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FrameBuilder.get=[];var i33007630020940=new FrameBuilder("33007630020940",false,"","<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<link rel=\"alternate\" type=\"application\/json+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=json&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F33007630020940\" title=\"oEmbed Form\"><link rel=\"alternate\" type=\"text\/xml+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=xml&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F33007630020940\" title=\"oEmbed Form\">\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>Form<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/static\/formCss.css?3.2.4096\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"http:\/\/max.jotfor.ms\/css\/styles\/nova.css?3.2.4096\" \/>\n<link type=\"text\/css\" media=\"print\" rel=\"stylesheet\" href=\"http:\/\/max.jotfor.ms\/css\/printForm.css?3.2.4096\" \/>\n<style type=\"text\/css\">\n    .form-label-left{\n        width:150px !important;\n    }\n    .form-line{\n        padding-top:12px;\n        padding-bottom:12px;\n    }\n    .form-label-right{\n        width:150px !important;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:false;\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:0px;\n        width:670px;\n        color:rgb(0, 0, 0) !important;\n        font-family:'Lucida Grande','  Lucida Sans Unicode','  Lucida Sans','  Verdana','  Tahoma','  sans-serif';\n        font-size:14px;\n    }\n    .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{\n        color: rgb(0, 0, 0);\n    }\n\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/static\/prototype.forms.js\" type=\"text\/javascript\"><\/script>\n<script src=\"http:\/\/max.jotfor.ms\/static\/jotform.forms.js?3.2.4096\" type=\"text\/javascript\"><\/script>\n<script src=\"http:\/\/max.jotfor.ms\/js\/vendor\/math-processor.js?v=3.2.4096\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n   JotForm.setCalculations([{\"decimalPlaces\":\"2\",\"equation\":\"\",\"ignoreHiddenFields\":\"\",\"insertAsText\":\"\",\"newCalculationType\":\"1\",\"operands\":\"\",\"readOnly\":\"1\",\"resultField\":\"24\",\"showBeforeInput\":\"\",\"showEmptyDecimals\":\"\"}]);<\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\n   JotForm.init(function(){\n      $('input_5').hint('ex: myname@example.com');\n   });\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotformpro.com\/submit\/33007630020940\/\" method=\"post\" name=\"form_33007630020940\" id=\"33007630020940\" accept-charset=\"utf-8\">\n  <input type=\"hidden\" name=\"formID\" value=\"33007630020940\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section\">\n      <li id=\"cid_1\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group\">\n          <div class=\"header-text httal htvam\">\n            <h1 id=\"header_1\" class=\"form-header\">\n              AbleGamers Grant Program\n            <\/h1>\n            <div id=\"subHeader_1\" class=\"form-subHeader\">\n              The AbleGamers Foundation is proud to offer a one time grant for gaming equipment.\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_text\" id=\"id_21\">\n        <div id=\"cid_21\" class=\"form-input-wide\">\n          <div id=\"text_21\" class=\"form-html\">\n            <p><span style=\"color:#993300;font-size:small;\">The AbleGamers Charity only fill grants for accessible gaming equipment, and accessories. As a rule, we do not grant game consoles or games. Further, due to many factors, we do not approve grants for equipment from Broadened Horizons, there are alternatives.<\/span><\/p>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_24\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_24\" for=\"input_24\">\n          Click here that you read the above.\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_24\" class=\"form-input\">\n          <div class=\"form-single-column\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_24_0\" name=\"q24_clickHere[]\" value=\"I read it.\" \/>\n              <label for=\"input_24_0\"> I read it. <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li id=\"cid_4\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group\">\n          <div class=\"header-text httal htvam\">\n            <h3 id=\"header_4\" class=\"form-header\">\n              Guardian \/ Caregiver\n            <\/h3>\n            <div id=\"subHeader_4\" class=\"form-subHeader\">\n              This grant is open to people of all ages, so please understand that we do not assume that all people with disabilities have a guardian. If you are your own caregiver, please fill this section out and select SAME AS ABOVE in the PERSON IN NEED section.\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_email\" id=\"id_5\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_5\" for=\"input_5\">\n          E-Mail\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_5\" class=\"form-input\">\n          <input type=\"email\" class=\" form-textbox validate[required, Email]\" id=\"input_5\" name=\"q5_email\" size=\"30\" value=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_fullname\" id=\"id_3\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_3\" for=\"input_3\">\n          Name\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_3\" class=\"form-input\">\n          <span class=\"form-sub-label-container\">\n            <input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q3_name[first]\" id=\"first_3\" \/>\n            <label class=\"form-sub-label\" for=\"first_3\" id=\"sublabel_first\"> First Name <\/label>\n          <\/span>\n          <span class=\"form-sub-label-container\">\n            <input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q3_name[last]\" id=\"last_3\" \/>\n            <label class=\"form-sub-label\" for=\"last_3\" id=\"sublabel_last\"> Last Name <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_address\" id=\"id_6\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_6\" for=\"input_6\">\n          Address\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_6\" class=\"form-input\">\n          <table summary=\"\" undefined class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n            <tr>\n              <td colspan=\"2\">\n                <span class=\"form-sub-label-container\">\n                  <input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q6_address6[addr_line1]\" id=\"input_6_addr_line1\" \/>\n                  <label class=\"form-sub-label\" for=\"input_6_addr_line1\" id=\"sublabel_6_addr_line1\"> Street Address <\/label>\n                <\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td colspan=\"2\">\n                <span class=\"form-sub-label-container\">\n                  <input class=\"form-textbox form-address-line\" type=\"text\" name=\"q6_address6[addr_line2]\" id=\"input_6_addr_line2\" size=\"46\" \/>\n                  <label class=\"form-sub-label\" for=\"input_6_addr_line2\" id=\"sublabel_6_addr_line2\"> Street Address Line 2 <\/label>\n                <\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\">\n                <span class=\"form-sub-label-container\">\n                  <input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q6_address6[city]\" id=\"input_6_city\" size=\"21\" \/>\n                  <label class=\"form-sub-label\" for=\"input_6_city\" id=\"sublabel_6_city\"> City <\/label>\n                <\/span>\n              <\/td>\n              <td>\n                <span class=\"form-sub-label-container\">\n                  <input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q6_address6[state]\" id=\"input_6_state\" size=\"22\" \/>\n                  <label class=\"form-sub-label\" for=\"input_6_state\" id=\"sublabel_6_state\"> State \/ Province <\/label>\n                <\/span>\n              <\/td>\n            <\/tr>\n            <tr>\n              <td width=\"50%\">\n                <span class=\"form-sub-label-container\">\n                  <input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q6_address6[postal]\" id=\"input_6_postal\" size=\"10\" \/>\n                  <label class=\"form-sub-label\" for=\"input_6_postal\" id=\"sublabel_6_postal\"> Postal \/ Zip Code <\/label>\n                <\/span>\n              <\/td>\n              <td>\n                <span class=\"form-sub-label-container\">\n                  <select class=\"form-dropdown validate[required] form-address-country\" name=\"q6_address6[country]\" id=\"input_6_country\">\n                    <option value=\"\" selected> Please Select <\/option>\n                    <option value=\"United States\"> United States <\/option>\n                    <option value=\"Afghanistan\"> Afghanistan <\/option>\n                    <option value=\"Albania\"> Albania <\/option>\n                    <option value=\"Algeria\"> Algeria <\/option>\n                    <option value=\"American Samoa\"> American Samoa <\/option>\n                    <option value=\"Andorra\"> Andorra <\/option>\n                    <option value=\"Angola\"> Angola <\/option>\n                    <option value=\"Anguilla\"> Anguilla <\/option>\n                    <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                    <option value=\"Argentina\"> Argentina <\/option>\n                    <option value=\"Armenia\"> Armenia <\/option>\n                    <option value=\"Aruba\"> Aruba <\/option>\n                    <option value=\"Australia\"> Australia <\/option>\n                    <option value=\"Austria\"> Austria <\/option>\n                    <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                    <option value=\"The Bahamas\"> The Bahamas <\/option>\n                    <option value=\"Bahrain\"> Bahrain <\/option>\n                    <option value=\"Bangladesh\"> Bangladesh 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   <option value=\"Burundi\"> Burundi <\/option>\n                    <option value=\"Cambodia\"> Cambodia <\/option>\n                    <option value=\"Cameroon\"> Cameroon <\/option>\n                    <option value=\"Canada\"> Canada <\/option>\n                    <option value=\"Cape Verde\"> Cape Verde <\/option>\n                    <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                    <option value=\"Central African Republic\"> Central African Republic <\/option>\n                    <option value=\"Chad\"> Chad <\/option>\n                    <option value=\"Chile\"> Chile <\/option>\n                    <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n                    <option value=\"Republic of China\"> Republic of China <\/option>\n                    <option value=\"Christmas Island\"> Christmas Island <\/option>\n                    <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands 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value=\"Jersey\"> Jersey <\/option>\n                    <option value=\"Jordan\"> Jordan <\/option>\n                    <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                    <option value=\"Kenya\"> Kenya <\/option>\n                    <option value=\"Kiribati\"> Kiribati <\/option>\n                    <option value=\"North Korea\"> North Korea <\/option>\n                    <option value=\"South Korea\"> South Korea <\/option>\n                    <option value=\"Kosovo\"> Kosovo <\/option>\n                    <option value=\"Kuwait\"> Kuwait <\/option>\n                    <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                    <option value=\"Laos\"> Laos <\/option>\n                    <option value=\"Latvia\"> Latvia <\/option>\n                    <option value=\"Lebanon\"> Lebanon <\/option>\n                    <option value=\"Lesotho\"> Lesotho <\/option>\n                    <option value=\"Liberia\"> Liberia <\/option>\n              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value=\"Mauritania\"> Mauritania <\/option>\n                    <option value=\"Mauritius\"> Mauritius <\/option>\n                    <option value=\"Mayotte\"> Mayotte <\/option>\n                    <option value=\"Mexico\"> Mexico <\/option>\n                    <option value=\"Micronesia\"> Micronesia <\/option>\n                    <option value=\"Moldova\"> Moldova <\/option>\n                    <option value=\"Monaco\"> Monaco <\/option>\n                    <option value=\"Mongolia\"> Mongolia <\/option>\n                    <option value=\"Montenegro\"> Montenegro <\/option>\n                    <option value=\"Montserrat\"> Montserrat <\/option>\n                    <option value=\"Morocco\"> Morocco <\/option>\n                    <option value=\"Mozambique\"> Mozambique <\/option>\n                    <option value=\"Myanmar\"> Myanmar <\/option>\n                    <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                    <option value=\"Namibia\"> Namibia <\/option>\n                    <option value=\"Nauru\"> Nauru <\/option>\n                    <option value=\"Nepal\"> Nepal <\/option>\n                    <option value=\"Netherlands\"> Netherlands <\/option>\n                    <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                    <option value=\"New Caledonia\"> New Caledonia <\/option>\n                    <option value=\"New Zealand\"> New Zealand <\/option>\n                    <option value=\"Nicaragua\"> Nicaragua <\/option>\n                    <option value=\"Niger\"> Niger <\/option>\n                    <option value=\"Nigeria\"> Nigeria <\/option>\n                    <option value=\"Niue\"> Niue <\/option>\n                    <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                    <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                    <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                    <option value=\"Norway\"> Norway <\/option>\n                    <option value=\"Oman\"> Oman <\/option>\n                    <option value=\"Pakistan\"> Pakistan <\/option>\n                    <option value=\"Palau\"> Palau <\/option>\n                    <option value=\"Palestine\"> Palestine <\/option>\n                    <option value=\"Panama\"> Panama <\/option>\n                    <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                    <option value=\"Paraguay\"> Paraguay <\/option>\n                    <option value=\"Peru\"> Peru <\/option>\n                    <option value=\"Philippines\"> Philippines <\/option>\n                    <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                    <option value=\"Poland\"> Poland <\/option>\n                    <option value=\"Portugal\"> Portugal <\/option>\n                    <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                    <option value=\"Qatar\"> Qatar <\/option>\n                    <option value=\"Romania\"> Romania <\/option>\n                    <option value=\"Russia\"> Russia <\/option>\n                    <option value=\"Rwanda\"> Rwanda <\/option>\n                    <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                    <option value=\"Saint Helena\"> Saint Helena <\/option>\n                    <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                    <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                    <option value=\"Saint Martin\"> Saint Martin <\/option>\n                    <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                    <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                    <option value=\"Samoa\"> Samoa <\/option>\n                    <option value=\"San Marino\"> San Marino <\/option>\n                    <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                    <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                    <option value=\"Senegal\"> Senegal <\/option>\n                    <option value=\"Serbia\"> Serbia <\/option>\n                    <option value=\"Seychelles\"> Seychelles <\/option>\n                    <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                    <option value=\"Singapore\"> Singapore <\/option>\n                    <option value=\"Slovakia\"> Slovakia <\/option>\n                    <option value=\"Slovenia\"> Slovenia <\/option>\n                    <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                    <option value=\"Somalia\"> Somalia <\/option>\n                    <option value=\"Somaliland\"> Somaliland <\/option>\n                    <option value=\"South Africa\"> South Africa <\/option>\n                    <option value=\"South Ossetia\"> South Ossetia <\/option>\n                    <option value=\"Spain\"> Spain <\/option>\n                    <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                    <option value=\"Sudan\"> Sudan <\/option>\n                    <option value=\"Suriname\"> Suriname <\/option>\n                    <option value=\"Svalbard\"> Svalbard <\/option>\n                    <option value=\"Swaziland\"> Swaziland <\/option>\n                    <option value=\"Sweden\"> Sweden <\/option>\n                    <option value=\"Switzerland\"> Switzerland <\/option>\n                    <option value=\"Syria\"> Syria <\/option>\n                    <option value=\"Taiwan\"> Taiwan <\/option>\n                    <option value=\"Tajikistan\"> Tajikistan <\/option>\n                    <option value=\"Tanzania\"> Tanzania <\/option>\n                    <option value=\"Thailand\"> Thailand <\/option>\n                    <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                    <option value=\"Togo\"> Togo <\/option>\n                    <option value=\"Tokelau\"> Tokelau <\/option>\n                    <option value=\"Tonga\"> Tonga <\/option>\n                    <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                    <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                    <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                    <option value=\"Tunisia\"> Tunisia <\/option>\n                    <option value=\"Turkey\"> Turkey <\/option>\n                    <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                    <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                    <option value=\"Tuvalu\"> Tuvalu <\/option>\n                    <option value=\"Uganda\"> Uganda <\/option>\n                    <option value=\"Ukraine\"> Ukraine <\/option>\n                    <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                    <option value=\"United Kingdom\"> United Kingdom <\/option>\n                    <option value=\"Uruguay\"> Uruguay <\/option>\n                    <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                    <option value=\"Vanuatu\"> Vanuatu <\/option>\n                    <option value=\"Vatican City\"> Vatican City <\/option>\n                    <option value=\"Venezuela\"> Venezuela <\/option>\n                    <option value=\"Vietnam\"> Vietnam <\/option>\n                    <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                    <option value=\"Isle of Man\"> Isle of Man <\/option>\n                    <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                    <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                    <option value=\"Western Sahara\"> Western Sahara <\/option>\n                    <option value=\"Yemen\"> Yemen <\/option>\n                    <option value=\"Zambia\"> Zambia <\/option>\n                    <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                    <option value=\"other\"> Other <\/option>\n                  <\/select>\n                  <label class=\"form-sub-label\" for=\"input_6_country\" id=\"sublabel_6_country\"> Country <\/label>\n                <\/span>\n              <\/td>\n            <\/tr>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_phone\" id=\"id_7\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_7\" for=\"input_7\">\n          Phone Number\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_7\" class=\"form-input\">\n          <span class=\"form-sub-label-container\">\n            <input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q7_phoneNumber7[area]\" id=\"input_7_area\" size=\"3\">\n            -\n            <label class=\"form-sub-label\" for=\"input_7_area\" id=\"sublabel_area\"> Area Code <\/label>\n          <\/span>\n          <span class=\"form-sub-label-container\">\n            <input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q7_phoneNumber7[phone]\" id=\"input_7_phone\" size=\"8\">\n            <label class=\"form-sub-label\" for=\"input_7_phone\" id=\"sublabel_phone\"> Phone Number <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li id=\"cid_8\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group\">\n          <div class=\"header-text httal htvam\">\n            <h3 id=\"header_8\" class=\"form-header\">\n              Person In Need - Information\n            <\/h3>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_20\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_20\" for=\"input_20\"> Same as above? <\/label>\n        <div id=\"cid_20\" class=\"form-input\">\n          <div class=\"form-single-column\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox\" id=\"input_20_0\" name=\"q20_sameAs[]\" value=\"Yes\" \/>\n              <label for=\"input_20_0\"> Yes <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_fullname\" id=\"id_9\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_9\" for=\"input_9\"> Full Name <\/label>\n        <div id=\"cid_9\" class=\"form-input\">\n          <span class=\"form-sub-label-container\">\n            <input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q9_fullName9[first]\" id=\"first_9\" \/>\n            <label class=\"form-sub-label\" for=\"first_9\" id=\"sublabel_first\"> First Name <\/label>\n          <\/span>\n          <span class=\"form-sub-label-container\">\n            <input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q9_fullName9[last]\" id=\"last_9\" \/>\n            <label class=\"form-sub-label\" for=\"last_9\" id=\"sublabel_last\"> Last Name <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_birthdate\" id=\"id_10\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_10\" for=\"input_10\">\n          Birth Date\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_10\" class=\"form-input\">\n          <span class=\"form-sub-label-container\">\n            <select class=\"form-dropdown validate[required]\" name=\"q10_birthDate10[month]\" id=\"input_10_month\">\n              <option>  <\/option>\n              <option value=\"January\"> January <\/option>\n              <option value=\"February\"> February <\/option>\n              <option value=\"March\"> March <\/option>\n              <option value=\"April\"> April <\/option>\n              <option value=\"May\"> May <\/option>\n              <option value=\"June\"> June <\/option>\n              <option value=\"July\"> July <\/option>\n              <option value=\"August\"> August <\/option>\n              <option value=\"September\"> September <\/option>\n              <option value=\"October\"> October <\/option>\n              <option value=\"November\"> November <\/option>\n              <option value=\"December\"> December <\/option>\n            <\/select>\n            <label class=\"form-sub-label\" for=\"input_10_month\" id=\"sublabel_month\"> Month <\/label>\n          <\/span>\n          <span class=\"form-sub-label-container\">\n            <select class=\"form-dropdown validate[required]\" name=\"q10_birthDate10[day]\" id=\"input_10_day\">\n              <option>  <\/option>\n              <option value=\"1\"> 1 <\/option>\n              <option value=\"2\"> 2 <\/option>\n              <option value=\"3\"> 3 <\/option>\n              <option value=\"4\"> 4 <\/option>\n              <option value=\"5\"> 5 <\/option>\n              <option value=\"6\"> 6 <\/option>\n              <option value=\"7\"> 7 <\/option>\n              <option value=\"8\"> 8 <\/option>\n              <option value=\"9\"> 9 <\/option>\n              <option value=\"10\"> 10 <\/option>\n              <option value=\"11\"> 11 <\/option>\n              <option value=\"12\"> 12 <\/option>\n              <option value=\"13\"> 13 <\/option>\n              <option value=\"14\"> 14 <\/option>\n              <option value=\"15\"> 15 <\/option>\n              <option value=\"16\"> 16 <\/option>\n              <option value=\"17\"> 17 <\/option>\n              <option value=\"18\"> 18 <\/option>\n              <option value=\"19\"> 19 <\/option>\n              <option value=\"20\"> 20 <\/option>\n              <option value=\"21\"> 21 <\/option>\n              <option value=\"22\"> 22 <\/option>\n              <option value=\"23\"> 23 <\/option>\n              <option value=\"24\"> 24 <\/option>\n              <option value=\"25\"> 25 <\/option>\n              <option value=\"26\"> 26 <\/option>\n              <option value=\"27\"> 27 <\/option>\n              <option value=\"28\"> 28 <\/option>\n              <option value=\"29\"> 29 <\/option>\n              <option value=\"30\"> 30 <\/option>\n              <option value=\"31\"> 31 <\/option>\n            <\/select>\n            <label class=\"form-sub-label\" for=\"input_10_day\" id=\"sublabel_day\"> Day <\/label>\n          <\/span>\n          <span class=\"form-sub-label-container\">\n            <select class=\"form-dropdown validate[required]\" name=\"q10_birthDate10[year]\" id=\"input_10_year\">\n              <option>  <\/option>\n              <option value=\"2014\"> 2014 <\/option>\n              <option value=\"2013\"> 2013 <\/option>\n              <option value=\"2012\"> 2012 <\/option>\n              <option value=\"2011\"> 2011 <\/option>\n              <option value=\"2010\"> 2010 <\/option>\n              <option value=\"2009\"> 2009 <\/option>\n              <option value=\"2008\"> 2008 <\/option>\n              <option value=\"2007\"> 2007 <\/option>\n              <option value=\"2006\"> 2006 <\/option>\n              <option value=\"2005\"> 2005 <\/option>\n              <option value=\"2004\"> 2004 <\/option>\n              <option value=\"2003\"> 2003 <\/option>\n              <option value=\"2002\"> 2002 <\/option>\n              <option value=\"2001\"> 2001 <\/option>\n              <option value=\"2000\"> 2000 <\/option>\n              <option value=\"1999\"> 1999 <\/option>\n              <option value=\"1998\"> 1998 <\/option>\n              <option value=\"1997\"> 1997 <\/option>\n              <option value=\"1996\"> 1996 <\/option>\n              <option value=\"1995\"> 1995 <\/option>\n              <option value=\"1994\"> 1994 <\/option>\n              <option value=\"1993\"> 1993 <\/option>\n              <option value=\"1992\"> 1992 <\/option>\n              <option value=\"1991\"> 1991 <\/option>\n              <option value=\"1990\"> 1990 <\/option>\n              <option value=\"1989\"> 1989 <\/option>\n              <option value=\"1988\"> 1988 <\/option>\n              <option value=\"1987\"> 1987 <\/option>\n              <option value=\"1986\"> 1986 <\/option>\n              <option value=\"1985\"> 1985 <\/option>\n              <option value=\"1984\"> 1984 <\/option>\n              <option value=\"1983\"> 1983 <\/option>\n              <option value=\"1982\"> 1982 <\/option>\n              <option value=\"1981\"> 1981 <\/option>\n              <option value=\"1980\"> 1980 <\/option>\n              <option value=\"1979\"> 1979 <\/option>\n              <option value=\"1978\"> 1978 <\/option>\n              <option value=\"1977\"> 1977 <\/option>\n              <option value=\"1976\"> 1976 <\/option>\n              <option value=\"1975\"> 1975 <\/option>\n              <option value=\"1974\"> 1974 <\/option>\n              <option value=\"1973\"> 1973 <\/option>\n              <option value=\"1972\"> 1972 <\/option>\n              <option value=\"1971\"> 1971 <\/option>\n              <option value=\"1970\"> 1970 <\/option>\n              <option value=\"1969\"> 1969 <\/option>\n              <option value=\"1968\"> 1968 <\/option>\n              <option value=\"1967\"> 1967 <\/option>\n              <option value=\"1966\"> 1966 <\/option>\n              <option value=\"1965\"> 1965 <\/option>\n              <option value=\"1964\"> 1964 <\/option>\n              <option value=\"1963\"> 1963 <\/option>\n              <option value=\"1962\"> 1962 <\/option>\n              <option value=\"1961\"> 1961 <\/option>\n              <option value=\"1960\"> 1960 <\/option>\n              <option value=\"1959\"> 1959 <\/option>\n              <option value=\"1958\"> 1958 <\/option>\n              <option value=\"1957\"> 1957 <\/option>\n              <option value=\"1956\"> 1956 <\/option>\n              <option value=\"1955\"> 1955 <\/option>\n              <option value=\"1954\"> 1954 <\/option>\n              <option value=\"1953\"> 1953 <\/option>\n              <option value=\"1952\"> 1952 <\/option>\n              <option value=\"1951\"> 1951 <\/option>\n              <option value=\"1950\"> 1950 <\/option>\n              <option value=\"1949\"> 1949 <\/option>\n              <option value=\"1948\"> 1948 <\/option>\n              <option value=\"1947\"> 1947 <\/option>\n              <option value=\"1946\"> 1946 <\/option>\n              <option value=\"1945\"> 1945 <\/option>\n              <option value=\"1944\"> 1944 <\/option>\n              <option value=\"1943\"> 1943 <\/option>\n              <option value=\"1942\"> 1942 <\/option>\n              <option value=\"1941\"> 1941 <\/option>\n              <option value=\"1940\"> 1940 <\/option>\n              <option value=\"1939\"> 1939 <\/option>\n              <option value=\"1938\"> 1938 <\/option>\n              <option value=\"1937\"> 1937 <\/option>\n              <option value=\"1936\"> 1936 <\/option>\n              <option value=\"1935\"> 1935 <\/option>\n              <option value=\"1934\"> 1934 <\/option>\n              <option value=\"1933\"> 1933 <\/option>\n              <option value=\"1932\"> 1932 <\/option>\n              <option value=\"1931\"> 1931 <\/option>\n              <option value=\"1930\"> 1930 <\/option>\n              <option value=\"1929\"> 1929 <\/option>\n              <option value=\"1928\"> 1928 <\/option>\n              <option value=\"1927\"> 1927 <\/option>\n              <option value=\"1926\"> 1926 <\/option>\n              <option value=\"1925\"> 1925 <\/option>\n              <option value=\"1924\"> 1924 <\/option>\n              <option value=\"1923\"> 1923 <\/option>\n              <option value=\"1922\"> 1922 <\/option>\n              <option value=\"1921\"> 1921 <\/option>\n              <option value=\"1920\"> 1920 <\/option>\n            <\/select>\n            <label class=\"form-sub-label\" for=\"input_10_year\" id=\"sublabel_year\"> Year <\/label>\n          <\/span>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_radio\" id=\"id_11\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_11\" for=\"input_11\">\n          Sex\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_11\" class=\"form-input\">\n          <div class=\"form-single-column\">\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_11_0\" name=\"q11_sex\" value=\"Male\" \/>\n              <label for=\"input_11_0\"> Male <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_11_1\" name=\"q11_sex\" value=\"Female\" \/>\n              <label for=\"input_11_1\"> Female <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_12\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_12\" for=\"input_12\">\n          Nature of the Disability\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_12\" class=\"form-input\">\n          <input type=\"text\" class=\" form-textbox validate[required]\" data-type=\"input-textbox\" id=\"input_12\" name=\"q12_natureOf\" size=\"20\" value=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_16\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_16\" for=\"input_16\">\n          What are you looking for from the grant?\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_16\" class=\"form-input\">\n          <textarea id=\"input_16\" class=\"form-textarea validate[required]\" name=\"q16_whatAre\" cols=\"40\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li id=\"cid_14\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group\">\n          <div class=\"header-text httal htvam\">\n            <h3 id=\"header_14\" class=\"form-header\">\n              General Household Information\n            <\/h3>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textbox\" id=\"id_18\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_18\" for=\"input_18\"> Number of kids under 18 in the house? <\/label>\n        <div id=\"cid_18\" class=\"form-input\">\n          <input type=\"text\" class=\" form-textbox\" data-type=\"input-textbox\" id=\"input_18\" name=\"q18_numberOf\" size=\"20\" value=\"\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_textarea\" id=\"id_17\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_17\" for=\"input_17\"> Other Info you want to share with AbleGamers to help the selection process <\/label>\n        <div id=\"cid_17\" class=\"form-input\">\n          <textarea id=\"input_17\" class=\"form-textarea\" name=\"q17_otherInfo\" cols=\"40\" rows=\"6\"><\/textarea>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_checkbox\" id=\"id_15\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_15\" for=\"input_15\">\n          Does the household already have a game system? (check all that apply)\n          <span class=\"form-required\">\n            *\n          <\/span>\n        <\/label>\n        <div id=\"cid_15\" class=\"form-input\">\n          <div class=\"form-single-column\">\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_0\" name=\"q15_doesThe15[]\" value=\"Yes - XBox 360\" \/>\n              <label for=\"input_15_0\"> Yes - XBox 360 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_1\" name=\"q15_doesThe15[]\" value=\"Yes - XBox One\" \/>\n              <label for=\"input_15_1\"> Yes - XBox One <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_2\" name=\"q15_doesThe15[]\" value=\"Yes - Playstation 3\" \/>\n              <label for=\"input_15_2\"> Yes - Playstation 3 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_3\" name=\"q15_doesThe15[]\" value=\"Yes - Playstation 4\" \/>\n              <label for=\"input_15_3\"> Yes - Playstation 4 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_4\" name=\"q15_doesThe15[]\" value=\"Yes - Wii\" \/>\n              <label for=\"input_15_4\"> Yes - Wii <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_5\" name=\"q15_doesThe15[]\" value=\"Yes - PC\" \/>\n              <label for=\"input_15_5\"> Yes - PC <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_6\" name=\"q15_doesThe15[]\" value=\"Yes - Mobile System\" \/>\n              <label for=\"input_15_6\"> Yes - Mobile System <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-checkbox-item\" style=\"clear:left;\">\n              <input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_15_7\" name=\"q15_doesThe15[]\" value=\"None\" \/>\n              <label for=\"input_15_7\"> None <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_radio\" id=\"id_19\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_19\" for=\"input_19\"> Household Income <\/label>\n        <div id=\"cid_19\" class=\"form-input\">\n          <div class=\"form-single-column\">\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_19_0\" name=\"q19_householdIncome\" value=\"Under $25,000\" \/>\n              <label for=\"input_19_0\"> Under $25,000 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_19_1\" name=\"q19_householdIncome\" value=\"$26,000 - $35,000\" \/>\n              <label for=\"input_19_1\"> $26,000 - $35,000 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_19_2\" name=\"q19_householdIncome\" value=\"$36,000 - $45,000\" \/>\n              <label for=\"input_19_2\"> $36,000 - $45,000 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_19_3\" name=\"q19_householdIncome\" value=\"$46,000 - $60,000\" \/>\n              <label for=\"input_19_3\"> $46,000 - $60,000 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_19_4\" name=\"q19_householdIncome\" value=\"$60,000 - $80,000\" \/>\n              <label for=\"input_19_4\"> $60,000 - $80,000 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_19_5\" name=\"q19_householdIncome\" value=\"$81,000 - $100,000\" \/>\n              <label for=\"input_19_5\"> $81,000 - $100,000 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_19_6\" name=\"q19_householdIncome\" value=\"More than $100,000\" \/>\n              <label for=\"input_19_6\"> More than $100,000 <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden\" data-type=\"control_radio\" id=\"id_22\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_22\" for=\"input_22\"> Management <\/label>\n        <div id=\"cid_22\" class=\"form-input always-hidden\">\n          <div class=\"form-single-column\">\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_22_0\" name=\"q22_management\" value=\"Approved\" \/>\n              <label for=\"input_22_0\"> Approved <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_22_1\" name=\"q22_management\" value=\"Rejected\" \/>\n              <label for=\"input_22_1\"> Rejected <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n            <span class=\"form-radio-item\" style=\"clear:left;\">\n              <input type=\"radio\" class=\"form-radio\" id=\"input_22_2\" name=\"q22_management\" value=\"Other\" \/>\n              <label for=\"input_22_2\"> Other <\/label>\n            <\/span>\n            <span class=\"clearfix\">\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden\" data-type=\"control_dropdown\" id=\"id_23\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_23\" for=\"input_23\"> Click to edit <\/label>\n        <div id=\"cid_23\" class=\"form-input always-hidden\">\n          <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_23\" name=\"q23_clickTo23\">\n            <option value=\"\">  <\/option>\n            <option value=\"No Actionable Information Given\"> No Actionable Information Given <\/option>\n            <option value=\"We lack the funding to support the request at this time\"> We lack the funding to support the request at this time <\/option>\n            <option value=\"Out of current funders focus area\"> Out of current funders focus area <\/option>\n            <option value=\"We do not support the technology asked for\"> We do not support the technology asked for <\/option>\n          <\/select>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\">\n          <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n            <button id=\"input_2\" type=\"submit\" class=\"form-submit-button\">\n              Submit\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"33007630020940\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"33007630020940-33007630020940\";\n  <\/script>\n<\/form><img src=\"\/\/tracking.jotform.com\/jsform\/33007630020940\" style=\"display:none\" \/>\n<\/body>\n<\/html>\n");(function(){window.handleIFrameMessage=function(e){var args=e.data.split(":");var iframe=document.getElementById("33007630020940");if(!iframe){return};switch(args[0]){case"scrollIntoView":if(!("nojump"in FrameBuilder.get)){iframe.scrollIntoView();}
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