Suriname</option>
<option id="q-s-o-281-178" value="SWA" rteonchange="evt_281_178();">Swaziland</option>
<option id="q-s-o-281-179" value="SWE" rteonchange="evt_281_179();">Sweden</option>
<option id="q-s-o-281-180" value="SWI" rteonchange="evt_281_180();">Switzerland</option>
<option id="q-s-o-281-181" value="SYR" rteonchange="evt_281_181();">Syria</option>
<option id="q-s-o-281-182" value="TAI" rteonchange="evt_281_182();">Taiwan</option>
<option id="q-s-o-281-183" value="TAJ" rteonchange="evt_281_183();">Tajikistan</option>
<option id="q-s-o-281-184" value="TAN" rteonchange="evt_281_184();">Tanzania</option>
<option id="q-s-o-281-185" value="THA" rteonchange="evt_281_185();">Thailand</option>
<option id="q-s-o-281-186" value="TLS" rteonchange="evt_281_186();">Timor-Leste</option>
<option id="q-s-o-281-187" value="TOG" rteonchange="evt_281_187();">Togo</option>
<option id="q-s-o-281-188" value="TON" rteonchange="evt_281_188();">Tonga</option>
<option id="q-s-o-281-189" value="TRI" rteonchange="evt_281_189();">Trinidad and Tobago</option>
<option id="q-s-o-281-190" value="TUN" rteonchange="evt_281_190();">Tunisia</option>
<option id="q-s-o-281-191" value="TUR" rteonchange="evt_281_191();">Turkey</option>
<option id="q-s-o-281-192" value="TKM" rteonchange="evt_281_192();">Turkmenistan</option>
<option id="q-s-o-281-193" value="UGA" rteonchange="evt_281_193();">Uganda</option>
<option id="q-s-o-281-194" value="UKR" rteonchange="evt_281_194();">Ukraine</option>
<option id="q-s-o-281-195" value="UAE" rteonchange="evt_281_195();">United Arab Emirates</option>
<option id="q-s-o-281-196" value="UK" rteonchange="evt_281_196();">United Kingdom</option>
<option id="q-s-o-281-197" value="URU" rteonchange="evt_281_197();">Uruguay</option>
<option id="q-s-o-281-198" value="UZB" rteonchange="evt_281_198();">Uzbekistan</option>
<option id="q-s-o-281-199" value="VAN" rteonchange="evt_281_199();">Vanuatu</option>
<option id="q-s-o-281-200" value="VEN" rteonchange="evt_281_200();">Venezuela</option>
<option id="q-s-o-281-201" value="VIE" rteonchange="evt_281_201();">Vietnam</option>
<option id="q-s-o-281-202" value="VAI" rteonchange="evt_281_202();">Virgin Islands, British</option>
<option id="q-s-o-281-203" value="WSA" rteonchange="evt_281_203();">Western Sahara</option>
<option id="q-s-o-281-204" value="YEM" rteonchange="evt_281_204();">Yemen</option>
<option id="q-s-o-281-205" value="ZAM" rteonchange="evt_281_205();">Zambia</option>
<option id="q-s-o-281-206" value="ZIM" rteonchange="evt_281_206();">Zimbabwe</option>
</optgroup>
</select>
</span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="rte-s" id="rte-s-20">
<div class=" section">
<h3 class="rte-s-label">Citizenship</h3>
<div class="rte-g" id="rte-g-34">
<div class=" group">
<div class="rte-radio rte-q" id="question-433"><a name="q433"></a>
<div class="citizen question type_radio ui-controlgroup field_citizen_type">
<div class="choice ui-controlgroup-controls" role="radiogroup">
<span id="container-question-433_1">
<input class="question-field" id="question-433_1" name="citizen_type" value="1" type="radio">
<label for="question-433_1">U.S. Citizen</label>
</span>
<span id="container-question-433_2">
<input class="question-field" id="question-433_2" name="citizen_type" value="2" type="radio">
<label for="question-433_2">Permanent Resident</label>
</span>
<span id="container-question-433_3">
<input class="question-field" id="question-433_3" name="citizen_type" value="3" type="radio">
<label for="question-433_3">Not a U.S. Citizen or Permanent Resident</label>
</span>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="rte-s" id="rte-s-21">
<div class=" section">
<h3 class="rte-s-label">Religious Information</h3>
<div class="rte-g" id="rte-g-35">
<div class=" group">
<div class="rte-select rte-q" id="question-441"><a name="q441"></a>
<div class="question type_select field_religious_pref">
<label for="question-select-441" class="rte-q-label">Religious Preference or Affiliation</label>
<span>
<select id="question-select-441" class="question-field" name="religious_pref" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-441-1" value="1">African Methodist Episcopal</option>
<option id="q-s-o-441-2" value="2">African Methodist Episcopal Zion</option>
<option id="q-s-o-441-3" value="3">Agnostic</option>
<option id="q-s-o-441-4" value="4">Anglican</option>
<option id="q-s-o-441-5" value="5">Apostolic Faith</option>
<option id="q-s-o-441-6" value="6">Assemblies of God</option>
<option id="q-s-o-441-7" value="7">Atheist</option>
<option id="q-s-o-441-8" value="8">Baha'i</option>
<option id="q-s-o-441-9" value="9">Baptist</option>
<option id="q-s-o-441-10" value="10">Brethren</option>
<option id="q-s-o-441-11" value="11">Buddhist</option>
<option id="q-s-o-441-12" value="12">Christian</option>
<option id="q-s-o-441-13" value="13">Christian and Missionary Alliance</option>
<option id="q-s-o-441-14" value="14">Christian Church/Disciples of Christ</option>
<option id="q-s-o-441-15" value="15">Christian Methodist Episcopal</option>
<option id="q-s-o-441-16" value="16">Christian Reformed Church</option>
<option id="q-s-o-441-17" value="17">Christian Scientist</option>
<option id="q-s-o-441-18" value="18">Church of Christ</option>
<option id="q-s-o-441-19" value="19">Church of God in Christ</option>
<option id="q-s-o-441-20" value="20">Church of the Nazarene</option>
<option id="q-s-o-441-21" value="21">Churches of God</option>
<option id="q-s-o-441-22" value="22">Churches of God (Anderson)</option>
<option id="q-s-o-441-23" value="23">Ecumenical</option>
<option id="q-s-o-441-24" value="24">Episcopal Church</option>
<option id="q-s-o-441-25" value="25">Greek Orthodox</option>
<option id="q-s-o-441-26" value="26">Hindu</option>
<option id="q-s-o-441-27" value="27">Holiness</option>
<option id="q-s-o-441-28" value="28">Islam</option>
<option id="q-s-o-441-29" value="29">Jehovah's Witness</option>
<option id="q-s-o-441-30" value="30">Judaism</option>
<option id="q-s-o-441-31" value="31">Latter-Day Saints/Mormon</option>
<option id="q-s-o-441-32" value="32">Lutheran</option>
<option id="q-s-o-441-33" value="33">Mennonite</option>
<option id="q-s-o-441-34" value="34">Mennonite Brethren</option>
<option id="q-s-o-441-35" value="35">Methodist</option>
<option id="q-s-o-441-36" value="36">Metropolitan Community Church</option>
<option id="q-s-o-441-37" value="37">Moravian</option>
<option id="q-s-o-441-38" value="38">Nondenominational</option>
<option id="q-s-o-441-39" value="39">None, No Preference</option>
<option id="q-s-o-441-40" value="40">Orthodox Christian</option>
<option id="q-s-o-441-41" value="41">Other</option>
<option id="q-s-o-441-42" value="42">Pentecostal</option>
<option id="q-s-o-441-43" value="43">Presbyterian</option>
<option id="q-s-o-441-44" value="44">Protestant</option>
<option id="q-s-o-441-45" value="45">Quaker (Society of Friends)</option>
<option id="q-s-o-441-46" value="46">Reformed</option>
<option id="q-s-o-441-47" value="47">Roman Catholic</option>
<option id="q-s-o-441-48" value="48">Russian Orthodox</option>
<option id="q-s-o-441-49" value="49">Salvation Army</option>
<option id="q-s-o-441-50" value="50">Seventh-Day Adventist</option>
<option id="q-s-o-441-51" value="51">Unitarian Universalist</option>
<option id="q-s-o-441-52" value="52">United Church of Christ</option>
<option id="q-s-o-441-53" value="53">Wesleyan</option>
</optgroup>
</select>
</span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="rte-s" id="rte-s-32">
<div class="parent-guardian section">
<h3 class="rte-s-label">Parent/Guardian Information</h3>
<div class="rte-g" id="rte-g-69">
<div class=" group">
<h4 class="title rte-g-label">First Parent/Guardian</h4>
<div class="rte-text rte-q" id="question-297"><a name="q297"></a>
<div class="question type_text field_parent_fname_1">
<label for="question-inputtext-297" class="rte-q-label">First Name</label>
<input autocomplete="off" name="parent_fname_1" id="question-inputtext-297" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-text rte-q" id="question-301"><a name="q301"></a>
<div class="question type_text field_parent_lname_1">
<label for="question-inputtext-301" class="rte-q-label">Last Name</label>
<input autocomplete="off" name="parent_lname_1" id="question-inputtext-301" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-custom-telephone rte-q" id="question-1317007"><a name="q1317007"></a>
<div class="question type_telephone field_phone_no_area_parent_1">
<div class="desc rte-q-label" id="question-1317007-label">Phone Number</div>
<div class="telephone" aria-labelledby="question-1317007-label" role="group">
<input class="question-field question-text" name="phone_no_area_parent_1" id="question-telephone1-1317007" type="tel" size="3" maxlength="3" title="Phone Number: Area Code">
<input class="question-field question-text" name="phone_no_prefix_parent_1" id="question-telephone2-1317007" type="tel" size="3" maxlength="3" title="Phone Number: Prefix">
<input class="question-field question-text" name="phone_no_last4_parent_1" id="question-telephone3-1317007" type="tel" size="4" maxlength="4" title="Phone Number: Last Four Digits">
</div>
</div>
</div>
<div class="rte-text rte-q" id="question-577"><a name="q577"></a>
<div class="question type_text field_parent_email">
<label for="question-inputtext-577" class="rte-q-label">Email Address</label>
<input autocomplete="off" name="parent_email" id="question-inputtext-577" type="text" class="question-field question-text" maxlength="60">
</div>
</div>
<div class="rte-select rte-q" id="question-444"><a name="q444"></a>
<div class="question type_select field_parent_relationship_1">
<label for="question-select-444" class="rte-q-label">Relationship</label>
<span>
<select id="question-select-444" class="question-field" name="parent_relationship_1" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-444-1" value="M">Mother</option>
<option id="q-s-o-444-2" value="F">Father</option>
<option id="q-s-o-444-3" value="SM">Stepmother</option>
<option id="q-s-o-444-4" value="SF">Stepfather</option>
<option id="q-s-o-444-5" value="GP">Grandparent</option>
<option id="q-s-o-444-6" value="G">Guardian</option>
<option id="q-s-o-444-7" value="O">Other</option>
</optgroup>
</select>
</span>
</div>
</div>
<div class="rte-radio rte-q" id="question-324"><a name="q324"></a>
<div class="question type_radio ui-controlgroup field_address_to_parent_1">
<div class="desc rte-q-label ui-controlgroup-label" id="question-324-label">Is this parent's/guardian's mailing address the same as yours?</div>
<div class="choice ui-controlgroup-controls" aria-labelledby="question-324-label" role="radiogroup">
<span id="container-question-324_1">
<input class="question-field" id="question-324_1" name="address_to_parent_1" value="Y" type="radio" onclick="evt_324_1();">
<label for="question-324_1">Yes</label>
</span>
<span id="container-question-324_2">
<input class="question-field" id="question-324_2" name="address_to_parent_1" value="N" type="radio" onclick="evt_324_2();">
<label for="question-324_2">No</label>
</span>
</div>
</div>
</div>
</div>
</div>
<div class="rte-g" id="rte-g-70" style="display:none;" aria-hidden="true">
<div class="follow-up close-gap group">
<div class="rte-text rte-q" id="question-311"><a name="q311"></a>
<div class="question type_text field_parent_addr1_1">
<label for="question-inputtext-311" class="rte-q-label">Address</label>
<input autocomplete="off" name="parent_addr1_1" id="question-inputtext-311" type="text" class="question-field question-text" maxlength="45">
</div>
</div>
<div class="rte-text rte-q" id="question-308"><a name="q308"></a>
<div class="question type_text field_parent_addr2_1">
<label for="question-inputtext-308" class="rte-q-label">Apt. #</label>
<input autocomplete="off" name="parent_addr2_1" id="question-inputtext-308" type="text" class="question-field question-text" maxlength="45">
</div>
</div>
<div class="rte-text rte-q" id="question-315"><a name="q315"></a>
<div class="question type_text field_parent_city_1">
<label for="question-inputtext-315" class="rte-q-label">City</label>
<input autocomplete="off" name="parent_city_1" id="question-inputtext-315" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-select rte-q" id="question-321"><a name="q321"></a>
<div class="question type_select field_parent_state_1">
<label for="question-select-321" class="rte-q-label">State/Province</label>
<span>
<select id="question-select-321" class="question-field" name="parent_state_1" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-321-1" value="AL">Alabama</option>
<option id="q-s-o-321-2" value="AK">Alaska</option>
<option id="q-s-o-321-3" value="AB">Alberta</option>
<option id="q-s-o-321-4" value="AS">American Samoa</option>
<option id="q-s-o-321-5" value="AZ">Arizona</option>
<option id="q-s-o-321-6" value="AR">Arkansas</option>
<option id="q-s-o-321-7" value="AA">Armed Forces Americas</option>
<option id="q-s-o-321-8" value="AE">Armed Forces Europe</option>
<option id="q-s-o-321-9" value="AP">Armed Forces Pacific</option>
<option id="q-s-o-321-10" value="BC">British Columbia</option>
<option id="q-s-o-321-11" value="CA">California</option>
<option id="q-s-o-321-12" value="CO">Colorado</option>
<option id="q-s-o-321-13" value="CT">Connecticut</option>
<option id="q-s-o-321-14" value="DE">Delaware</option>
<option id="q-s-o-321-15" value="DC">District of Columbia</option>
<option id="q-s-o-321-16" value="FL">Florida</option>
<option id="q-s-o-321-17" value="GA">Georgia</option>
<option id="q-s-o-321-18" value="GU">Guam</option>
<option id="q-s-o-321-19" value="HI">Hawaii</option>
<option id="q-s-o-321-20" value="ID">Idaho</option>
<option id="q-s-o-321-21" value="IL">Illinois</option>
<option id="q-s-o-321-22" value="IN">Indiana</option>
<option id="q-s-o-321-23" value="IA">Iowa</option>
<option id="q-s-o-321-24" value="KS">Kansas</option>
<option id="q-s-o-321-25" value="KY">Kentucky</option>
<option id="q-s-o-321-26" value="LA">Louisiana</option>
<option id="q-s-o-321-27" value="ME">Maine</option>
<option id="q-s-o-321-28" value="MB">Manitoba</option>
<option id="q-s-o-321-29" value="MH">Marshall Islands</option>
<option id="q-s-o-321-30" value="MD">Maryland</option>
<option id="q-s-o-321-31" value="MA">Massachusetts</option>
<option id="q-s-o-321-32" value="MI">Michigan</option>
<option id="q-s-o-321-33" value="MN">Minnesota</option>
<option id="q-s-o-321-34" value="MS">Mississippi</option>
<option id="q-s-o-321-35" value="MO">Missouri</option>
<option id="q-s-o-321-36" value="MT">Montana</option>
<option id="q-s-o-321-37" value="MP">N. Mariana Islands</option>
<option id="q-s-o-321-38" value="NE">Nebraska</option>
<option id="q-s-o-321-39" value="NV">Nevada</option>
<option id="q-s-o-321-40" value="NB">New Brunswick</option>
<option id="q-s-o-321-41" value="NH">New Hampshire</option>
<option id="q-s-o-321-42" value="NJ">New Jersey</option>
<option id="q-s-o-321-43" value="NM">New Mexico</option>
<option id="q-s-o-321-44" value="NY">New York</option>
<option id="q-s-o-321-45" value="NL">Newfoundland/Labrador</option>
<option id="q-s-o-321-46" value="NC">North Carolina</option>
<option id="q-s-o-321-47" value="ND">North Dakota</option>
<option id="q-s-o-321-48" value="NT">Northwest Territories</option>
<option id="q-s-o-321-49" value="NS">Nova Scotia</option>
<option id="q-s-o-321-50" value="NU">Nunavut</option>
<option id="q-s-o-321-51" value="OH">Ohio</option>
<option id="q-s-o-321-52" value="OK">Oklahoma</option>
<option id="q-s-o-321-53" value="ON">Ontario</option>
<option id="q-s-o-321-54" value="OR">Oregon</option>
<option id="q-s-o-321-55" value="PA">Pennsylvania</option>
<option id="q-s-o-321-56" value="PE">Prince Edward Island</option>
<option id="q-s-o-321-57" value="PR">Puerto Rico</option>
<option id="q-s-o-321-58" value="QC">Quebec</option>
<option id="q-s-o-321-59" value="RI">Rhode Island</option>
<option id="q-s-o-321-60" value="SK">Saskatchewan</option>
<option id="q-s-o-321-61" value="SC">South Carolina</option>
<option id="q-s-o-321-62" value="SD">South Dakota</option>
<option id="q-s-o-321-63" value="TN">Tennessee</option>
<option id="q-s-o-321-64" value="TX">Texas</option>
<option id="q-s-o-321-65" value="UT">Utah</option>
<option id="q-s-o-321-66" value="VT">Vermont</option>
<option id="q-s-o-321-67" value="VI">Virgin Islands</option>
<option id="q-s-o-321-68" value="VA">Virginia</option>
<option id="q-s-o-321-69" value="WA">Washington</option>
<option id="q-s-o-321-70" value="WV">West Virginia</option>
<option id="q-s-o-321-71" value="WI">Wisconsin</option>
<option id="q-s-o-321-72" value="WY">Wyoming</option>
<option id="q-s-o-321-73" value="YT">Yukon</option>
</optgroup>
</select>
</span>
</div>
</div>
<div class="rte-text rte-q" id="question-312"><a name="q312"></a>
<div class="question type_text field_parent_zip5_dash_zip4_1">
<label for="question-inputtext-312" class="rte-q-label">ZIP/Postal Code</label>
<input autocomplete="off" name="parent_zip5_dash_zip4_1" id="question-inputtext-312" type="text" class="question-field question-text" maxlength="10">
</div>
</div>
<div class="rte-select rte-q" id="question-318"><a name="q318"></a>
<div class="question type_select field_parent_country_cd_1">
<label for="question-select-318" class="rte-q-label">Country</label>
<span>
<select id="question-select-318" class="question-field" name="parent_country_cd_1" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-318-1" value="USA" rteonchange="evt_318_1();">United States</option>
<option id="q-s-o-318-2" value="AFG" rteonchange="evt_318_2();">Afghanistan</option>
<option id="q-s-o-318-3" value="ALB" rteonchange="evt_318_3();">Albania</option>
<option id="q-s-o-318-4" value="ALG" rteonchange="evt_318_4();">Algeria</option>
<option id="q-s-o-318-5" value="AND" rteonchange="evt_318_5();">Andorra</option>
<option id="q-s-o-318-6" value="ANG" rteonchange="evt_318_6();">Angola</option>
<option id="q-s-o-318-7" value="ANU" rteonchange="evt_318_7();">Anguilla</option>
<option id="q-s-o-318-8" value="ANT" rteonchange="evt_318_8();">Antigua and Barbuda</option>
<option id="q-s-o-318-9" value="ARG" rteonchange="evt_318_9();">Argentina</option>
<option id="q-s-o-318-10" value="ARM" rteonchange="evt_318_10();">Armenia</option>
<option id="q-s-o-318-11" value="ARU" rteonchange="evt_318_11();">Aruba</option>
<option id="q-s-o-318-12" value="AUS" rteonchange="evt_318_12();">Australia</option>
<option id="q-s-o-318-13" value="AST" rteonchange="evt_318_13();">Austria</option>
<option id="q-s-o-318-14" value="AZE" rteonchange="evt_318_14();">Azerbaijan</option>
<option id="q-s-o-318-15" value="BAH" rteonchange="evt_318_15();">Bahamas, The</option>
<option id="q-s-o-318-16" value="BHR" rteonchange="evt_318_16();">Bahrain</option>
<option id="q-s-o-318-17" value="BNG" rteonchange="evt_318_17();">Bangladesh</option>
<option id="q-s-o-318-18" value="BAR" rteonchange="evt_318_18();">Barbados</option>
<option id="q-s-o-318-19" value="BEL" rteonchange="evt_318_19();">Belarus</option>
<option id="q-s-o-318-20" value="BLG" rteonchange="evt_318_20();">Belgium</option>
<option id="q-s-o-318-21" value="BZE" rteonchange="evt_318_21();">Belize</option>
<option id="q-s-o-318-22" value="BEN" rteonchange="evt_318_22();">Benin</option>
<option id="q-s-o-318-23" value="BER" rteonchange="evt_318_23();">Bermuda</option>
<option id="q-s-o-318-24" value="BHU" rteonchange="evt_318_24();">Bhutan</option>
<option id="q-s-o-318-25" value="BOL" rteonchange="evt_318_25();">Bolivia</option>
<option id="q-s-o-318-26" value="BOS" rteonchange="evt_318_26();">Bosnia and Herzegovina</option>
<option id="q-s-o-318-27" value="BOT" rteonchange="evt_318_27();">Botswana</option>
<option id="q-s-o-318-28" value="BRA" rteonchange="evt_318_28();">Brazil</option>
<option id="q-s-o-318-29" value="BRU" rteonchange="evt_318_29();">Brunei</option>
<option id="q-s-o-318-30" value="BUL" rteonchange="evt_318_30();">Bulgaria</option>
<option id="q-s-o-318-31" value="BUR" rteonchange="evt_318_31();">Burkina Faso</option>
<option id="q-s-o-318-32" value="BDI" rteonchange="evt_318_32();">Burundi</option>
<option id="q-s-o-318-33" value="CAM" rteonchange="evt_318_33();">Cambodia</option>
<option id="q-s-o-318-34" value="COO" rteonchange="evt_318_34();">Cameroon</option>
<option id="q-s-o-318-35" value="CAN" rteonchange="evt_318_35();">Canada</option>
<option id="q-s-o-318-36" value="CVE" rteonchange="evt_318_36();">Cape Verde</option>
<option id="q-s-o-318-37" value="CAY" rteonchange="evt_318_37();">Cayman Islands</option>
<option id="q-s-o-318-38" value="CAR" rteonchange="evt_318_38();">Central African Republic</option>
<option id="q-s-o-318-39" value="CHA" rteonchange="evt_318_39();">Chad</option>
<option id="q-s-o-318-40" value="CHI" rteonchange="evt_318_40();">Chile</option>
<option id="q-s-o-318-41" value="CHN" rteonchange="evt_318_41();">China</option>
<option id="q-s-o-318-42" value="COL" rteonchange="evt_318_42();">Colombia</option>
<option id="q-s-o-318-43" value="COM" rteonchange="evt_318_43();">Comoros</option>
<option id="q-s-o-318-44" value="CON" rteonchange="evt_318_44();">Congo, Democratic Republic of the</option>
<option id="q-s-o-318-45" value="COG" rteonchange="evt_318_45();">Congo, Republic of the</option>
<option id="q-s-o-318-46" value="CSA" rteonchange="evt_318_46();">Costa Rica</option>
<option id="q-s-o-318-47" value="CTE" rteonchange="evt_318_47();">Cote d'Ivoire</option>
<option id="q-s-o-318-48" value="CRO" rteonchange="evt_318_48();">Croatia</option>
<option id="q-s-o-318-49" value="CUB" rteonchange="evt_318_49();">Cuba</option>
<option id="q-s-o-318-50" value="CUR" rteonchange="evt_318_50();">Curacao</option>
<option id="q-s-o-318-51" value="CYP" rteonchange="evt_318_51();">Cyprus</option>
<option id="q-s-o-318-52" value="CZE" rteonchange="evt_318_52();">Czech Republic</option>
<option id="q-s-o-318-53" value="DEN" rteonchange="evt_318_53();">Denmark</option>
<option id="q-s-o-318-54" value="DJI" rteonchange="evt_318_54();">Djibouti</option>
<option id="q-s-o-318-55" value="DOM" rteonchange="evt_318_55();">Dominica</option>
<option id="q-s-o-318-56" value="DNR" rteonchange="evt_318_56();">Dominican Republic</option>
<option id="q-s-o-318-57" value="ECU" rteonchange="evt_318_57();">Ecuador</option>
<option id="q-s-o-318-58" value="EGY" rteonchange="evt_318_58();">Egypt</option>
<option id="q-s-o-318-59" value="ELD" rteonchange="evt_318_59();">El Salvador</option>
<option id="q-s-o-318-60" value="EQU" rteonchange="evt_318_60();">Equatorial Guinea</option>
<option id="q-s-o-318-61" value="ERI" rteonchange="evt_318_61();">Eritrea</option>
<option id="q-s-o-318-62" value="EST" rteonchange="evt_318_62();">Estonia</option>
<option id="q-s-o-318-63" value="ETH" rteonchange="evt_318_63();">Ethiopia</option>
<option id="q-s-o-318-64" value="FIJ" rteonchange="evt_318_64();">Fiji</option>
<option id="q-s-o-318-65" value="FIN" rteonchange="evt_318_65();">Finland</option>
<option id="q-s-o-318-66" value="FRA" rteonchange="evt_318_66();">France</option>
<option id="q-s-o-318-67" value="FRG" rteonchange="evt_318_67();">French Guiana</option>
<option id="q-s-o-318-68" value="FRP" rteonchange="evt_318_68();">French Polynesia</option>
<option id="q-s-o-318-69" value="GAB" rteonchange="evt_318_69();">Gabon</option>
<option id="q-s-o-318-70" value="BAM" rteonchange="evt_318_70();">Gambia, The</option>
<option id="q-s-o-318-71" value="GEO" rteonchange="evt_318_71();">Georgia</option>
<option id="q-s-o-318-72" value="GER" rteonchange="evt_318_72();">Germany</option>
<option id="q-s-o-318-73" value="GHA" rteonchange="evt_318_73();">Ghana</option>
<option id="q-s-o-318-74" value="GIB" rteonchange="evt_318_74();">Gibraltar</option>
<option id="q-s-o-318-75" value="GRE" rteonchange="evt_318_75();">Greece</option>
<option id="q-s-o-318-76" value="GRL" rteonchange="evt_318_76();">Greenland</option>
<option id="q-s-o-318-77" value="GRD" rteonchange="evt_318_77();">Grenada</option>
<option id="q-s-o-318-78" value="GDL" rteonchange="evt_318_78();">Guadeloupe</option>
<option id="q-s-o-318-79" value="GUA" rteonchange="evt_318_79();">Guatemala</option>
<option id="q-s-o-318-80" value="GUI" rteonchange="evt_318_80();">Guinea</option>
<option id="q-s-o-318-81" value="GUB" rteonchange="evt_318_81();">Guinea-Bissau</option>
<option id="q-s-o-318-82" value="GUY" rteonchange="evt_318_82();">Guyana</option>
<option id="q-s-o-318-83" value="HAI" rteonchange="evt_318_83();">Haiti</option>
<option id="q-s-o-318-84" value="HON" rteonchange="evt_318_84();">Honduras</option>
<option id="q-s-o-318-85" value="HGK" rteonchange="evt_318_85();">Hong Kong</option>
<option id="q-s-o-318-86" value="HUN" rteonchange="evt_318_86();">Hungary</option>
<option id="q-s-o-318-87" value="ICE" rteonchange="evt_318_87();">Iceland</option>
<option id="q-s-o-318-88" value="IND" rteonchange="evt_318_88();">India</option>
<option id="q-s-o-318-89" value="INA" rteonchange="evt_318_89();">Indonesia</option>
<option id="q-s-o-318-90" value="IRA" rteonchange="evt_318_90();">Iran</option>
<option id="q-s-o-318-91" value="IRQ" rteonchange="evt_318_91();">Iraq</option>
<option id="q-s-o-318-92" value="IRL" rteonchange="evt_318_92();">Ireland</option>
<option id="q-s-o-318-93" value="ISR" rteonchange="evt_318_93();">Israel</option>
<option id="q-s-o-318-94" value="ITY" rteonchange="evt_318_94();">Italy</option>
<option id="q-s-o-318-95" value="JAM" rteonchange="evt_318_95();">Jamaica</option>
<option id="q-s-o-318-96" value="JAP" rteonchange="evt_318_96();">Japan</option>
<option id="q-s-o-318-97" value="JOR" rteonchange="evt_318_97();">Jordan</option>
<option id="q-s-o-318-98" value="KAZ" rteonchange="evt_318_98();">Kazakhstan</option>
<option id="q-s-o-318-99" value="KEN" rteonchange="evt_318_99();">Kenya</option>
<option id="q-s-o-318-100" value="KIR" rteonchange="evt_318_100();">Kiribati</option>
<option id="q-s-o-318-101" value="KOR" rteonchange="evt_318_101();">Korea, North</option>
<option id="q-s-o-318-102" value="KRR" rteonchange="evt_318_102();">Korea, South</option>
<option id="q-s-o-318-103" value="KOS" rteonchange="evt_318_103();">Kosovo</option>
<option id="q-s-o-318-104" value="KUW" rteonchange="evt_318_104();">Kuwait</option>
<option id="q-s-o-318-105" value="KYR" rteonchange="evt_318_105();">Kyrgyzstan</option>
<option id="q-s-o-318-106" value="LAO" rteonchange="evt_318_106();">Laos</option>
<option id="q-s-o-318-107" value="LAT" rteonchange="evt_318_107();">Latvia</option>
<option id="q-s-o-318-108" value="LEB" rteonchange="evt_318_108();">Lebanon</option>
<option id="q-s-o-318-109" value="LES" rteonchange="evt_318_109();">Lesotho</option>
<option id="q-s-o-318-110" value="LIB" rteonchange="evt_318_110();">Liberia</option>
<option id="q-s-o-318-111" value="LIY" rteonchange="evt_318_111();">Libya</option>
<option id="q-s-o-318-112" value="LIE" rteonchange="evt_318_112();">Liechtenstein</option>
<option id="q-s-o-318-113" value="LIT" rteonchange="evt_318_113();">Lithuania</option>
<option id="q-s-o-318-114" value="LUX" rteonchange="evt_318_114();">Luxembourg</option>
<option id="q-s-o-318-115" value="MAC" rteonchange="evt_318_115();">Macau</option>
<option id="q-s-o-318-116" value="MAD" rteonchange="evt_318_116();">Macedonia</option>
<option id="q-s-o-318-117" value="MDG" rteonchange="evt_318_117();">Madagascar</option>
<option id="q-s-o-318-118" value="MAL" rteonchange="evt_318_118();">Malawi</option>
<option id="q-s-o-318-119" value="MAY" rteonchange="evt_318_119();">Malaysia</option>
<option id="q-s-o-318-120" value="MLD" rteonchange="evt_318_120();">Maldives</option>
<option id="q-s-o-318-121" value="MLI" rteonchange="evt_318_121();">Mali</option>
<option id="q-s-o-318-122" value="MTA" rteonchange="evt_318_122();">Malta</option>
<option id="q-s-o-318-123" value="MAU" rteonchange="evt_318_123();">Mauritania</option>
<option id="q-s-o-318-124" value="MRI" rteonchange="evt_318_124();">Mauritius</option>
<option id="q-s-o-318-125" value="MEX" rteonchange="evt_318_125();">Mexico</option>
<option id="q-s-o-318-126" value="MIC" rteonchange="evt_318_126();">Micronesia, Federated States of</option>
<option id="q-s-o-318-127" value="MOL" rteonchange="evt_318_127();">Moldova</option>
<option id="q-s-o-318-128" value="MNA" rteonchange="evt_318_128();">Monaco</option>
<option id="q-s-o-318-129" value="MNG" rteonchange="evt_318_129();">Mongolia</option>
<option id="q-s-o-318-130" value="MON" rteonchange="evt_318_130();">Montenegro</option>
<option id="q-s-o-318-131" value="MOR" rteonchange="evt_318_131();">Morocco</option>
<option id="q-s-o-318-132" value="MOZ" rteonchange="evt_318_132();">Mozambique</option>
<option id="q-s-o-318-133" value="MYA" rteonchange="evt_318_133();">Myanmar</option>
<option id="q-s-o-318-134" value="NAM" rteonchange="evt_318_134();">Namibia</option>
<option id="q-s-o-318-135" value="NEP" rteonchange="evt_318_135();">Nepal</option>
<option id="q-s-o-318-136" value="NET" rteonchange="evt_318_136();">Netherlands</option>
<option id="q-s-o-318-137" value="NCL" rteonchange="evt_318_137();">New Caledonia</option>
<option id="q-s-o-318-138" value="NZE" rteonchange="evt_318_138();">New Zealand</option>
<option id="q-s-o-318-139" value="NIC" rteonchange="evt_318_139();">Nicaragua</option>
<option id="q-s-o-318-140" value="NIG" rteonchange="evt_318_140();">Niger</option>
<option id="q-s-o-318-141" value="NGA" rteonchange="evt_318_141();">Nigeria</option>
<option id="q-s-o-318-142" value="NOR" rteonchange="evt_318_142();">Norway</option>
<option id="q-s-o-318-143" value="OMA" rteonchange="evt_318_143();">Oman</option>
<option id="q-s-o-318-144" value="PAK" rteonchange="evt_318_144();">Pakistan</option>
<option id="q-s-o-318-145" value="PAN" rteonchange="evt_318_145();">Panama</option>
<option id="q-s-o-318-146" value="PAP" rteonchange="evt_318_146();">Papua New Guinea</option>
<option id="q-s-o-318-147" value="PAR" rteonchange="evt_318_147();">Paraguay</option>
<option id="q-s-o-318-148" value="PER" rteonchange="evt_318_148();">Peru</option>
<option id="q-s-o-318-149" value="PHI" rteonchange="evt_318_149();">Philippines</option>
<option id="q-s-o-318-150" value="POL" rteonchange="evt_318_150();">Poland</option>
<option id="q-s-o-318-151" value="POR" rteonchange="evt_318_151();">Portugal</option>
<option id="q-s-o-318-152" value="QAT" rteonchange="evt_318_152();">Qatar</option>
<option id="q-s-o-318-153" value="ROM" rteonchange="evt_318_153();">Romania</option>
<option id="q-s-o-318-154" value="RUS" rteonchange="evt_318_154();">Russia</option>
<option id="q-s-o-318-155" value="RWA" rteonchange="evt_318_155();">Rwanda</option>
<option id="q-s-o-318-156" value="SKN" rteonchange="evt_318_156();">Saint Kitts and Nevis</option>
<option id="q-s-o-318-157" value="SLU" rteonchange="evt_318_157();">Saint Lucia</option>
<option id="q-s-o-318-158" value="SVT" rteonchange="evt_318_158();">Saint Vincent and The Grenadines</option>
<option id="q-s-o-318-159" value="SAM" rteonchange="evt_318_159();">Samoa</option>
<option id="q-s-o-318-160" value="SNM" rteonchange="evt_318_160();">San Marino</option>
<option id="q-s-o-318-161" value="STP" rteonchange="evt_318_161();">Sao Tome and Principe</option>
<option id="q-s-o-318-162" value="SAA" rteonchange="evt_318_162();">Saudi Arabia</option>
<option id="q-s-o-318-163" value="SEN" rteonchange="evt_318_163();">Senegal</option>
<option id="q-s-o-318-164" value="SER" rteonchange="evt_318_164();">Serbia</option>
<option id="q-s-o-318-165" value="SIE" rteonchange="evt_318_165();">Sierra Leone</option>
<option id="q-s-o-318-166" value="SNG" rteonchange="evt_318_166();">Singapore</option>
<option id="q-s-o-318-167" value="SIN" rteonchange="evt_318_167();">Sint Maarten</option>
<option id="q-s-o-318-168" value="SLO" rteonchange="evt_318_168();">Slovakia</option>
<option id="q-s-o-318-169" value="SVE" rteonchange="evt_318_169();">Slovenia</option>
<option id="q-s-o-318-170" value="SOL" rteonchange="evt_318_170();">Solomon Islands</option>
<option id="q-s-o-318-171" value="SOM" rteonchange="evt_318_171();">Somalia</option>
<option id="q-s-o-318-172" value="SAF" rteonchange="evt_318_172();">South Africa</option>
<option id="q-s-o-318-173" value="SSD" rteonchange="evt_318_173();">South Sudan</option>
<option id="q-s-o-318-174" value="SPA" rteonchange="evt_318_174();">Spain</option>
<option id="q-s-o-318-175" value="SRI" rteonchange="evt_318_175();">Sri Lanka</option>
<option id="q-s-o-318-176" value="SUD" rteonchange="evt_318_176();">Sudan</option>
<option id="q-s-o-318-177" value="SUR" rteonchange="evt_318_177();">Suriname</option>
<option id="q-s-o-318-178" value="SWA" rteonchange="evt_318_178();">Swaziland</option>
<option id="q-s-o-318-179" value="SWE" rteonchange="evt_318_179();">Sweden</option>
<option id="q-s-o-318-180" value="SWI" rteonchange="evt_318_180();">Switzerland</option>
<option id="q-s-o-318-181" value="SYR" rteonchange="evt_318_181();">Syria</option>
<option id="q-s-o-318-182" value="TAI" rteonchange="evt_318_182();">Taiwan</option>
<option id="q-s-o-318-183" value="TAJ" rteonchange="evt_318_183();">Tajikistan</option>
<option id="q-s-o-318-184" value="TAN" rteonchange="evt_318_184();">Tanzania</option>
<option id="q-s-o-318-185" value="THA" rteonchange="evt_318_185();">Thailand</option>
<option id="q-s-o-318-186" value="TLS" rteonchange="evt_318_186();">Timor-Leste</option>
<option id="q-s-o-318-187" value="TOG" rteonchange="evt_318_187();">Togo</option>
<option id="q-s-o-318-188" value="TON" rteonchange="evt_318_188();">Tonga</option>
<option id="q-s-o-318-189" value="TRI" rteonchange="evt_318_189();">Trinidad and Tobago</option>
<option id="q-s-o-318-190" value="TUN" rteonchange="evt_318_190();">Tunisia</option>
<option id="q-s-o-318-191" value="TUR" rteonchange="evt_318_191();">Turkey</option>
<option id="q-s-o-318-192" value="TKM" rteonchange="evt_318_192();">Turkmenistan</option>
<option id="q-s-o-318-193" value="UGA" rteonchange="evt_318_193();">Uganda</option>
<option id="q-s-o-318-194" value="UKR" rteonchange="evt_318_194();">Ukraine</option>
<option id="q-s-o-318-195" value="UAE" rteonchange="evt_318_195();">United Arab Emirates</option>
<option id="q-s-o-318-196" value="UK" rteonchange="evt_318_196();">United Kingdom</option>
<option id="q-s-o-318-197" value="URU" rteonchange="evt_318_197();">Uruguay</option>
<option id="q-s-o-318-198" value="UZB" rteonchange="evt_318_198();">Uzbekistan</option>
<option id="q-s-o-318-199" value="VAN" rteonchange="evt_318_199();">Vanuatu</option>
<option id="q-s-o-318-200" value="VEN" rteonchange="evt_318_200();">Venezuela</option>
<option id="q-s-o-318-201" value="VIE" rteonchange="evt_318_201();">Vietnam</option>
<option id="q-s-o-318-202" value="VAI" rteonchange="evt_318_202();">Virgin Islands, British</option>
<option id="q-s-o-318-203" value="WSA" rteonchange="evt_318_203();">Western Sahara</option>
<option id="q-s-o-318-204" value="YEM" rteonchange="evt_318_204();">Yemen</option>
<option id="q-s-o-318-205" value="ZAM" rteonchange="evt_318_205();">Zambia</option>
<option id="q-s-o-318-206" value="ZIM" rteonchange="evt_318_206();">Zimbabwe</option>
</optgroup>
</select>
</span>
</div>
</div>
</div>
</div>
<div class="rte-g" id="rte-g-68">
<div class=" group">
<h4 class="title rte-g-label">Second Parent/Guardian</h4>
<div class="rte-text rte-q" id="question-298"><a name="q298"></a>
<div class="question type_text field_parent_fname_2">
<label for="question-inputtext-298" class="rte-q-label">First Name</label>
<input autocomplete="off" name="parent_fname_2" id="question-inputtext-298" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-text rte-q" id="question-302"><a name="q302"></a>
<div class="question type_text field_parent_lname_2">
<label for="question-inputtext-302" class="rte-q-label">Last Name</label>
<input autocomplete="off" name="parent_lname_2" id="question-inputtext-302" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-custom-telephone rte-q" id="question-1317008"><a name="q1317008"></a>
<div class="question type_telephone field_phone_no_area_parent_2">
<div class="desc rte-q-label" id="question-1317008-label">Phone Number</div>
<div class="telephone" aria-labelledby="question-1317008-label" role="group">
<input class="question-field question-text" name="phone_no_area_parent_2" id="question-telephone1-1317008" type="tel" size="3" maxlength="3" title="Phone Number: Area Code">
<input class="question-field question-text" name="phone_no_prefix_parent_2" id="question-telephone2-1317008" type="tel" size="3" maxlength="3" title="Phone Number: Prefix">
<input class="question-field question-text" name="phone_no_last4_parent_2" id="question-telephone3-1317008" type="tel" size="4" maxlength="4" title="Phone Number: Last Four Digits">
</div>
</div>
</div>
<div class="rte-text rte-q" id="question-303"><a name="q303"></a>
<div class="question type_text field_parent_email_2">
<label for="question-inputtext-303" class="rte-q-label">Email Address</label>
<input autocomplete="off" name="parent_email_2" id="question-inputtext-303" type="text" class="question-field question-text" maxlength="60">
</div>
</div>
<div class="rte-select rte-q" id="question-445"><a name="q445"></a>
<div class="question type_select field_parent_relationship_2">
<label for="question-select-445" class="rte-q-label">Relationship</label>
<span>
<select id="question-select-445" class="question-field" name="parent_relationship_2" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-445-1" value="M">Mother</option>
<option id="q-s-o-445-2" value="F">Father</option>
<option id="q-s-o-445-3" value="SM">Stepmother</option>
<option id="q-s-o-445-4" value="SF">Stepfather</option>
<option id="q-s-o-445-5" value="GP">Grandparent</option>
<option id="q-s-o-445-6" value="G">Guardian</option>
<option id="q-s-o-445-7" value="O">Other</option>
</optgroup>
</select>
</span>
</div>
</div>
<div class="rte-radio rte-q" id="question-325"><a name="q325"></a>
<div class="question type_radio ui-controlgroup field_address_to_parent_2">
<div class="desc rte-q-label ui-controlgroup-label" id="question-325-label">Is this parent's/guardian's mailing address the same as yours?</div>
<div class="choice ui-controlgroup-controls" aria-labelledby="question-325-label" role="radiogroup">
<span id="container-question-325_1">
<input class="question-field" id="question-325_1" name="address_to_parent_2" value="Y" type="radio" onclick="evt_325_1();">
<label for="question-325_1">Yes</label>
</span>
<span id="container-question-325_2">
<input class="question-field" id="question-325_2" name="address_to_parent_2" value="N" type="radio" onclick="evt_325_2();">
<label for="question-325_2">No</label>
</span>
</div>
</div>
</div>
</div>
</div>
<div class="rte-g" id="rte-g-71" style="display:none;" aria-hidden="true">
<div class="follow-up close-gap group">
<div class="rte-text rte-q" id="question-310"><a name="q310"></a>
<div class="question type_text field_parent_addr1_2">
<label for="question-inputtext-310" class="rte-q-label">Address</label>
<input autocomplete="off" name="parent_addr1_2" id="question-inputtext-310" type="text" class="question-field question-text" maxlength="45">
</div>
</div>
<div class="rte-text rte-q" id="question-309"><a name="q309"></a>
<div class="question type_text field_parent_addr2_2">
<label for="question-inputtext-309" class="rte-q-label">Apt. #</label>
<input autocomplete="off" name="parent_addr2_2" id="question-inputtext-309" type="text" class="question-field question-text" maxlength="45">
</div>
</div>
<div class="rte-text rte-q" id="question-316"><a name="q316"></a>
<div class="question type_text field_parent_city_2">
<label for="question-inputtext-316" class="rte-q-label">City</label>
<input autocomplete="off" name="parent_city_2" id="question-inputtext-316" type="text" class="question-field question-text" maxlength="25">
</div>
</div>
<div class="rte-select rte-q" id="question-322"><a name="q322"></a>
<div class="question type_select field_parent_state_2">
<label for="question-select-322" class="rte-q-label">State/Province</label>
<span>
<select id="question-select-322" class="question-field" name="parent_state_2" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-322-1" value="AL">Alabama</option>
<option id="q-s-o-322-2" value="AK">Alaska</option>
<option id="q-s-o-322-3" value="AB">Alberta</option>
<option id="q-s-o-322-4" value="AS">American Samoa</option>
<option id="q-s-o-322-5" value="AZ">Arizona</option>
<option id="q-s-o-322-6" value="AR">Arkansas</option>
<option id="q-s-o-322-7" value="AA">Armed Forces Americas</option>
<option id="q-s-o-322-8" value="AE">Armed Forces Europe</option>
<option id="q-s-o-322-9" value="AP">Armed Forces Pacific</option>
<option id="q-s-o-322-10" value="BC">British Columbia</option>
<option id="q-s-o-322-11" value="CA">California</option>
<option id="q-s-o-322-12" value="CO">Colorado</option>
<option id="q-s-o-322-13" value="CT">Connecticut</option>
<option id="q-s-o-322-14" value="DE">Delaware</option>
<option id="q-s-o-322-15" value="DC">District of Columbia</option>
<option id="q-s-o-322-16" value="FL">Florida</option>
<option id="q-s-o-322-17" value="GA">Georgia</option>
<option id="q-s-o-322-18" value="GU">Guam</option>
<option id="q-s-o-322-19" value="HI">Hawaii</option>
<option id="q-s-o-322-20" value="ID">Idaho</option>
<option id="q-s-o-322-21" value="IL">Illinois</option>
<option id="q-s-o-322-22" value="IN">Indiana</option>
<option id="q-s-o-322-23" value="IA">Iowa</option>
<option id="q-s-o-322-24" value="KS">Kansas</option>
<option id="q-s-o-322-25" value="KY">Kentucky</option>
<option id="q-s-o-322-26" value="LA">Louisiana</option>
<option id="q-s-o-322-27" value="ME">Maine</option>
<option id="q-s-o-322-28" value="MB">Manitoba</option>
<option id="q-s-o-322-29" value="MH">Marshall Islands</option>
<option id="q-s-o-322-30" value="MD">Maryland</option>
<option id="q-s-o-322-31" value="MA">Massachusetts</option>
<option id="q-s-o-322-32" value="MI">Michigan</option>
<option id="q-s-o-322-33" value="MN">Minnesota</option>
<option id="q-s-o-322-34" value="MS">Mississippi</option>
<option id="q-s-o-322-35" value="MO">Missouri</option>
<option id="q-s-o-322-36" value="MT">Montana</option>
<option id="q-s-o-322-37" value="MP">N. Mariana Islands</option>
<option id="q-s-o-322-38" value="NE">Nebraska</option>
<option id="q-s-o-322-39" value="NV">Nevada</option>
<option id="q-s-o-322-40" value="NB">New Brunswick</option>
<option id="q-s-o-322-41" value="NH">New Hampshire</option>
<option id="q-s-o-322-42" value="NJ">New Jersey</option>
<option id="q-s-o-322-43" value="NM">New Mexico</option>
<option id="q-s-o-322-44" value="NY">New York</option>
<option id="q-s-o-322-45" value="NL">Newfoundland/Labrador</option>
<option id="q-s-o-322-46" value="NC">North Carolina</option>
<option id="q-s-o-322-47" value="ND">North Dakota</option>
<option id="q-s-o-322-48" value="NT">Northwest Territories</option>
<option id="q-s-o-322-49" value="NS">Nova Scotia</option>
<option id="q-s-o-322-50" value="NU">Nunavut</option>
<option id="q-s-o-322-51" value="OH">Ohio</option>
<option id="q-s-o-322-52" value="OK">Oklahoma</option>
<option id="q-s-o-322-53" value="ON">Ontario</option>
<option id="q-s-o-322-54" value="OR">Oregon</option>
<option id="q-s-o-322-55" value="PA">Pennsylvania</option>
<option id="q-s-o-322-56" value="PE">Prince Edward Island</option>
<option id="q-s-o-322-57" value="PR">Puerto Rico</option>
<option id="q-s-o-322-58" value="QC">Quebec</option>
<option id="q-s-o-322-59" value="RI">Rhode Island</option>
<option id="q-s-o-322-60" value="SK">Saskatchewan</option>
<option id="q-s-o-322-61" value="SC">South Carolina</option>
<option id="q-s-o-322-62" value="SD">South Dakota</option>
<option id="q-s-o-322-63" value="TN">Tennessee</option>
<option id="q-s-o-322-64" value="TX">Texas</option>
<option id="q-s-o-322-65" value="UT">Utah</option>
<option id="q-s-o-322-66" value="VT">Vermont</option>
<option id="q-s-o-322-67" value="VI">Virgin Islands</option>
<option id="q-s-o-322-68" value="VA">Virginia</option>
<option id="q-s-o-322-69" value="WA">Washington</option>
<option id="q-s-o-322-70" value="WV">West Virginia</option>
<option id="q-s-o-322-71" value="WI">Wisconsin</option>
<option id="q-s-o-322-72" value="WY">Wyoming</option>
<option id="q-s-o-322-73" value="YT">Yukon</option>
</optgroup>
</select>
</span>
</div>
</div>
<div class="rte-text rte-q" id="question-313"><a name="q313"></a>
<div class="question type_text field_parent_zip5_dash_zip4_2">
<label for="question-inputtext-313" class="rte-q-label">ZIP/Postal Code</label>
<input autocomplete="off" name="parent_zip5_dash_zip4_2" id="question-inputtext-313" type="text" class="question-field question-text" maxlength="10">
</div>
</div>
<div class="rte-select rte-q" id="question-319"><a name="q319"></a>
<div class="question type_select field_parent_country_cd_2">
<label for="question-select-319" class="rte-q-label">Country</label>
<span>
<select id="question-select-319" class="question-field" name="parent_country_cd_2" onchange="r.r.callOptionOnChange(this);" autocomplete="off">
<optgroup>
<option value="">--</option>
<option id="q-s-o-319-1" value="USA" rteonchange="evt_319_1();">United States</option>
<option id="q-s-o-319-2" value="AFG" rteonchange="evt_319_2();">Afghanistan</option>
<option id="q-s-o-319-3" value="ALB" rteonchange="evt_319_3();">Albania</option>
<option id="q-s-o-319-4" value="ALG" rteonchange="evt_319_4();">Algeria</option>
<option id="q-s-o-319-5" value="AND" rteonchange="evt_319_5();">Andorra</option>
<option id="q-s-o-319-6" value="ANG" rteonchange="evt_319_6();">Angola</option>
<option id="q-s-o-319-7" value="ANU" rteonchange="evt_319_7();">Anguilla</option>
<option id="q-s-o-319-8" value="ANT" rteonchange="evt_319_8();">Antigua and Barbuda</option>
<option id="q-s-o-319-9" value="ARG" rteonchange="evt_319_9();">Argentina</option>
<option id="q-s-o-319-10" value="ARM" rteonchange="evt_319_10();">Armenia</option>
<option id="q-s-o-319-11" value="ARU" rteonchange="evt_319_11();">Aruba</option>
<option id="q-s-o-319-12" value="AUS" rteonchange="evt_319_12();">Australia</option>
<option id="q-s-o-319-13" value="AST" rteonchange="evt_319_13();">Austria</option>
<option id="q-s-o-319-14" value="AZE" rteonchange="evt_319_14();">Azerbaijan</option>
<option id="q-s-o-319-15" value="BAH" rteonchange="evt_319_15();">Bahamas, The</option>
<option id="q-s-o-319-16" value="BHR" rteonchange="evt_319_16();">Bahrain</option>
<option id="q-s-o-319-17" value="BNG" rteonchange="evt_319_17();">Bangladesh</option>
<option id="q-s-o-319-18" value="BAR" rteonchange="evt_319_18();">Barbados</option>
<option id="q-s-o-319-19" value="BEL" rteonchange="evt_319_19();">Belarus</option>
<option id="q-s-o-319-20" value="BLG" rteonchange="evt_319_20();">Belgium</option>
<option id="q-s-o-319-21" value="BZE" rteonchange="evt_319_21();">Belize</option>
<option id="q-s-o-319-22" value="BEN" rteonchange="evt_319_22();">Benin</option>
<option id="q-s-o-319-23" value="BER" rteonchange="evt_319_23();">Bermuda</option>
<option id="q-s-o-319-24" value="BHU" rteonchange="evt_319_24();">Bhutan</option>
<option id="q-s-o-319-25" value="BOL" rteonchange="evt_319_25();">Bolivia</option>
<option id="q-s-o-319-26" value="BOS" rteonchange="evt_319_26();">Bosnia and Herzegovina</option>
<option id="q-s-o-319-27" value="BOT" rteonchange="evt_319_27();">Botswana</option>
<option id="q-s-o-319-28" value="BRA" rteonchange="evt_319_28();">Brazil</option>
<option id="q-s-o-319-29" value="BRU" rteonchange="evt_319_29();">Brunei</option>
<option id="q-s-o-319-30" value="BUL" rteonchange="evt_319_30();">Bulgaria</option>
<option id="q-s-o-319-31" value="BUR" rteonchange="evt_319_31();">Burkina Faso</option>
<option id="q-s-o-319-32" value="BDI" rteonchange="evt_319_32();">Burundi</option>
<option id="q-s-o-319-33" value="CAM" rteonchange="evt_319_33();">Cambodia</option>
<option id="q-s-o-319-34" value="COO" rteonchange="evt_319_34();">Cameroon</option>
<option id="q-s-o-319-35" value="CAN" rteonchange="evt_319_35();">Canada</option>
<option id="q-s-o-319-36" value="CVE" rteonchange="evt_319_36();">Cape Verde</option>
<option id="q-s-o-319-37" value="CAY" rteonchange="evt_319_37();">Cayman Islands</option>
<option id="q-s-o-319-38" value="CAR" rteonchange="evt_319_38();">Central African Republic</option>
<option id="q-s-o-319-39" value="CHA" rteonchange="evt_319_39();">Chad</option>
<option id="q-s-o-319-40" value="CHI" rteonchange="evt_319_40();">Chile</option>
<option id="q-s-o-319-41" value="CHN" rteonchange="evt_319_41();">China</option>
<option id="q-s-o-319-42" value="COL" rteonchange="evt_319_42();">Colombia</option>
<option id="q-s-o-319-43" value="COM" rteonchange="evt_319_43();">Comoros</option>
<option id="q-s-o-319-44" value="CON" rteonchange="evt_319_44();">Congo, Democratic Republic of the</option>
<option id="q-s-o-319-45" value="COG" rteonchange="evt_319_45();">Congo, Republic of the</option>
<option id="q-s-o-319-46" value="CSA" rteonchange="evt_319_46();">Costa Rica</option>
<option id="q-s-o-319-47" value="CTE" rteonchange="evt_319_47();">Cote d'Ivoire</option>
<option id="q-s-o-319-48" value="CRO" rteonchange="evt_319_48();">Croatia</option>
<option id="q-s-o-319-49" value="CUB" rteonchange="evt_319_49();">Cuba</option>
<option id="q-s-o-319-50" value="CUR" rteonchange="evt_319_50();">Curacao</option>
<option id="q-s-o-319-51" value="CYP" rteonchange="evt_319_51();">Cyprus</option>
<option id="q-s-o-319-52" value="CZE" rteonchange="evt_319_52();">Czech Republic</option>
<option id="q-s-o-319-53" value="DEN" rteonchange="evt_319_53();">Denmark</option>
<option id="q-s-o-319-54" value="DJI" rteonchange="evt_319_54();">Djibouti</option>
<option id="q-s-o-319-55" value="DOM" rteonchange="evt_319_55();">Dominica</option>
<option id="q-s-o-319-56" value="DNR" rteonchange="evt_319_56();">Dominican Republic</option>
<option id="q-s-o-319-57" value="ECU" rteonchange="evt_319_57();">Ecuador</option>
<option id="q-s-o-319-58" value="EGY" rteonchange="evt_319_58();">Egypt</option>
<option id="q-s-o-319-59" value="ELD" rteonchange="evt_319_59();">El Salvador</option>
<option id="q-s-o-319-60" value="EQU" rteonchange="evt_319_60();">Equatorial Guinea</option>
<option id="q-s-o-319-61" value="ERI" rteonchange="evt_319_61();">Eritrea</option>
<option id="q-s-o-319-62" value="EST" rteonchange="evt_319_62();">Estonia</option>
<option id="q-s-o-319-63" value="ETH" rteonchange="evt_319_63();">Ethiopia</option>
<option id="q-s-o-319-64" value="FIJ" rteonchange="evt_319_64();">Fiji</option>
<option id="q-s-o-319-65" value="FIN" rteonchange="evt_319_65();">Finland</option>
<option id="q-s-o-319-66" value="FRA" rteonchange="evt_319_66();">France</option>
<option id="q-s-o-319-67" value="FRG" rteonchange="evt_319_67();">French Guiana</option>
<option id="q-s-o-319-68" value="FRP" rteonchange="evt_319_68();">French Polynesia</option>
<option id="q-s-o-319-69" value="GAB" rteonchange="evt_319_69();">Gabon</option>
<option id="q-s-o-319-70" value="BAM" rteonchange="evt_319_70();">Gambia, The</option>
<option id="q-s-o-319-71" value="GEO" rteonchange="evt_319_71();">Georgia</option>
<option id="q-s-o-319-72" value="GER" rteonchange="evt_319_72();">Germany</option>
<option id="q-s-o-319-73" value="GHA" rteonchange="evt_319_73();">Ghana</option>
<option id="q-s-o-319-74" value="GIB" rteonchange="evt_319_74();">Gibraltar</option>
<option id="q-s-o-319-75" value="GRE" rteonchange="evt_319_75();">Greece</option>
<option id="q-s-o-319-76" value="GRL" rteonchange="evt_319_76();">Greenland</option>
<option id="q-s-o-319-77" value="GRD" rteonchange="evt_319_77();">Grenada</option>
<option id="q-s-o-319-78" value="GDL" rteonchange="evt_319_78();">Guadeloupe</option>
<option id="q-s-o-319-79" value="GUA" rteonchange="evt_319_79();">Guatemala</option>
<option id="q-s-o-319-80" value="GUI" rteonchange="evt_319_80();">Guinea</option>
<option id="q-s-o-319-81" value="GUB" rteonchange="evt_319_81();">Guinea-Bissau</option>
<option id="q-s-o-319-82" value="GUY" rteonchange="evt_319_82();">Guyana</option>
<option id="q-s-o-319-83" value="HAI" rteonchange="evt_319_83();">Haiti</option>
<option id="q-s-o-319-84" value="HON" rteonchange="evt_319_84();">Honduras</option>
<option id="q-s-o-319-85" value="HGK" rteonchange="evt_319_85();">Hong Kong</option>
<option id="q-s-o-319-86" value="HUN" rteonchange="evt_319_86();">Hungary</option>
<option id="q-s-o-319-87" value="ICE" rteonchange="evt_319_87();">Iceland</option>
<option id="q-s-o-319-88" value="IND" rteonchange="evt_319_88();">India</option>
<option id="q-s-o-319-89" value="INA" rteonchange="evt_319_89();">Indonesia</option>
<option id="q-s-o-319-90" value="IRA" rteonchange="evt_319_90();">Iran</option>
<option id="q-s-o-319-91" value="IRQ" rteonchange="evt_319_91();">Iraq</option>
<option id="q-s-o-319-92" value="IRL" rteonchange="evt_319_92();">Ireland</option>
<option id="q-s-o-319-93" value="ISR" rteonchange="evt_319_93();">Israel</option>
<option id="q-s-o-319-94" value="ITY" rteonchange="evt_319_94();">Italy</option>
<option id="q-s-o-319-95" value="JAM" rteonchange="evt_319_95();">Jamaica</option>
<option id="q-s-o-319-96" value="JAP" rteonchange="evt_319_96();">Japan</option>
<option id="q-s-o-319-97" value="JOR" rteonchange="evt_319_97();">Jordan</option>
<option id="q-s-o-319-98" value="KAZ" rteonchange="evt_319_98();">Kazakhstan</option>
<option id="q-s-o-319-99" value="KEN" rteonchange="evt_319_99();">Kenya</option>
<option id="q-s-o-319-100" value="KIR" rteonchange="evt_319_100();">Kiribati</option>
<option id="q-s-o-319-101" value="KOR" rteonchange="evt_319_101();">Korea, North</option>
<option id="q-s-o-319-102" value="KRR" rteonchange="evt_319_102();">Korea, South</option>
<option id="q-s-o-319-103" value="KOS" rteonchange="evt_319_103();">Kosovo</option>
<option id="q-s-o-319-104" value="KUW" rteonchange="evt_319_104();">Kuwait</option>
<option id="q-s-o-319-105" value="KYR" rteonchange="evt_319_105();">Kyrgyzstan</option>
<option id="q-s-o-319-106" value="LAO" rteonchange="evt_319_106();">Laos</option>
<option id="q-s-o-319-107" value="LAT" rteonchange="evt_319_107();">Latvia</option>
<option id="q-s-o-319-108" value="LEB" rteonchange="evt_319_108();">Lebanon</option>
<option id="q-s-o-319-109" value="LES" rteonchange="evt_319_109();">Lesotho</option>
<option id="q-s-o-319-110" value="LIB" rteonchange="evt_319_110();">Liberia</option>
<option id="q-s-o-319-111" value="LIY" rteonchange="evt_319_111();">Libya</option>
<option id="q-s-o-319-112" value="LIE" rteonchange="evt_319_112();">Liechtenstein</option>
<option id="q-s-o-319-113" value="LIT" rteonchange="evt_319_113();">Lithuania</option>
<option id="q-s-o-319-114" value="LUX" rteonchange="evt_319_114();">Luxembourg</option>
<option id="q-s-o-319-115" value="MAC" rteonchange="evt_319_115();">Macau</option>
<option id="q-s-o-319-116" value="MAD" rteonchange="evt_319_116();">Macedonia</option>
<option id="q-s-o-319-117" value="MDG" rteonchange="evt_319_117();">Madagascar</option>
<option id="q-s-o-319-118" value="MAL" rteonchange="evt_319_118();">Malawi</option>
<option id="q-s-o-319-119" value="MAY" rteonchange="evt_319_119();">Malaysia</option>
<option id="q-s-o-319-120" value="MLD" rteonchange="evt_319_120();">Maldives</option>
<option id="q-s-o-319-121" value="MLI" rteonchange="evt_319_121();">Mali</option>
<option id="q-s-o-319-122" value="MTA" rteonchange="evt_319_122();">Malta</option>
<option id="q-s-o-319-123" value="MAU" rteonchange="evt_319_123();">Mauritania</option>
<option id="q-s-o-319-124" value="MRI" rteonchange="evt_319_124();">Mauritius</option>
<option id="q-s-o-319-125" value="MEX" rteonchange="evt_319_125();">Mexico</option>
<option id="q-s-o-319-126" value="MIC" rteonchange="evt_319_126();">Micronesia, Federated States of</option>
<option id="q-s-o-319-127" value="MOL" rteonchange="evt_319_127();">Moldova</option>
<option id="q-s-o-319-128" value="MNA" rteonchange="evt_319_128();">Monaco</option>
<option id="q-s-o-319-129" value="MNG" rteonchange="evt_319_129();">Mongolia</option>
<option id="q-s-o-319-130" value="MON" rteonchange="evt_319_130();">Montenegro</option>
<option id="q-s-o-319-131" value="MOR" rteonchange="evt_319_131();">Morocco</option>
<option id="q-s-o-319-132" value="MOZ" rteonchange="evt_319_132();">Mozambique</option>
<option id="q-s-o-319-133" value="MYA" rteonchange="evt_319_133();">Myanmar</option>
<option id="q-s-o-319-134" value="NAM" rteonchange="evt_319_134();">Namibia</option>
<option id="q-s-o-319-135" value="NEP" rteonchange="evt_319_135();">Nepal</option>
<option id="q-s-o-319-136" value="NET" rteonchange="evt_319_136();">Netherlands</option>
<option id="q-s-o-319-137" value="NCL" rteonchange="evt_319_137();">New Caledonia</option>
<option id="q-s-o-319-138" value="NZE" rteonchange="evt_319_138();">New Zealand</option>
<option id="q-s-o-319-139" value="NIC" rteonchange="evt_319_139();">Nicaragua</option>
<option id="q-s-o-319-140" value="NIG" rteonchange="evt_319_140();">Niger</option>
<option id="q-s-o-319-141" value="NGA" rteonchange="evt_319_141();">Nigeria</option>
<option id="q-s-o-319-142" value="NOR" rteonchange="evt_319_142();">Norway</option>
<option id="q-s-o-319-143" value="OMA" rteonchange="evt_319_143();">Oman</option>
<option id="q-s-o-319-144" value="PAK" rteonchange="evt_319_144();">Pakistan</option>
<option id="q-s-o-319-145" value="PAN" rteonchange="evt_319_145();">Panama</option>
<option id="q-s-o-319-146" value="PAP" rteonchange="evt_319_146();">Papua New Guinea</option>
<option id="q-s-o-319-147" value="PAR" rteonchange="evt_319_147();">Paraguay</option>
<option id="q-s-o-319-148" value="PER" rteonchange="evt_319_148();">Peru</option>
<option id="q-s-o-319-149" value="PHI" rteonchange="evt_319_149();">Philippines</option>
<option id="q-s-o-319-150" value="POL" rteonchange="evt_319_150();">Poland</option>
<option id="q-s-o-319-151" value="POR" rteonchange="evt_319_151();">Portugal</option>
<option id="q-s-o-319-152" value="QAT" rteonchange="evt_319_152();">Qatar</option>
<option id="q-s-o-319-153" value="ROM" rteonchange="evt_319_153();">Romania</option>
<option id="q-s-o-319-154" value="RUS" rteonchange="evt_319_154();">Russia</option>
<option id="q-s-o-319-155" value="RWA" rteonchange="evt_319_155();">Rwanda</option>
<option id="q-s-o-319-156" value="SKN" rteonchange="evt_319_156();">Saint Kitts and Nevis</option>
<option id="q-s-o-319-157" value="SLU" rteonchange="evt_319_157();">Saint Lucia</option>
<option id="q-s-o-319-158" value="SVT" rteonchange="evt_319_158();">Saint Vincent and The Grenadines</option>
<option id="q-s-o-319-159" value="SAM" rteonchange="evt_319_159();">Samoa</option>
<option id="q-s-o-319-160" value="SNM" rteonchange="evt_319_160();">San Marino</option>
<option id="q-s-o-319-161" value="STP" rteonchange="evt_319_161();">Sao Tome and Principe</option>
<option id="q-s-o-319-162" value="SAA" rteonchange="evt_319_162();">Saudi Arabia</option>
<option id="q-s-o-319-163" value="SEN" rteonchange="evt_319_163();">Senegal</option>
<option id="q-s-o-319-164" value="SER" rteonchange="evt_319_164();">Serbia</option>
<option id="q-s-o-319-165" value="SIE" rteonchange="evt_319_165();">Sierra Leone</option>
<option id="q-s-o-319-166" value="SNG" rteonchange="evt_319_166();">Singapore</option>
<option id="q-s-o-319-167" value="SIN" rteonchange="evt_319_167();">Sint Maarten</option>
<option id="q-s-o-319-168" value="SLO" rteonchange="evt_319_168();">Slovakia</option>
<option id="q-s-o-319-169" value="SVE" rteonchange="evt_319_169();">Slovenia</option>
<option id="q-s-o-319-170" value="SOL" rteonchange="evt_319_170();">Solomon Islands</option>
<option id="q-s-o-319-171" value="SOM" rteonchange="evt_319_171();">Somalia</option>
<option id="q-s-o-319-172" value="SAF" rteonchange="evt_319_172();">South Africa</option>
<option id="q-s-o-319-173" value="SSD" rteonchange="evt_319_173();">South Sudan</option>
<option id="q-s-o-319-174" value="SPA" rteonchange="evt_319_174();">Spain</option>
<option id="q-s-o-319-175" value="SRI" rteonchange="evt_319_175();">Sri Lanka</option>
<option id="q-s-o-319-176" value="SUD" rteonchange="evt_319_176();">Sudan</option>
<option id="q-s-o-319-177" value="SUR" rteonchange="evt_319_177();">Suriname</option>
<option id="q-s-o-319-178" value="SWA" rteonchange="evt_319_178();">Swaziland</option>
<option id="q-s-o-319-179" value="SWE" rteonchange="evt_319_179();">Sweden</option>
<option id="q-s-o-319-180" value="SWI" rteonchange="evt_319_180();">Switzerland</option>
<option id="q-s-o-319-181" value="SYR" rteonchange="evt_319_181();">Syria</option>
<option id="q-s-o-319-182" value="TAI" rteonchange="evt_319_182();">Taiwan</option>
<option id="q-s-o-319-183" value="TAJ" rteonchange="evt_319_183();">Tajikistan</option>
<option id="q-s-o-319-184" value="TAN" rteonchange="evt_319_184();">Tanzania</option>
<option id="q-s-o-319-185" value="THA" rteonchange="evt_319_185();">Thailand</option>
<option id="q-s-o-319-186" value="TLS" rteonchange="evt_319_186();">Timor-Leste</option>
<option id="q-s-o-319-187" value="TOG" rteonchange="evt_319_187();">Togo</option>
<option id="q-s-o-319-188" value="TON" rteonchange="evt_319_188();">Tonga</option>
<option id="q-s-o-319-189" value="TRI" rteonchange="evt_319_189();">Trinidad and Tobago</option>
<option id="q-s-o-319-190" value="TUN" rteonchange="evt_319_190();">Tunisia</option>
<option id="q-s-o-319-191" value="TUR" rteonchange="evt_319_191();">Turkey</option>
<option id="q-s-o-319-192" value="TKM" rteonchange="evt_319_192();">Turkmenistan</option>
<option id="q-s-o-319-193" value="UGA" rteonchange="evt_319_193();">Uganda</option>
<option id="q-s-o-319-194" value="UKR" rteonchange="evt_319_194();">Ukraine</option>
<option id="q-s-o-319-195" value="UAE" rteonchange="evt_319_195();">United Arab Emirates</option>
<option id="q-s-o-319-196" value="UK" rteonchange="evt_319_196();">United Kingdom</option>
<option id="q-s-o-319-197" value="URU" rteonchange="evt_319_197();">Uruguay</option>
<option id="q-s-o-319-198" value="UZB" rteonchange="evt_319_198();">Uzbekistan</option>
<option id="q-s-o-319-199" value="VAN" rteonchange="evt_319_199();">Vanuatu</option>
<option id="q-s-o-319-200" value="VEN" rteonchange="evt_319_200();">Venezuela</option>
<option id="q-s-o-319-201" value="VIE" rteonchange="evt_319_201();">Vietnam</option>
<option id="q-s-o-319-202" value="VAI" rteonchange="evt_319_202();">Virgin Islands, British</option>
<option id="q-s-o-319-203" value="WSA" rteonchange="evt_319_203();">Western Sahara</option>
<option id="q-s-o-319-204" value="YEM" rteonchange="evt_319_204();">Yemen</option>
<option id="q-s-o-319-205" value="ZAM" rteonchange="evt_319_205();">Zambia</option>
<option id="q-s-o-319-206" value="ZIM" rteonchange="evt_319_206();">Zimbabwe</option>
</optgroup>
</select>
</span>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="rte-s" id="rte-s-22">
<div class=" section">
<h3 class="rte-s-label">Ethnicity <span class="tip">(optional)</span></h3>
<div class="header rte-s-header">
<p>If you wish to be identified with a particular ethnic group, please select the choice that most accurately describes your heritage. Indicating an ethnicity will not affect your admission decision.</p>
</div>
<div class="rte-g" id="rte-g-36">
<div class="close-gap group">
<div class="rte-custom-ethnicity rte-q" id="question-484"><a name="q484"></a>
<div class="question type_ethnicity field_ethnicity_hispanic">
<div id="q_484" class=" question type_radio ui-controlgroup">
<div class="desc rte-q-label ui-controlgroup-label" id="question-484_hispanic_label">Are you Hispanic or Latino?</div>
<div class="choice ui-controlgroup-controls" role="radiogroup" aria-labelledby="question-484_hispanic_label">
<span><input id="question-484_1" type="radio" class="question-field radio" value="Y" name="ethnicity_hispanic"><label for="question-484_1">Yes</label></span>
<span><input id="question-484_2" type="radio" class="question-field radio" value="N" name="ethnicity_hispanic"><label for="question-484_2">No</label></span>
</div>
</div>
<div class="question type_multicheck ui-controlgroup">
<div class="desc rte-q-label ui-controlgroup-label" id="question-484_races_label">Please select one or more of the following races:</div>
<div class="choice ui-controlgroup-controls" role="group" aria-labelledby="question-484_races_label">
<span><input type="checkbox" class="checkbox" id="cb2_race_american_indian_c" value="Y" onchange="r.e.flipFromCheckbox(this);"><label for="cb2_race_american_indian_c">American Indian or Alaska Native</label></span>
<span><input type="checkbox" class="checkbox" id="cb3_race_asian_c" value="Y" onchange="r.e.flipFromCheckbox(this);"><label for="cb3_race_asian_c">Asian</label></span>
<span><input type="checkbox" class="checkbox" id="cb4_race_black_c" value="Y" onchange="r.e.flipFromCheckbox(this);"><label for="cb4_race_black_c">Black or African American</label></span>
<span><input type="checkbox" class="checkbox" id="cb5_race_native_hawaiian_c" value="Y" onchange="r.e.flipFromCheckbox(this);"><label for="cb5_race_native_hawaiian_c">Native Hawaiian or Other Pacific Islander</label></span>
<span><input type="checkbox" class="checkbox" id="cb6_race_white_c" value="Y" onchange="r.e.flipFromCheckbox(this);"><label for="cb6_race_white_c">White</label></span>
</div>
</div>
</div>
<input type="hidden" name="race_american_indian" id="cb2_race_american_indian" value="" class="question-field" onchange="r.e.flipToCheckbox(this);">
<input type="hidden" name="race_asian" id="cb3_race_asian" value="" class="question-field" onchange="r.e.flipToCheckbox(this);">
<input type="hidden" name="race_black" id="cb4_race_black" value="" class="question-field" onchange="r.e.flipToCheckbox(this);">
<input type="hidden" name="race_native_hawaiian" id="cb5_race_native_hawaiian" value="" class="question-field" onchange="r.e.flipToCheckbox(this);">
<input type="hidden" name="race_white" id="cb6_race_white" value="" class="question-field" onchange="r.e.flipToCheckbox(this);">
</div>
</div>
</div>
</div>
</div>
<div class="rte-s" id="rte-s-1040082" style="display:none;">
<div class="scholarship section">
<h3 class="rte-s-label">Other Affiliations <span class="tip">(optional)</span></h3>
<div class="rte-g" id="rte-g-1063156">
<div class="for-scholarship group">
<div class="rte-custom-checkbox rte-q" id="question-1336476"><a name="q1336476"></a>
<div class="question type_multicheck ui-controlgroup">
<div class="desc rte-q-label ui-controlgroup-label" id="question-1336476-label">Please answer these questions to determine if you may be eligible for specific scholarships.</div>
<div class="choice ui-controlgroup-controls" role="group" aria-labelledby="question-1336476-label">
<span>
<input onclick="r.e.flipToCheckbox(this);" id="question-1336476-dependent-checkbox" name="dependent" class="question-field" type="hidden" value="">
<input onclick="r.e.flipFromCheckbox(this);" id="question-1336476-dependent-checkbox_c" type="checkbox" value="Y">
<label for="question-1336476-dependent-checkbox_c"> I am a dependent of a current Regent University faculty or staff member.</label></span>
<span>
<input onclick="r.e.flipToCheckbox(this);" id="question-1336476-military-checkbox" name="military" class="question-field" type="hidden" value="">
<input onclick="r.e.flipFromCheckbox(this);" id="question-1336476-military-checkbox_c" type="checkbox" value="Y">
<label for="question-1336476-military-checkbox_c"> I am a dependent of someone on active duty in the U.S. military, a U.S. military veteran or a retired U.S. military veteran.</label></span>
<span>
<input onclick="r.e.flipToCheckbox(this);" id="question-1336476-regent_grad-checkbox" name="regent_grad" class="question-field" type="hidden" value="">
<input onclick="r.e.flipFromCheckbox(this);" id="question-1336476-regent_grad-checkbox_c" type="checkbox" value="Y">
<label for="question-1336476-regent_grad-checkbox_c"> I am a sibling, child or grandchild of a Regent University or CBN University graduate.</label></span>
<span>
<input onclick="r.e.flipToCheckbox(this);" id="question-1336476-national_merit-checkbox" name="national_merit" class="question-field" type="hidden" value="">
<input onclick="r.e.flipFromCheckbox(this);" id="question-1336476-national_merit-checkbox_c" type="checkbox" value="Y">
<label for="question-1336476-national_merit-checkbox_c"> I am a National Merit Semifinalist or Finalist.</label></span>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</form>POST
<form id="__previewlookform__" method="post"><input type="hidden" name="email" id="__PREVIEW_EMAIL_HIDDEN"><input type="hidden" name="__JSON" value="{}"><input type="hidden" name="__MODE" id="__PREVIEW_MODE" value=""></form>POST
<form id="__loginform__" method="post"><input type="hidden" name="__USERNAME" id="__USERNAME_HIDDEN"><input type="hidden" name="__PASSWORD" id="__PASSWORD_HIDDEN"><input type="hidden" name="__REMEMBERME" id="__REMEMBERME_HIDDEN"><input type="hidden"
name="__COMM" id="__COMM_HIDDEN" value=""><input type="hidden" name="__JSON" id="__JSON_HIDDEN"></form>GET
<form id="__blankform__" method="get" target="_blank"></form>POST https://payment.app-info.net/paypal/accepted.cfm
<form id="__paypalform__" method="post" action="https://payment.app-info.net/paypal/accepted.cfm">
<input type="hidden" name="PARTNER" value="PayPal">
<input type="hidden" name="TYPE" value="S">
<input type="hidden" name="EMAILCUSTOMER" value="True">
<input type="hidden" name="INVOICE" id="pp_INVOICE" value="">
<input type="hidden" name="COMMENT1" id="pp_COMMENT1" value="">
<input type="hidden" name="COMMENT2" id="pp_COMMENT2" value="">
<input type="hidden" name="USER1" id="pp_USER1" value="">
<input type="hidden" name="USER2" id="pp_USER2" value="">
<input type="hidden" name="USER3" id="pp_USER3" value="">
<input type="hidden" name="USER4" id="pp_USER4" value="">
<input type="hidden" name="USER5" id="pp_USER5" value="">
<input type="hidden" name="USER6" id="pp_USER6" value="">
<input type="hidden" name="USER7" id="pp_USER7" value="">
<input type="hidden" name="USER8" id="pp_USER8" value="">
<input type="hidden" name="LOGIN" id="pp_LOGIN" value="">
<input type="hidden" name="CUSTID" id="pp_CUSTID" value="">
<input type="hidden" name="AMOUNT" id="pp_AMOUNT" value="">
</form>POST _docshot.htm
<form action="_docshot.htm" id="custom-upload-form" method="post" enctype="multipart/form-data" target="docshot-iframe">
<div class="student-upload-modal"></div>
</form>Text Content
WORLD CHANGER APPLICATION * Personal Information * Education & Activities * Final Steps FIRST TIME HERE? This application can be completed in one sitting. Take a look or start filling it out right now. Once you do, we'll set you up with a secure Username and Password. Already started your application? Log back in to pick up where you left off. YOUR PERSONAL INFORMATION First Name Middle Name Last Name Preferred Name Email Address Home Phone Number Cell Phone Number Gender Male Female Date of Birth -- JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember -- 12345678910111213141516171819202122232425262728293031 -- 200820072006200520042003200220012000199919981997 Do you plan to apply for financial aid? Yes No If you're applying for financial aid, your Social Security number is required. Social Security Number (optional) Show Social Security Number MAILING ADDRESS Address Apt. # City State/Province -- Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N. Mariana Islands Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland/Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon ZIP/Postal Code Country -- United States Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Mauritania Mauritius Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Western Sahara Yemen Zambia Zimbabwe CITIZENSHIP U.S. Citizen Permanent Resident Not a U.S. Citizen or Permanent Resident RELIGIOUS INFORMATION Religious Preference or Affiliation -- African Methodist Episcopal African Methodist Episcopal Zion Agnostic Anglican Apostolic Faith Assemblies of God Atheist Baha'i Baptist Brethren Buddhist Christian Christian and Missionary Alliance Christian Church/Disciples of Christ Christian Methodist Episcopal Christian Reformed Church Christian Scientist Church of Christ Church of God in Christ Church of the Nazarene Churches of God Churches of God (Anderson) Ecumenical Episcopal Church Greek Orthodox Hindu Holiness Islam Jehovah's Witness Judaism Latter-Day Saints/Mormon Lutheran Mennonite Mennonite Brethren Methodist Metropolitan Community Church Moravian Nondenominational None, No Preference Orthodox Christian Other Pentecostal Presbyterian Protestant Quaker (Society of Friends) Reformed Roman Catholic Russian Orthodox Salvation Army Seventh-Day Adventist Unitarian Universalist United Church of Christ Wesleyan PARENT/GUARDIAN INFORMATION FIRST PARENT/GUARDIAN First Name Last Name Phone Number Email Address Relationship -- Mother Father Stepmother Stepfather Grandparent Guardian Other Is this parent's/guardian's mailing address the same as yours? Yes No Address Apt. # City State/Province -- Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N. Mariana Islands Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland/Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon ZIP/Postal Code Country -- United States Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Mauritania Mauritius Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Western Sahara Yemen Zambia Zimbabwe SECOND PARENT/GUARDIAN First Name Last Name Phone Number Email Address Relationship -- Mother Father Stepmother Stepfather Grandparent Guardian Other Is this parent's/guardian's mailing address the same as yours? Yes No Address Apt. # City State/Province -- Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N. Mariana Islands Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland/Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon ZIP/Postal Code Country -- United States Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Mauritania Mauritius Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Western Sahara Yemen Zambia Zimbabwe ETHNICITY (OPTIONAL) If you wish to be identified with a particular ethnic group, please select the choice that most accurately describes your heritage. Indicating an ethnicity will not affect your admission decision. Are you Hispanic or Latino? Yes No Please select one or more of the following races: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White OTHER AFFILIATIONS (OPTIONAL) Please answer these questions to determine if you may be eligible for specific scholarships. I am a dependent of a current Regent University faculty or staff member. I am a dependent of someone on active duty in the U.S. military, a U.S. military veteran or a retired U.S. military veteran. I am a sibling, child or grandchild of a Regent University or CBN University graduate. I am a National Merit Semifinalist or Finalist. Save & Continue Regent University * Help * Privacy 1000 Regent University Drive Virginia Beach, VA 23464 888.718.1222